I got a "nice" letter from my PCP today...

[Telly]

My health and well-being is their TOP priority! And since I am now or will soon be turning 65, they wanted to tell me about Medicare insurance coverage.

They wanted to tell me that they have contracted with a few Medicare Advantage plans and listed them, and listed a few more MA Plans that they accept.

And then went on to say if I decided to join or remain with standard Medicare Part B rather than one of their MA plans, they would be so happy to transfer my medical records... elsewhere!

How nice!

 

[marko]

So your health is their TOP priority, right behind their TIP-TOP priority which is making money.
They might be doing you a favor.

 

[Another Reader]

Dump that doctor ASAP. Anyone that takes an Advantage plan but not standard Medicare is not a quality doctor.

 

[athena53]

Did their "nice" letter mention that if you choose Medicare Advantage and then decide later to switch to Medicare B, the supplement carrier can subject you to "medical underwriting"- i.e., they don't have to accept you? (There are some exceptions; you CAN switch within 12 months, for example.) That was one of the major reasons DH and I both chose Medicare B from the beginning.

Oh, they forgot to mention that, huh?

 

[joeea]

My health and well-being is their TOP priority! And since I am now or will soon be turning 65, they wanted to tell me about Medicare insurance coverage.

They wanted to tell me that they have contracted with a few Medicare Advantage plans and listed them, and listed a few more MA Plans that they accept.

And then went on to say if I decided to join or remain with standard Medicare Part B rather than one of their MA plans, they would be so happy to transfer my medical records... elsewhere!

Better than being surprised to learn you aren't covered after choosing just Part B.

 

[Jerry1]

Dump that doctor ASAP. Anyone that takes an Advantage plan but not standard Medicare is not a quality doctor.

This is just not true. Just because a doctor is financially motivated doesn’t mean they are not a quality doctor. Additionally, many doctors are now in practices where they are run by a group. The doctor you see may not be too involved in these types of decisions. Doesn’t make the situation any less frustrating, but it’s not fair to impugn the doctors quality. Wasn’t he a high quality doctor before he changed over to this arrangement?

The letter my father got said the physician would keep seeing him for the additional annual sum of $1,600. That did cause him to change doctors.

 

[VanWinkle]

This is just not true. Just because a doctor is financially motivated doesn’t mean they are not a quality doctor. Additionally, many doctors are now in practices where they are run by a group. The doctor you see may not be too involved in these types of decisions. Doesn’t make the situation any less frustrating, but it’s not fair to impugn the doctors quality. Wasn’t he a high quality doctor before he changed over to this arrangement?

The letter my father got said the physician would keep seeing him for the additional annual sum of $1,600. That did cause him to change doctors.

Isn't a Doctor's care like a managed investment account- the more you pay the more you get?

 

[Jerry1]

Isn't a Doctor's care like a managed investment account- the more you pay the more you get?

Of course comparison to an investment advisor isn’t apples to apples. I’m sure there are investment managers that are worth more than others, unfortunately their benchmark is an unmanaged (index) fund and as a whole, there seems to be no correlation in fees to performance being better than the index.

In healthcare, there are indeed experts that do better than the averages. And we seek these people out when we are sick and a way they distribute their time is based on money. I think there is a much higher correlation in performance to payment in a physician versus an investment manager.

Please don’t assume this doesn’t frustrate me as much as you and others, but that is the way I think it shakes out. Look at some of the posts here and when someone is really sick, the advice is typically to go to a prestigious medical team (Anderson, Cleveland Clinic, Mayo . . .). Unfortunately, those folks aren’t cheap. And even if they do take Medicare, then they shift the cost to commercial and self paying individuals.

 

[calico1597]

We are snowbirds and were advised before turning 65 to not take a Medicare advantage plan due to our winter travels.

 

[ivinsfan]

I'll take the other side and say they let you know well in advance of getting Medicare. They laid all the options on the table so that you didn't go in after turning 65 only to be told you couldn't remain as a patient.

You have a choice to make and some time to make it. MY DH has had some issues since turning 65 and the medically allowed amount on some Medicare procedures is laughably low.

