Talk of The Villages Florida - There outta' be a law....Medicare plans

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- - There outta' be a law....Medicare plans (https://www.talkofthevillages.com/forums/medical-health-discussion-94/there-outta-law-medicare-plans-329821/)

Note that Medicare Advantage plans are run by private companies that have a profit motive. So, they can maximize their profit by screening out providers based on how many claims and the types of claims they submit. And, that is why they require patient copays. Also, they have an incentive to prevent fraudulent claims and wasteful claims.

By contrast, Original Medicare is run by a bureaucratic Federal Government agency that has no profit motive. They have no incentive to reduce costs by screening out any providers, regardless of how many claims they submit. With a Supplement plan, the patient can avoid copays. And, they make very little effort to prevent fraudulent and wasteful claims.

Just my observation. I don't know which system is better for the patient, but I think the Advantage model makes more sense for the taxpayers.

What you described is perfectly legal. You aren’t being prevented from seeing your PCP, as a Medicare participant he must see you and treat you. Medicare will pay for 80% of his normal and customary charges. What’s changed is that you must pay for 20% of his charges instead of some form of Medicare supplemental insurance.

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Originally Posted by Villages Kahuna (Post 2068725)

I'm confused. Are you saying that the OP can take advantage of the Original Medicare Part B insurance even though he does not have Medicare Part B insurance? I don't think that is the way it works. The out-of-network doctor may be limited in the amount he can charge the OP, but I don't think the OP can benefit from both Medicare Advantage and Original Medicare at the same time. If he has an Advantage plan (Part C), I don't think he will get the 80 percent Part B reimbursement. He would need to pay the full Medicare amount to the doctor.

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Originally Posted by jswirs (Post 2068059)

Just recently my PCP cancelled my appointments because it was decided that patients with my particular Medicare Advantage Plan are no longer being accepted, unless I pay "out of pocket" cost. (For personal and financial reasons I decided not to pay "out of pocket"). This information was not given to me until I called the office one week before my appointment.
I understand a doctor's decision to do this, however, I was not informed by my insurance people, Medicare, or my doctor's office. If I did not happen to call the office I would have shown up for an appointment that no longer existed.
I know I am not the only person this has happened to, so, my question is: "Why can't the doctor's office inform patients when the decision is made to drop those patients who have a particular insurance plan?"
I was told that the responsibility to do this falls on the insurance company. But the insurance company may have tens of thousands of people on their books, leaving the possibility of overlooking someone.
The way I see it, if a doctor can confirm every appointment by texting, why couldn't a simple "FYI" text be sent to patients when their appointments are cancelled because of an insurance decision? (There are some states that require a doctor's office to inform patients with a 60 day notice before any existing appointments are cancelled.)
I know there are a few MD's, as well as insurance folks, on this forum, and I thank them and anyone else who may reply.

This happened to me in Jacksonville. The specialist stopped taking United Health. They didn’t tell me until I arrived at the appointment. They called me two days prior to confirm my appointment & never informed me they no longer took my insurance. I drove 10 miles to this doctor in heavy traffic. I was furious.
I wasn’t disappointed losing the doctor. I didn’t like him. I found a great specialist who really helped me. I sometimes wonder if our insurance didn’t cancel him.

So much misinformation here about advantage plans. One type of advantage plan is a PPO. In my opinion much more flexible than an Advantage HMO plan.The Villages Health Care accepts this plan. Here is a link to a one page synopsis by Medicare.gov that will educate you about choice of doctors, specialists, etc.

Preferred Provider Organization (PPO) | Medicare

1 FYI when you do your analysis don't forget to multiply your supplemental premium by 12 and then compare to your advantage plans out of pocket max.
2 No one is guaranteed their doctors will continue to accept any plan including straight forward Medicare.
3 If you need some world renown specialist at our ages your close to cashing in your chips. In today's electronic communication age most doctors and organizations are up to date on gold standards. For me it's quality of life (including the burden I may submit my family to) Vs quantity.

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Originally Posted by Villages Kahuna (Post 2068620)

OP says “… In effect, you can go to most every doctor anywhere in the country except for the Mayo Clinic which will not accept Medicare.…”

This is incorrect. There are quite a number of doctors and hospitals, including most of the very best in the country, which do not accept any of the Medicare plans. Even The Villages Health only accepts the Medicare Advantage plans offered by United Healthcare, Florida Blue and Humana if you are Medicare-eligible.

This is from the Mayo site: Does Mayo Clinic accept Medicare?
Yes, Mayo Clinic is a participating Medicare facility in Arizona, in Florida, in Rochester, Minn. and at all Mayo Clinic Health System locations.

Perhaps you mean they don’t accept some Advantage plans? Most providers do accept or participate in original Medicare.

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Originally Posted by dblwyr (Post 2068735)

Mayo Clinic accepts my Florida Blue MA plan.