Mayo Warns It Won't Take Most Medicare Advantage Plans

[SheltieLover]

https://www.medpagetoday.com/special-reports/exclusives/101320

Letters to Florida, Arizona patients suggest they enroll in original Medicare with a supplement

The Mayo Clinic sent letters this fall to all eligible Medicare beneficiaries who received care at its Arizona and Florida facilities in the last 3 years, warning them that it is out-of-network "with most Medicare Advantage plans."

The letter sent to Florida beneficiaries said that "marketing for Medicare Advantage Plans may indicate that you can be seen at any facility that accepts Medicare, however Mayo Clinic in Florida is out of network on these plans."

Asked about the reasoning behind the letters, Mayo communications manager Kevin Punsky replied that they are intended to serve as "a courtesy reminder" at the start of the annual Medicare re-enrollment window that began Oct. 15. They are intended to notify those eligible for Medicare that if they want coverage for non-emergency care at the Mayo Clinic in those two states, they should enroll in "Original Medicare (Parts A, B and D) as well as Medicare supplements."

More at link.

[gab13by13]

1. A step in the right direction to saving Medicare.

There's a reason there have been so many Medicare Advantage commercials on TV. I have gotten 100 junk mailers that make the Advantage plans look like it's from Medicare.

Medi-Gap plans are fine.

[SheltieLover]

4. Yup!

[Maine Abu El Banat]

11. Medi gap plans are expensive

My advantage plan is fine. I enjoy hearing with my new aids, I pay low drug co-pays, have dental and eyecare. I have the same PCP I've had for 20 years. What is the problem. Is it still that illusion that Medicare is free? It's not!

[ashredux]

13. Rule: There is NO free lunch

You do not get “more” without loosing something…..

[paleotn]

23. Exactly. Cost of all the benefits above, plus the slick TV ads, plus profit....

equals less going to healthcare providers. Sometimes to the point where those providers can't even cover costs of providing care. Providers have no choice but to step out of network just to break even on Advantage patients.

[Karma13612]

19. 👍👍👍

My AETNA Medicare is great.

[Skittles]

2. in a perfect world, no one would

fucking scam

[SheltieLover]

6. I agree, Skittles!

[Skittles]

7. greetings!

my work hours changed a bit - well OK, I actually changed companies....

[SheltieLover]

46. Congrats on your new job!

[Hortensis]

32. Don't need a perfect world, just a sufficient Democratic majority

for long enough to implement it. We've always had the will. The electorate as a whole has not.

[Demsrule86]

36. If we try to get rid of the advantage plans, we will lose the next election there are likely more

on Advantage. You could remove the rule that allows underwriting if a person leaves the original medicare. Thus it would help original medicare but not make the electorate burn us at the stake.

[Hortensis]

43. Yes, have to oversee MA and protect their customers while

protecting the Medicare program from attempts to destroy it.

But, a free society SHOULD have choices that include a national universal healthcare program AND private plans, including employer-subsidized. Fight all attempts to deny either to the people.

Fwiw, Mayo Clinic's notice highlights a big limitation of Advantage plans, which can't compete on that basis with the giant -- Medicare.

[Emile]

3. Pisses me off these private insurance companies are called Medicare!

[SheltieLover]

5. I couldn't agree more!

Grifters!

Why is this even legal?

[Demsrule86]

38. This always annoys me. I have an Advantage plan because it was what I could afford...

Medi-gap plans are done through insurance companies...I don't see original Medicare as 'pure'. It also involved insurance and has out-of-pocket and deductibles.

[unc70]

8. Looks like Mayo is in contract negotiations with UHC, et al

This looks like typical negotiating behavior between corporate giants Mayo and United Health. The Minnesota Mayo has already reached agreement.

This is similar to how cable TV negotiates with a content provider like Disney/ABC/ESPN. Media giants dividing up the channel packages.

[JohnSJ]

12. I don't believe this has anything to do with that. Most Medicare Advantage plans had restrictions

where you could get services

[Demsrule86]

39. Medicare Adantage offers PPO where you can go out of network.

[JohnSJ]

42. My understanding is that even MA PPO's still operate under a closed provider network, which limit

your choice of which doctor or medical facility to use, and need referrals to see specialists.