 

[upset264]

We moved from one Connecticut town to another about 10 miles away 15 years ago. For a few years I traveled back to the old hometown to see the long term primary care physician as needed. Then I decided to change to another doctor in the current hometown, still with the same group. There were two to choose from, a younger female and an older male. I went with the female on the theory that the male was more my age, close to retirement and I wanted a long term relationship. Shortly after that I got a letter that she was leaving, so I switched to the remaining male. Shortly after that I got a letter that he's retiring. So much for that. So now I'm on yet another doctor who I have to say I'm not too happy with.
Recently there was an article in the local newspaper about the shortage of primary care physicians in CT. The independent practice is virtually extinct because one or two doctors can't support the office staff required to do all the insurance and government mandated paperwork. Also in the medical schools the students are well aware that the money is in specialties, not general practice.
Bottom line is I'm sympathetic to the plight of the common family doctor. It's not what it used to be. In the future I believe primary care will be the walk in clinic. Different doctor every time. The doctor doesn't know you, the database does.

 

[VanWinkle]

Of course comparison to an investment advisor isn’t apples to apples. I’m sure there are investment managers that are worth more than others, unfortunately their benchmark is an unmanaged (index) fund and as a whole, there seems to be no correlation in fees to performance being better than the index.

In healthcare, there are indeed experts that do better than the averages. And we seek these people out when we are sick and a way they distribute their time is based on money. I think there is a much higher correlation in performance to payment in a physician versus an investment manager.

Please don’t assume this doesn’t frustrate me as much as you and others, but that is the way I think it shakes out. Look at some of the posts here and when someone is really sick, the advice is typically to go to a prestigious medical team (Anderson, Cleveland Clinic, Mayo . . .). Unfortunately, those folks aren’t cheap. And even if they do take Medicare, then they shift the cost to commercial and self paying individuals.

I agree specialized care is worth every penny. I just don't think you need to pay extra every year for a check up. I will be glad to pay the difference to a specialist with a great reputation.

 

[mamadogmamacat]

.............I believe primary care will be the walk in clinic. Different doctor every time. The doctor doesn't know you, the database does.

+1
This I also believe is the future. Indeed,although not yet old enough for Medicare, often go to the local doc in a box just for convenience when I know it is just another sinus infection, or UTI, as they are easy to get in/out without an appt, and with the lab onsite, actually cheaper. Actually have had the same Dr there the last three times over the past 5 yrs. As it is a rather high COL state (I know I still have family there and lived there myself a couple times, as a child and for a job for about 3 yrs), I expect CT is somewhat ahead of the game for this trend of PC Dr shortages.

 

[aja8888]

Did the letter state that even if you sign on with their MA practice, there is no guarantee you will be assigned "your doc" once the plan is in effect?

 

[Car-Guy]

My health and well-being is their TOP priority!

When I read your first sentence, I thought for sure I was in the "It's Funny Jokes Thursday" thread.

That's the same general BS headings my Health and Drug Insurance companies start off with on their correspondence to me.

 

[razztazz]

In the future I believe primary care will be the walk in clinic. Different doctor every time.

Just like "Sick Call" in the Army.

The doctor doesn't know you, the database does

G.I.G.O.

Seriously, none of my PCs have ever known anything about me anyway. Kept writing prescrips for drugs that would kill me. And they were the ones who had prescribed them in the first place that lead to the bad reactions. They did, however, manage to keep track of whether or not I was on statins and always tried to pimp some notion of phantom "risk" because I wasn't on them.

The No-Name / No-Face doctor just might be better. Or at least easier.

 

[Brat]

Odd because the Kaiser Medicare Advantage Plan REQUIRES that you have Medicare Part B. ??

 

[aja8888]

Odd because the Kaiser Medicare Advantage Plan REQUIRES that you have Medicare Part B. ??

I'm pretty sure all MA plans do since the payment funds come from Medicare and your copays.

 

[Another Reader]

I think some people may be confusing Medicare Part B with the supplement plans. Medicare Advantage Plans are in addition to Part B, just as Medicare supplement plans are. They are cheaper because they require you to use their providers and can deny services that are not "medically necessary." People that want some choice and access to all medical services and treatments will want to avoid the Advantage Plans.

The Kaiser family had a good idea when they created plans to obtain health care for their lower income workers and their families. Somehow, managed care and the HMO have become the model for all health care. Only the most astute and determined people can get the premium quality health care they want and need.

