Medigap Insurance - your experience with the nitty-gritty of finding care.

[walkinwood]

I have been part of an HMO (Kaiser Permanente) ever since ACA was enacted. But for Medicare, I want to go the Medigap route - probably Plan G.

The nice thing about an HMO like KP is that everything is under one roof. Your PCP & team help direct you to the right care. How does that work in the medicare world?

We live in Denver CO, so any feedback from people living in urban areas would be much appreciated.

Do most of you find a general practitioner that is part of a "group"? And use them as a focal point for care?
How do you go about finding a specialist when you need one?
What has your experience been on lead times for an appointment? (That is one complaint about KP, though if I get on the phone, I can usually find an appt in a reasonable time)

What other things should I be thinking about where obtaining care is concerned?

 

[Irishgirlyc58]

I don’t live in an urban area but I did switch from 25 years at Kaiser to a different insurance plan in 2021 in preparation for when I went on Medicare in 2023. I was eligible for Kaiser through my employer but I don’t live in the Kaiser service area so once I went on Medicare I was going to have to switch any way.
So 2021 was not an easy year to switch because of the impact to the health profession from the pandemic.
I just called the largest healthcare group in my area and tried to get an appointment. Which was a lot harder than it sounds or should be in my opinion.
I started with a nurse practitioner because he was taking new patients but then 6 months later I was able to change to the PCP I have now. Once I had the PCP I got referrals for some specialist- like the allergist but I didn’t need one for the dermatologist or GI doctor.
Prior to getting the PCP I used urgent care a few times.
It was a learning curve to not have everything under one roof. I actually still don’t like it but I’ve liked the doctors that I’ve seen.

I did find that it is impossible to set up anything prior to switching.

 

[tutan]

It is definitely convenient to be able to get labs, X-rays, MRIs done within the same organization. DW belongs to Stanford Healthcare in the SF bay area which has them in-house. Less chance of miscommunication I think. Also as the doctors use the same software system, they get to access and share patients’ medical records. To see a specialist within Stanford requires the PCP’s referral however. Not sure why but that’s their rule. They seem to have a bunch of specialists, some of whom also teach at the University. Unacceptably long lead time for an appointment is a good reason to go outside Stanford. It does happen but not frequent so far. So maybe it’s good to join a group that has a lot of specialty doctors??

 

[rk911]

Our docs have been part of a regional group prior to us going on Medicare. From conversations we knew that the group accepted Medicare and our selected Medigap carrier, Blue Cross/Blue Shield. Had they not we would have switched doctors.

A few years later our primary care doc informed us that HE would no longer accept Medicare in favor of a specific Medicare Advantage plan. We declined to make that change and were transfered to a new PCP...which we actually like better than our original PCP. All of our specialists are within the group and all accept Medicare and BCBS.

 

[RetiredHappy]

We used to have Kaiser in California. We moved out of state and had to learn a new system. What we have learned is that the most important doctor to have is the Primary Care Physician. A well networked PCP is able to refer you to the best specialists, orders comprehensive lab work for you every 6 months. We have a concierge PCP so that we can text him at all hours, and be seen the same day. He is very well networked into the best specialists, not just within the same state, but out of state if necessary. He can get us expedited appointments with the specialists as necessary.

 

[Texas Proud]

I was using a Dr we have had for years.... she has been a a few different groups... so we went with the other Drs in their group without any problems... except for a few items where we found one we liked...

BUT, she just changed groups again!!! Not sure what we are going to do... with the gap insurance I can go to any Dr that accepts medicare so it is much better IMO...

 

[Dash man]

We’ve been with Main Line Health for 23 years here in PA. Our PCPs have all been great and recommended great specialists. They have several hospitals in their group, all with excellent reputations. DW is a 20 year survivor of ovarian and uterine cancers. I’ve had great care with my myriad of medical problems. My transition from employee health insurance to Medicare with Plan N was seamless. Most doctors participate in their online application, so seeing reports and test results is easy.
My only gripe is the local ambulance service only takes you to two other closer hospitals not related to MLH.

 

[walkinwood]

Thank you all for your responses. It looks like the best advice is to find a practice that has a number of different specialist & to search for a good PCP. The latter (good PCP) has been true at Kaiser too.

 

[audreyh1]

I don’t think you need specialists in the same practice. What you need is a good PCP who can refer you to a wide variety of specialists. Our PCP would also refer us to specialists we’d seen before if asked. Now that we are on traditional Medicare we can go directly see any specialist we want that accepts Medicare. But we still use a PCP, not necessarily as a gatekeeper any longer, but for routine stuff and the occasional urgent care.

 

[Jerry1]

Thank you all for your responses. It looks like the best advice is to find a practice that has a number of different specialist & to search for a good PCP. The latter (good PCP) has been true at Kaiser too.

I live near the University of Michigan. If you live near an academic institution finding a PCP connected with them will be very helpful. My main doctor is my rheumatologist and she can (and has) referred me to other docs with no issues. The next step is a large local health system. If one of those are nearby, getting a doc associated with them will help. First thing to do, and it’s not easy, is to find a PCP associated with a good system. All the doctors don’t need to be in the same practice. That’s unlikely anyway since they tend to create groups based on their specialties.

 

[RetiredHappy]

Thank you all for your responses. It looks like the best advice is to find a practice that has a number of different specialist & to search for a good PCP. The latter (good PCP) has been true at Kaiser too.

You need to get out of the mindset of "a practice that has different number of specialists". A well-connected PCP will refer you to the best specialists, and each is very likely to have their own practice.

