Did moving to Medicare at 65 impact your access to choice of doctors?

[meierlde]

Not sure, but I think Medicare A is automatic when one has already signed up for Social Security. Otherwise, one needs to enroll.

Actually part A and B are automatic if you are getting benefits. You have to take action if you don't want part B.

 

[marko]

Is the idea that if you require something expensive like surgery or chemo, then you'd use insurance to pay for the surgeon/oncologist/hospital? Your liability to the concierge doc is his/her annual fee for office visits and referrals? Or is there some way that your uninsured costs from the concierge doc can skyrocket if you have expensive health problems?

I pay a $100 a month fee. For that I get 10 visits to the doc, an annual physical, almost immediate callback/email/Skype with him, same day appointments and he can spend as much as an hour with me if need be. And for $30 he'll make a house call.
Any other stuff is covered by insurance or Medicare

 

[Oma_here]

Not sure, but I think Medicare A is automatic when one has already signed up for Social Security. Otherwise, one needs to enroll.

+1.

Automatic enrollment is limited to those already on SS. If you have sufficient (credible? Not sure of the terminology used) other insurance you don't have to enroll and you don't get dinged with higher premiums if you sign up later for part B or D. You need proof of previous insurance to avoid the life long surcharge though

 

[Tree-dweller]

Fewer docs opting out in 2017 per this article:

http://www.modernhealthcare.com/article/20180130/NEWS/180139995

I thought that was going to be good news, but then I read it. Excerpt:
“One theory is that MACRA ended the need for providers to renew opt-out affidavits every two years; now opt-outs can be indefinite, and providers must ask to rejoin the program.
"Figures from 2015 and 2016 may represent the first wave of physicians opting out and lower 2017 data may reflect the fact that physicians no longer need to file affidavits to renew," said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. “

 

[Tree-dweller]

I pay a $100 a month fee. For that I get 10 visits to the doc, an annual physical, almost immediate callback/email/Skype with him, same day appointments and he can spend as much as an hour with me if need be. And for $30 he'll make a house call.
Any other stuff is covered by insurance or Medicare

Is yours local or part of some kind of nationwide consortium? I gotta look into this, sounds interesting.

 

[marko]

Is yours local or part of some kind of nationwide consortium? I gotta look into this, sounds interesting.

Check out / Google "Direct Primary Care". Local and independent but gaining national momentum as a movement.

Here's a good link: https://www.dpcare.org/

My doc used to have 2500 patients and could only spend 15 minutes with them. Now he has limited his practice to 650 and spends as much time as necessary.

He came to realize that 90% of his staff (and costs) were people just dealing with insurance. Now he has one receptionist and one nurse.

 

[DEC-1982]

Mr. A. had to apply for Part A. It was not automatic.

Not sure, but I think Medicare A is automatic when one has already signed up for Social Security. Otherwise, one needs to enroll.

Good to know, since my FRA is after 65 and I plan to start SS at or after FRA.

 

[Tree-dweller]

Check out / Google "Direct Primary Care". Local and independent but gaining national momentum as a movement.

Here's a good link: https://www.dpcare.org/

My doc used to have 2500 patients and could only spend 15 minutes with them. Now he has limited his practice to 650 and spends as much time as necessary.

He came to realize that 90% of his staff (and costs) were people just dealing with insurance. Now he has one receptionist and one nurse.

Thanks for the link. Curious, are the monthly fees considered medical expenses for tax purposes?

 

[marko]

Thanks for the link. Curious, are the monthly fees considered medical expenses for tax purposes?

Not at this time. They're pushing for this through Congress but it's slow going. The website outlines this battle.

 

[Tree-dweller]

Well, I decided to give Direct Primary Care a try, like Marko. It’s costing me $90/month for the next 12 months, half of which will be after I’ve turned 65 and am on Medicare. It’s an experiment that I am fortunate enough to be able to afford supplementing my former employers continuation ppo insurance and then Medicare, and allows me to have a PCP I can readily access. It’s early on, but just in the last 2 weeks the pcp has called me 3 times to see how I am progressing with some hip pain and other diagnostics. Positive experience so far.

 

[marko]

Well, I decided to give Direct Primary Care a try, like Marko.

Part of the pitch my Direct Care Dr gave was that many doctors decline Medicare patients.

 

[ShokWaveRider]

When I turn 65, my Medicare total costs (Including Plan F) will be $400pm MORE than it is now on the ACA.

 

[wmc1000]

ShokWaveRider just went on Medicare today DW went on last October, and our total costs went up $467 per month including Rx Part D. We went with Plan G. Still a BARGAIN IMO!

