According to a Kaiser Family Foundation 2016 report, Medicare Advantage administered by private insurance companies has “tripled from 5.3 million members in 2004 to 17.6 million in 2016.”
Although private insurers must offer benefits as good as Original Medicare, Advantage plans have increased in numbers due to extra Federal subsidies and aggressive T.V. advertising by insurance companies who rely on the Advantage program as a major source of their profits.
Since the majority of members, about 11.2 million are steered to HMO’s (Health Maintenance Organizations), and about 5.2 million PPO’s (Preferred Provider Organizations), their options are very limited if they are diagnosed with a serious illness and want to go to Mayo clinic.
Patients covered under a Medicare Advantage HMO plan without authorization may not be seen at any of the Mayo clinic facilities in Rochester Minnesota, Florida or Arizona.
Even worse, HMO patients cannot be seen on a self- pay basis.
The Mayo Clinic in Arizona where many “traveling snowbird Medicare beneficiaries” hold up for the winter is even more restrictive. They deny coverage to any Medicare Advantage members (HMO, PPO, or PFFS) with the exception of Cost Share/HCPP. And, patients cannot be seen on a self- pay basis.
However, Medicare members enrolled in Original Medicare can choose their own doctor, don’t need a referral and can use their plan anywhere in the United States where Medicare is accepted including Mayo Clinics. Original Medicare plans would provide much more flexibility for retirees who travel somewhere warmer for the winter months.
Don’t be fooled by a Medicare Advantage sales pitch offering no premium, free gym membership, vision or dental because you will give up your freedom to choose the best doctors in the country if your condition requires very specialized treatment.