Medicare Advantage
(also known as Part C)
• Medicare Advantage is a Medicare-approved
plan from a private company that offers an
alternative to Original Medicare for your health
and drug coverage. These “bundled” plans
include Part A, Part B, and usually Part D.
• In most cases, you can only use doctors who are
in the plan’s network.
• In many cases, you may need to get approval
from your plan before it covers certain drugs or
services.
• Plans may have lower out-of-pocket costs than
Original Medicare.
• Plans may offer some extra benefits that Original
Medicare doesn’t cover—like vision, hearing, and
dental services

https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf

[mitch96]

21. Could Mayo be trying to channel patients to it's own medicare advantage plan? nt

[Hortensis]

34. No. There is no such thing.

[mitch96]

51. 👍 tnx..nt

[gab13by13]

9. People need to read the fine print in those fake Medicare plans.

There are 2 major health care providers in Pittsburgh. I am on Medicare, I had no problem picking a doctor at UPMC who fixed my A-fib.
I want to get my knee fixed at some point and I can pick a doctor at AHN in Pittsburgh. My point, I get more choices of where I can go to find a good doctor. People on fake Medicare plans have to go to doctors in the network that their fake Medicare plan provides or they will pay out of network fees.

[SheltieLover]

10. Absolutely!

These plans should be illegal imo.

[Emile]

15. Republican Advantage Plans are designed to do away with Medicare

and clearly their plan is working. The more people who sign up for this scam are taking money away from Medicare and making Medicare more expensive.

[SheltieLover]

16. Absolutely!

[Traildogbob]

22. It's not fucking free

When you sign up they take your Medicare premium out of your SS. If you believe these for profit private ins. Greedy assholes ate gonna give you free Ins, including dental and eye and low meds plus hearing aids, you believe Fox is 100 percent honest. They spend only 60 percent from premiums on patient care, the other is on Joe Namath and JJ Walker style bullshit adds. Every other add. And the cost of those non stop glossy expensive mail “Booklets”. Medicare has zero advertising costs. No TV. 95 percent of premiums is on patient care. Advantage is not just a gap coverage. It takes away Medicare. It’s hell to get out of after you get screed. It’s a Bush era GQP scam to destroy Medicare and fully privatize all health care. They are over 50 percent there. So when they take over watch the hell they bring on us.
I got scammed into it. My VA care files Ins claims with my insurance and only takes what insurance pays. After 3 years, VA notified me all my care would need to be reevaluated if I did not end Advantage. They were not covering ANY care. Took a year to switch back.
Hearing aids are non Over the counter, thank you Joe.
I thing is Free, especially health care. And they do not put money back into your SS. Fir fucks sake, anybody that believes this scam believes trump would never lie, and he did do much good.
Not enough time to write all the scamming it has done to my entire state health care here. They cover just enough people to hook us into the scam. When they get us all and end Medicare, the same scammers will come to privatize SS. And take it all.
Free health care, free dental, free eye, free hearing cheap as hell meds. From Corp medical companies. Actually give you SS money back. Ya see why people buy GQP and Fox bullshit. Jeeeebus. No trillion dollar corp is gonna give you free stuff.
And all those Medicare premiums are paying for relentless advertising on TV and mail, to destroy fucking Medicare. What a brilliant damn scam. Money intended to care for Medicare patients. 🤑🤑🤑🤑🤑🤑🤑💰💰💰💰💰💰💰💰💰💰💰💰💰💰

[Karma13612]

26. Medicare is deducted from your SS no matter if you go with straight

Medicare or an Advantage plan.

[Traildogbob]

33. Exactly

But Advantage gets it when you sign with them. And most of THAT goes to advertising. And when it leaves, Medicare, they will go broke. The Advantage scam plan. When it is gone, we will be on private health care. And we all know how American private health care works. When they get full control, with no options for anyone, the claws will come out.
And seniors will lose the most. Especially after GQP ends SS. Let seniors die, to help economy, the Covid plan of GQP. Death Panels, just like all GQP projection. It’s their plan.
And if anybody thinks when SS is gone and no money gets to Advantage that they gonna still give you Free everything care, well, Trump IS Gawds BFF. After Kool aid we all meet in Heaven with Streets of gold and mansions for all. With free cleaning service.

