Choosing best insurance and insurance at Mayo

Posted by skipinjb @skipinjb, Oct 27, 2023

HAVING to go on medicare is a pain, so what supplemental plans has anyone utilized that mayo clinic accepts and does not cost an arm and a leg to purchase and has a huge out of pocket expense? I want good coverage like the plan I had with the fire department (florida blue) but the drug plans and part G plans are not the same.....where this becomes frustrating is that why do I have to go on something when I have something that I like?

Interested in more discussions like this? Go to the Visiting Mayo Clinic Support Group.

@hsminc

At one time not too long ago we had a very active patient advocacy business in Minnesota. As you said, patients want to go to Mayo and want Mayo to be in network. Some major health plan networks included Mayo as a provider but there were hoops and loops that patients had to go through to just get a referral there. Then if the patient did get a referral, the health plan required additional loops for tests, procedures, etc..
I have had doctors tell me (when I protested on behalf of patients) that Mayo offered nothing better than their own community hospital. This was totally untrue. I would not have been fighting to get our patients to Mayo if I did not know the care would have been much much quicker, more efficient and also more effective with a better array of treatment options.
These health systems MAY be pressuring their physicians to keep patients local. I suspect this is the case.

Jump to this post

"....These health systems MAY be pressuring their physicians to keep patients local. I suspect this is the case"
In fact, after wondering how to say it ....when I told my local Pulmonologist (whose major interest was asthma) that I was going to Mayo and to forward my scans to Mayo, she suggested I be diagnosed there (by her) and treated at Mayo!!!! I of course said no. That certainly was not in my best interests.
She ordered a needle biopsy that her own Radiologist refused to do because it was too dangerous and would not obtain enough sample. Then they said they could do the other lung instead! The PET scan showed uptick in both lungs Like what would that prove? Mayo never even did the needle biopsy. I have read that needle biopsies are not recommended, and Pulmonologists should do bronchoscopy ones instead. Mayo scheduled me for immediate surgery (bronchoscopy and removal in one sitting). It was cancer. I shutter to think what they would have done to me locally had I not been proactive and had traditional Medicare.

REPLY

All I ever hear is complaints about advantage plans . I can only talk about my experience. I’ve had an advantage plan since 2007. In 2018 I had a kidney transplant at Mayo. My largest bill after the transplant was $750. I even had a 1 year allotment that covered any hotel and parking costs and covered costs for fuel since we lived more than 100 miles from Mayo. We rented an Airbnb in Rochester for one month. It was payed for by my insurance. I pay 79 dollars for a 90 day supply of my immunosuppressants and 0 out of pocket for the rest of my meds. Our premiums have varied over the years. Next year my husband and I will each pay $66 dollars a month for our premiums. My husband has been hospitalized twice in the past few years. He had dementia. The first time the total cost was $100. This past summer he was hospitalized for Covid. The bill was $150. The ambulance bill was$250. I’ve never been unhappy with our advantage plan. Mayo does have an agreement with United Health Care, which is what we have now. We’ve never had cancer so I can’t speak to those costs.

REPLY
@cmael

All I ever hear is complaints about advantage plans . I can only talk about my experience. I’ve had an advantage plan since 2007. In 2018 I had a kidney transplant at Mayo. My largest bill after the transplant was $750. I even had a 1 year allotment that covered any hotel and parking costs and covered costs for fuel since we lived more than 100 miles from Mayo. We rented an Airbnb in Rochester for one month. It was payed for by my insurance. I pay 79 dollars for a 90 day supply of my immunosuppressants and 0 out of pocket for the rest of my meds. Our premiums have varied over the years. Next year my husband and I will each pay $66 dollars a month for our premiums. My husband has been hospitalized twice in the past few years. He had dementia. The first time the total cost was $100. This past summer he was hospitalized for Covid. The bill was $150. The ambulance bill was$250. I’ve never been unhappy with our advantage plan. Mayo does have an agreement with United Health Care, which is what we have now. We’ve never had cancer so I can’t speak to those costs.

Jump to this post

I don't think everyone is complaining about Advantage Plans. They are good for some and for others. But they also have a network so can prevent being seen at some facilities.