 

[Dtail]

When I turn 65, my Medicare total costs (Including Plan F) will be $400pm MORE than it is now on the ACA.

I will also probably have higher Medicare costs than ACA.
Hey the ACA subsidies are a true gift.
At least you should still have a good choice of doctors accepting Medicare in FLA.

 

[Katsmeow]

My perception is that the issue on Medicare if it exists is more with primary care doctors than specialists. We moved soon before he turned 65 so he didn't have an existing primary care doctor. However, I had a primary care doctor and usually he doesn't accept anyone on Medicare unless they were a patient before turning 65. But, since I was a patient he agreed to accept DH. All of his specialists have accepted assignment.

My mom is 94 and has had no problem. She did have one specialist for several years that I realize now didn't accept assignment. So she had to pay a little extra. But, she doesn't see that doctor any more.

DH and I just moved 250 miles away so we both need to find new primary care doctors. I go on Medicare next year.

I do have a friend who does something like marko - pays $100 or so a month for a primary care doctor who doesn't take Medicare. If I had chronic conditions that required me to see a doctor regularly I think I might do that. As it is, DH has a couple of specialists that he sees every 6 months but he rarely needs primary care. I go and do lab work about once a year or so. So, paying $100 a month when we take no medications and rarely see a doctor wouldn't be worth it now. But, I can see it working if I felt I would use $1200 worth of services in a year.

 

[beowulf]

If you are over 65 and you feel your good health will last a long time and that you may never need hospitalization and many doctor visits, then taking Medicare is a waster of money. OTOH, just dropping dead one day is not the normal exit strategy for most people. If you don't take medicare at 65, you will pay a 10% penalty for each year you don't have it. If you are lucky enough to know when you are going to have a condition that require hospitalization you can sign up, pay the penalty and then drop it. Part A, which covers hospitalizations, is free for most people as they have paid for it all your life. But there are lots of things it doesn't cover. You pay your money and you take your chances. I'm not sure, but I believe you can't get ACA once you are over 65 and eligible for Medicare. I'm not sure I understand how paying $100 a month to a primary care doctor insures that you will receive unlimited health care. I did have a doctor who changed his practice to concierge practice. You pay an annual fee that gets you fast access, but then he bills for services provided. No insurance or Medicare accepted. Needless to say, I switched providers. Medicare is health insurance. I pay more for multiple car insurance than Medicare. I'm certainly not going to drop that unless I stop driving.

 

[Tree-dweller]

I'm not sure I understand how paying $100 a month to a primary care doctor insures that you will receive unlimited health care.

I understand my direct primary care (not concierge) arrangement doesn’t insure unlimited health care. It’s not insurance. It’s a membership. It supplements the ppo insurance I have. It does grant me almost immediate access to my pcp with either same or next-day appts, Skype-like video discussion, telephone, or via secure text via an encrypted app. I’ll say that,in the short time I’ve been a member, I have gotten more follow up from this practice than I ever did with any other pcp. As for cost ($81/month for me after discount) I pay more for my family membership at the YMCA. Bottom line, it’s an experiment I am fortunate to be able to afford, an option I became familiar with at the same time my old pcp decided he didn’t want to be a pcp anymore. I’ll reevaluate after the year is up.

 

[marko]

I understand my direct primary care (not concierge) arrangement doesn’t insure unlimited health care. It’s not insurance. It’s a membership. It supplements the ppo insurance I have. It does grant me almost immediate access to my pcp with either same or next-day appts, Skype-like video discussion, telephone, or via secure text via an encrypted app. I’ll say that,in the short time I’ve been a member, I have gotten more follow up from this practice than I ever did with any other pcp. As for cost ($81/month for me after discount) I pay more for my family membership at the YMCA.

+1 Everything you said. I'm into year 3 with my Direct Care physician. Very happy with the followup and my doc's ability to spend a long as need be with me...sometimes as much as 45 minutes. What you're paying for is really just very, very personal and focused attention.

As noted, it's not unlimited but I get 10 visits a year, but I usually only see him two or three times. After that there is a modest additional fee.

 

[NoMoreJob]

This page explains it.

But it may not be nearly as onerous as it sounds if a doctor or facility doesn't accept assignment, especially if you have a supplement plan that pays 'excess charges' (F and G).

I recently had a serious medical condition and was accepted by a very highly respected medical facility for treatment. They do not accept assignment. Although there was a little more paperwork involved, since I had plan G which covers the excess charges all that I paid out-of-pocket was an occasional 2% (that's another story - see 'Medicare Sequestration).

Don't think that because a facility or doctor don't accept assignment that they should be ruled out of consideration. I'm certainly glad that I didn't!