 

[Telly]

Yes, those who choose to go the Medicare Advantage (MA) Plan route still pay their Medicare Part B premiums to the feds. And CMS turns around and hands roughly $10k to the MA Plan for the MA Plan to handle the patient and billing, at least that is what I understand from the book I have. So it would seem to me that a Drs. office would deal with just one insurance company for those who are on MA.

Going the "Original Medicare" route like I (hopefully!) plan to do, uses the feds for Part A and Part B expenses, and then uses the Medigap Plan of my choosing for the residual (how much "residual" is covered depends on the Medigap letter plan chosen). So it would seem to me that the Drs. office has to deal with TWO paying organizations. So maybe that is one reason for some Drs. groups to avoid Original Medicare.

Some background on my PCP... They started out many years ago as a single-site business, with a handful of doctors. They later moved to a new location, and either created, or joined, a practice group, that grew to about 3 - 4 locations, all in the metro area. They also offered extended hours, for a price, at select sites.

Sometime recently without me realizing it, it all expanded to many sites, more than 10. The Dr. I used to go to (infrequently, I only go if there is a problem, and sometimes used a doc-in-a-box instead) quit practicing, I have seen another guy there before, he was OK. The site location is close by me, I know the facility, and I know the routine and what to expect there. As far as any Dr. there knowing me or history, all they have is notes on my last visits, which were far apart! No way would they remember me personally. So the "knowing me" medically aspect is not really important to me. It's as if it's more important to me, that I know them! I realize that may strike some as a bit odd, but I do not go for "routine" visits or tests or physicals or etc. But I'm probably more like the ~6.5 billion other people on this planet, than the "average" American.

I DID plan to check with their office a bit later this year to see if they said the magic words "accept assignment", or not. I was expecting that would be a "Yes we do". So much for that expectation!

 

[sengsational]

The letter came from the green-eyeshade hacks that now run the medical establishment (not your doctor).

Your doctor, and most doctors, have encountered a financial and regulatory environment that pushed them away of being their own boss, and from handing patients they way they'd like to. "Big Medical" has bought-up every group around here, and I think it's common in other places in the country too. So when you pick a doctor, you might think you're making a choice, but really, since pretty much all provider groups are owned by a handful of corporations. You're really selecting between that handful of corporations, and their doctors all live within the rules of the megacorp. If you want something different, you have to find a doctor that hasn't fallen into the web, and those are the concierge guys/gals.

 

[athena53]

If you want something different, you have to find a doctor that hasn't fallen into the web, and those are the concierge guys/gals.

I agree. Fortunately I have no ongoing health issues but if I did (and I probably will if I live long enough), I'd get a concierge doctor.

 

[gayl]

I agree. Fortunately I have no ongoing health issues but if I did (and I probably will if I live long enough), I'd get a concierge doctor.

So worth it!

 

[NoiseBoy]

This thread prompted me to look up some statistics on Medicare coverage and I was very surprised to see that it is not nearly as high as I thought. I found an AARP report from 2012 and another website with data from 2016 that puts the percentage of the over 65 population that is covered by Medicare as something less than 20% (roughly 50 million people). I just assumed that almost everyone switched to Medicare for their primary insurance once they turned 65.

If asked, I would've said 80% of the over 65 population was on Medicare and 20% wasn't! That is certainly the impression that I have received from reading threads here and from my own personal experience. If I have my facts straight, what are the other 80% of the elderly population doing for health insurance?

 

[aja8888]

This thread prompted me to look up some statistics on Medicare coverage and I was very surprised to see that it is not nearly as high as I thought. I found an AARP report from 2012 and another website with data from 2016 that puts the percentage of the over 65 population that is covered by Medicare as something less than 20% (roughly 50 million people). I just assumed that almost everyone switched to Medicare for their primary insurance once they turned 65.

If asked, I would've said 80% of the over 65 population was on Medicare and 20% wasn't! That is certainly the impression that I have received from reading threads here and from my own personal experience. If I have my facts straight, what are the other 80% of the elderly population doing for health insurance?

That's a good question because EVERYBODY I know over 65 is on Medicare/Medigap or using a MA service.