 

[Texas Proud]

YES... one of the benefits of regular medicare is that you do not have to stick with a practice that is part of your insurance... you go where you want to go..

 

[Dtail]

Also leaving the ACA for Medigap Part G next year. All my current doctors are in Medicare and Medigap. My PCP has always continued to recommend specialists and will continue to do so.

 

[target2019]

We stick with the same large health group as before Medicare.

 

[rodi]

Following this. On Kaiser but plan to switch to G or G HD in less than 2 years when I hit Medicare.

Most of the PCPs that aren't Kaiser around here (San Diego) are part of one of the large groups. Scripps, Sharp, and UCSD.

Hubby is in the Sharp infrastructure. For the most part the record sharing works... This has been important as he has gone through his prostate cancer treatment. His radiologist gets most of the info in his record. His urologist has full access to the radiologist and the PCP, the PCP can't see the radiologist data,. But they all work with the same Sharp app. I think the radiologist is a contracted group... Talking to a woman who was getting radiology for breast cancer, the radiology and chemo oncologist couldn't see each other's input, even though the departments were in the same building and under the Sharp umbrella.

I will probably go with Scripps or UCSD ... But Scripps has some stuff that about me... Like they kicked all their Medicare advantage patients of their system last year. Lots of my friends were impacted. Kind of left a distrust in my mind.


Picking the PCP will be the hardest part.

 

[LizaBBBB]

I have been part of an HMO (Kaiser Permanente) ever since ACA was enacted. But for Medicare, I want to go the Medigap route - probably Plan G.

The nice thing about an HMO like KP is that everything is under one roof. Your PCP & team help direct you to the right care. How does that work in the medicare world?

We live in Denver CO, so any feedback from people living in urban areas would be much appreciated.

Do most of you find a general practitioner that is part of a "group"? And use them as a focal point for care?
How do you go about finding a specialist when you need one?
What has your experience been on lead times for an appointment? (That is one complaint about KP, though if I get on the phone, I can usually find an appt in a reasonable time)

What other things should I be thinking about where obtaining care is concerned?

I was with the same primary before I began Medicare (with Plan F supplemnt, which is closed to new enrollees, so G a v good choice), and after. She and I were proactive in terms of my care,so I already had the one specialist I needed. But then, she changed to Mayo Perimary, which does not take Medicare (for primary; they do for their specialists). But I was able to find a totally independent primary MD. Again, he and I are proactive about my health. If one can afford it, suplement is the way to go. In gthe near (and far) term you will spend less overall, with 100% predictable costs.

 

[jpeter1093]

I have been part of an HMO (Kaiser Permanente) ever since ACA was enacted. But for Medicare, I want to go the Medigap route - probably Plan G.

The nice thing about an HMO like KP is that everything is under one roof. Your PCP & team help direct you to the right care. How does that work in the medicare world?

We live in Denver CO, so any feedback from people living in urban areas would be much appreciated.

Do most of you find a general practitioner that is part of a "group"? And use them as a focal point for care?
How do you go about finding a specialist when you need one?
What has your experience been on lead times for an appointment? (That is one complaint about KP, though if I get on the phone, I can usually find an appt in a reasonable time)

What other things should I be thinking about where obtaining care is concerned?

I'm also in Denver and went with plan N and found a PCP with Intermountain Health. They offer office and video visits. Been with them for 3 years and been very happy with the practice.

 

[Lstansbury]

My personal insurance is original Medicare plus Plan G supplement and Wellcare Part D. Love, love, love going to any doctor who has an opening. I'm also part of a large medical system for my PCP, and the ease of seeing someone in the system is good. But I've been rescheduled for a hepatology appointment three times, usually about a day or two before the appointment each time. I've waited almost 6 months already. And that's in the big system with 600 doctors.

So I've made an appointment with a hepatologist out of town who is in a private practice with great reviews - and I'll see him in two weeks. No need for a referral. I feel like my supplement gives me a Gold Card to care.

 

[isisdave]

Find a big group, preferable affiliated with or sponsored by a hospital. Get PCP by referral from friend if you can, otherwise just try a likely one (board certified, younger than you but not just out of school). Hospital-based groups usually have their own labs and radiology, plus all the specialists you need. Here in Evansville, it's Deaconess (huge) and Ascension St Vincent (moderate here but big thru Indiana).

 

[CRLLS]

Unlike an HMO, with traditional Medicare a person does not need a referral to see a specialist. You can just make an appointment with the specialist yourself. I have no PCP and seen several specialists under trad Medicare. DW has a PCP but has made appointments with specialists without referrals. What she found out with one specialist is the best appointment she got was a few months out. Her PCP helped to make that a couple of weeks. It does help to consolidate medical records under one umbrella but not necessary. YMMV.

 

[BeachOrCity]

Just came upon this thread. A VERY IMPORTANT consideration. Not mentioned so far.

The only time you can get a medicare supplement without being individually underwritten is when you turn 65 (with a few technical exceptions).

What this means in practice is if you go the medicare advantage route and want back in to traditional medicare you can forget about getting A supplement or pay thru the nose for one to the extent it no longer makes sense.

The medicare advantage people never mention this.

A recent newspaper artical discussed how medicare advantage plans ration end of life care. Many enrollees had to switch back to traditional medicare and pay the full 20% themselves for very expensive things like rehab inpatient….all bc the advantage plan would not pay but medicare would.

Imho, unless you cant afford it, go traditional medicare and get the best supplement available.