[Demsrule86]

40. Advantage plans often have give back plans where they give all or part of Part B back... Also,

Part A deductibles are not paid.

[Karma13612]

17. I'll stay away from

The Mayo Clinic anyway. I’ve heard some pretty alarming stories about them.

Not allowing patients to leave the hospital, taking away their rights?

Very bad stuff.

[SheltieLover]

18. The "bad news" here is grifting Advantage plans

[mahina]

29. My close friend is a public health researcher. I asked her once

how she decided where to get treatment for a medical condition. To my surprise she say she looks at US news and world report articles on who’s best for whatever the conditions. For example, what is the best best place for breast cancer or whatever. It turns out that cancer centers get much better outcomes overall but Mayo does very well. That tracks with my family and friends’ experiences.

Do you care to say more about what you have heard? Thank you

[Karma13612]

31. Here ya go...

https://kdvr.com/news/trending/teen-accuses-mayo-clinic-of-medical-kidnapping/

I found it rather frightening. It might have been later shown to be bad reporting, but it’s obvious this was a very bad situation. In my opinion, Mayo was quite heavy handed.

[JohnSJ]

44. Guess what, you will find "alarming stories" about any of the top rated medical facilities.

Anecdotal is not always the best way to judge something

"Not allowing patients to leave the hospital, taking away their rights"? without more details on the circumstances, Medical Power of Attorney, etc.

[Karma13612]

50. See the link

I supplied at my comment #31.

[JohnSJ]

52. I saw it. I still stand by my comment

[paleotn]

24. Zero sum game folks. The slick TV ads. The profit. Someone has to pay for all that.

As ashredux wisely noted above (13), lower costs to Advantage customers ALSO have to be paid for by someone. THERE IS NO FREE LUNCH! All that adds up to healthcare providers not being able to cover their costs, thus Mayo has opted out of network where reimbursements are at least somewhat higher. The next step is to not take Advantage plans at all. Fee for service or get out.

As has been batted about ad nauseam, the only logical and most efficient solution to this zero sum game is universal coverage. Period. End of story. Traditional Medicare for older Americans and ALL Americans. Everything else is just one group or another fighting over how much of the set sized pie they get to keep. Like the laws of physics inside a black hole, market economics does not work in healthcare. It just doesn't.

[Lonestarblue]

25. Medicare Advantage means that profit-driven insurance executives make your medical decisions

for anything major. For example, if you have cancer insurance companies will make you try the least expensive treatment first even if your doctor does not believe it will work. You also need referrals to higher care specialists, who will have to be in network and may not be the best or the ones you would have chosen.

The solution is to improve original Medicare to include the services provided by Advantage plans but leave the program in government hands, not in private insurance hands that are driven solely by profits.

[RocRizzo55]

27. Late stage capitalism at its best

Soak all seniors for their money, and make it look like they are getting a great deal. Probably better off moving to a civilized country with universal healthcare.
They really turned the Medicare program into a handout to the insurance companies. Like they don’t already make enough money.

[area51]

28. We desperately need universal healthcare.

Physicians for a National Health Program

[Ziggysmom]

30. The husband chose AARP United Healthcare Advantage plan because he THOUGHT being

affiliated with AARP made it better. Guess again.
With most Advantage plans, you can only see doctors in your plan’s network. Plus the greedy insurance companies that manage Advantage plans can DENY claims for some expenses that they say are too expensive or unnecessary, like imaging tests, or new drugs, even when they are covered under Medicare.

We have friends who love their Advantage plan, but they are healthy and not taking a lot of medications like my husband who is disabled and on continuous oxygen, needing 15+ prescriptions.

Bottom line, log in at https://www.medicare.gov/
Compare all plans and combinations available to you. You can create a log in and enter your medications & treatments, then evaluate the cost using various plans.