I posted some time ago the letter Mayo Jacksonville puts out each year about Advantage Plans and that they do not accept them with some exceptions so check with their insurance section if considering changing from traditional Medicare to an Advantage Plan.

I have traditional Medicare and a secondary insurance that pays the deductibles and co-payments of Medicare. I can go anywhere Medicare is accepted and my secondary insurance will cover all that Medicare does not.

United Health Care is promoted by AARP and from what I have read a good plan. I had a friend go to Moffitt Cancer Center with the Advantage United Health Care and got great care. What a lot do not understand that when you go with Advantage Plans you are no longer a Medicare Patient you are a patient under the Advantage Plan. So each Advantage Plan have a network, and also what they pay and don't pay. So if you need to go to a Specialty Provider I would be sure to check first to see if your Advantage Plan will cover you going there prior to signing up.

But even with Medicare there can be limits on a Specialty Provider. Mayo Jacksonville limits the number of Medicare Patients even though Medicare classifies Mayo as a specialty provider and allowed to charge more for their services. Some of my friends in my retirement community could not get into Mayo even though it is 30 minutes away.

REPLY
@vic83

Short answer: GO WITH ORIGINAL/TRADITIONAL MEDICARE = Part A, Part B and Part D - then purchase a Medigap policy to cover the 20% Medicare does not pay. Go to the Medicare site to be able to compare Medigap Plans. Medicare has a table giving plan types a LETTER and showing what each type plan covers (deductible, foreign travel etc). This allows you to compare the Medigap plans in your area. In comparing these Medigap plan prices, they should have the same letter type.
In original Medicare YOU CAN SELF REFER TO ANY DOCTOR IN THE US THAT TAKES MEDICARE INCLUDING MAYO CLINIC! YOU DON'T NEED APPROVAL FOR TESTS AND PROCEDURES!
In original Medicare Part A is hospital and has no premium, Part B (tests, drs visits etc) is a monthly premium you pay to Medicare ($174/mo for 2024). Part D is a private insurance drug plan and the Medicare tool is very good to help choose a plan. You put in your drugs and it pulls up all the plans in your area and tells you what total cost will be for each one. That can be very cheap and you can change each year. The Medigap plan is private insurance, and you will find various options.

NOW Medicare Advantage plans are Part C, they are private insurance companies and there are many complaints against them. They advertise incessantly. THE TRUTH IS they seem cheaper BUT 1) YOU CANNOT SELF REFER, YOU NEED APPROVAL FOR PROCEDURES AND TESTS, YOU MUST STAY IN THEIR NETWORK AND THEY MAY NOT HAVE THE SPECIALISTS YOU NEED OR THE CAPACITY TO OFFER BEST TREATMENT OPTIONS - lots of doctors are dropping these plans, 2) You have copays for doctor visits, you need to be referred to specialist with more copays, copays on tests. Costs will quickly add up if you start going to doctors.
WORSE - when you realize that Advantage plan is costing you money and they don't have the doctors you need and you want to go to Original Medicare and get a Medigap plan - GUESS WHAT? The Medigap plan does not have to take you like in the beginning!!!
With age comes health problems. You do not want the aggravation of fighting insurance company when you have cancer - and that is what happens with Medicare Advantage plans. They get paid by Medicare based on head count, so they have a profit interest in signing up as many people as possible and then making it complicated for people to get medical attention, so they don't have to pay out.

Jump to this post

The problem is that in the State of AZ a Medicare beneficiary under the age of 65 cannot get a supplemental plan! AZ is one of about 7 states that do not require insurance companies to provide medical insurance for under age 65.

REPLY
@mercuryrose

I go to Phoenix AZ. Mayo Clinic and have Medicare and AARP Plan F Supplemental. Just received a letter from Mayo stating they don’t bill it take Advantage. I had a friend low income retiree switched to Advantage and it costs her a great deal for breaking her hip from a fall for surgery.

Jump to this post

I don't understand you. The letter put out by Phoenix Mayo states they do not take Medicare Advantage but do take supplementals.

REPLY

Each of the 3 Mayo centers accept different insurance. I believe all take Medicare but they take different advantage plans. I know that Kaiser Southern California Medicare Advantage is taken by Phoenix Mayo if you are referred by Kaiser. It save me hundreds of thousands of dollars.

REPLY
Please sign in or register to post a reply.