And don't listen to Joe Namath commercials! The corporation behind those is Benefytt Technologies.
"The Federal Trade Commission is taking action against healthcare company Benefytt Technologies, two subsidiaries, former CEO Gavin Southwell, and former vice president of sales Amy Brady, for lying to consumers about their sham health insurance plans and using deceptive lead generation websites to lure them in".
https://www.ftc.gov/news-events/news/press-releases/2022/08/ftc-action-against-benefytt-results-100-million-refunds-consumers-tricked-sham-health-plans-charged

[Traildogbob]

37. 👏👏👏👏👏

They are thieves. Private health care CEO’s will not give you free coverage and fork out billions in claims. Somebody also gotta pay for horrible actors every other commercial. They DO NOT care if you die. They got yachts to keep up. When SS is gone according to GQP, no insurance gets paid. Think it’s gonna still be free then. Ask Joe and JJ. And as I am typing, Shatner is on saying they pit money back in your SS. Really? Are people that stupid, yes, they still love trump. FFS.

[gulliver]

35. Medicare Advantage plans have MOOPs and sometimes include vision and dental

Now, let's say Medicare/Medicaid provided those things natively. Then, to me, that's universal healthcare. That's why we shouldn't be promoting Medicare for All. It should me more like an ACA expansion that provides true universal healthcare while governing profiteering. I have zero problem with corporate profit and non-profit insurance companies playing roles in the healthcare supply.

It's almost impossible to put a lid on excess costs in a subjective, suspicious, Dunning-Krueger world. But we can do a lot better.

As far as I can tell, Biden and the Dems did us all a gigantic favor by allowing Medicare to bargain with drug companies. Yet Republicans keep dissing him and some Dems don't seem to get just how great he is.

[Hortensis]

41. "Medicare Advantage plans have been under increasing scrutiny and investigation

because so many of them have been accused by federal agencies of denying care, exaggerating the severity of illnesses to pull billions more from Medicare, and delaying care with lengthy prior authorization requirements.

Additionally, unhappy enrollees who want to disenroll often find they can't sign up for a supplemental plan without underwriting, which can result in rejection of beneficiaries with certain common underlying health conditions. ...

As a broker, she noted, "While you can and should be able to be seen at any hospital for emergency services, Medicare Advantage marketers and agents need to make it clear that in non-emergent situations, MA plan customers cannot be seen at any facility that accepts Medicare, but only those that are within the plan's network. Otherwise, the customer would pay for those out-of-network services," she said.

Contracting with a network of providers to keep down costs is normal with Medicare Advantage plans. Nothing new here.

Medicare is accepted by almost all hospitals -- except VA and military and a few others. "Hospitals need to follow specific safety and health regulations in order to participate with Medicare."

[Hotler]

45. HI! IT'S ME AGAIN......

[Thunderbeast]

47. We are happy with our zero premium advantage plans.

I am on five meds Two of them have a $10 copay for 90 day supply. Three are free. My diabetic test strips, lancets, and monitors have no copay. Specialist visits cost $40.

My spouse had cancer surgery a few years ago. Our out of pocket was negligible. Her $2,600 Prolia shot costs less than $300 twice a year.

The provider is proactive in preventative care. Gym membership and OTC pharmacy benefits are added benefits. This year, dental and optical benefits have been added.

[Karma13612]

53. 👍👍👍

[LiberalBrooke]

48. I have original Medicare and it has been great. Most people I know are opting for an Advantage plan

because they are cheaper. It is not worth it to me. I had major health issues this past year and it was hard enough to choose doctors while sick without worrying about a network. As it turns out, several of them would not have been covered. I feel very fortunate that I could choose the best care and that included Mayo Clinic in Minnesota.

[SheltieLover]

49. Glad you were able to get the care you needed from the best docs!

I was recent helping a person with Medicaid (TN) trying to get dental care...

A root canal was required & eventually approved, however there were NO endodontists, even in Nashville (3 hrs away!), except one with a 2 star rating.

This region is hardly known for quality medical care, but for gawd's sake!

So the area one lives in might make a difference, but I'm with you. NO PPO for me!