Traditional Medicare/Supplement Not Accepted Locally?

[mountainsoft]

My mom's medical office just notified us they will no longer accept her Medicare Advantage plan. She's also switching to Medicaid, so choosing a new plan is going to get messy.

Anyway, I started doing some research to see which plans are accepted at most of our local medical offices (for my own use in a few years). Except for the two main hospitals (Legacy and PeaceHealth), the two largest medical organizations in our area (Kaiser and The Vancouver Clinic) do NOT accept traditional medicare or supplement plans. They only take Medicare Advantage plans. There might be some independent offices somewhere in town, but Kaiser and TVC make up the vast majority of medical offices in our area.

This really surprised me as I always viewed Medicare/Supplements as the "gold standard" accepted everywhere. However, short of going to one of the main hospitals for all medical care (not convenient) or finding an independent medical office, it seems Medicare Advantage is the only real option in these parts.

 

[RetiredHappy]

HMO organizations only take their own Advantage plans because they get paid something like $14K per patient from Medicare. It is a different operating model.

 

[rk911]

We had to change our PCP a few years back because he dropped traditional Medicare in favor of MA. He was part of a large medical practice.

 

[Teacher Terry]

In my local area everyone takes regular Medicare. Maybe things will change by the time you qualify.

 

[aja8888]

Houston area here -- be coming one of the largest concentrations of medical facilities in the U.S. Both MA and traditional Medicare are accepted in the vast majority of facilities.

 

[ShokWaveRider]

OP: That is because MA is NOT "Proper" Medicare (In the True sense (I.E. Government Sponsored)). MA is an insurance product with all the caveats, no matter what one is led to believe. It seems odd that folks in your neck of the woods do not accept Medicare. Regular Medicare + a Part G supplement is accepted by all our local providers. I have yet to fine one in our area that does not. Yet lots are dropping MA. It is always a risk with MA of it getting dropped by providers. This subject has been discussed exhaustively in other threads. We both have had Regular Medicare + a supplement for the last 6 years and have yet to find a practice or Hospital (Including Mayo and Baptist) that do not accept it.

 

[MichaelB]

OP: That is because MA is NOT "Proper" Medicare (In the True sense (I.E. Government Sponsored)). MA is an insurance product with all the caveats, no matter what one is led to believe. Regular Medicare + a Part G supplement is accepted by most (If not all) providers. I have yet to fine one in our area that does not. Yet lots are dropping MA. It is always a risk with MA of it getting dropped by providers. This subject has been discussed exhaustively in other threads.

MA is proper and official Medicare. The policy must, by law, cover everything traditional Medicare covers, without exception. The most notable differences are MA policies may have different networks that are more limited.

 

[ShokWaveRider]

MA is proper and official Medicare. The policy must, by law, cover everything traditional Medicare covers, without exception. The most notable differences are MA policies may have different networks that are more limited.

AND it is an insurance product, not a Government funded one, I.E. the Government/Medicare does not pay the providers in an MA situation, the insurance company does. Yes it is "Sanctioned" by Medicare and Medicare subsidizes the insurance companies, but MA is definitely not the same as regular Medicare.

 

[MichaelB]

AND it is an insurance product, not a Government funded. Yes it is "Sanctioned" by Medicare and Medicare subsidizes the insurance companies, but MA is definitely not the same as regular Medicare.

It is government funded. The coverage requirements are exactly the same.

Once again, the differences are MA may have more limited provider networks.

 

[mountainsoft]

HMO organizations only take their own Advantage plans because they get paid something like $14K per patient from Medicare. It is a different operating model.

Yes, I understand that with an HMO like Kaiser. We had them for years while my wife was working and had no issues. They were just more expensive once we retired.

The Vancouver Clinic is a large medical organization in our area (at least 4-5 offices within 20 minutes of our home). They work closely with the two main hospitals (about 40 minutes from our home). They accept several different PPO Medicare Advantage plans. However, I was surprised to find they do not accept traditional Medicare with a supplement. Especially since the two main hospitals do accept Medicare/Supplements.

I did some quick searching and could only find a few doctors who take traditional medicare (outside of the main hospitals), and they were rather specialized. I'm sure there are probably other's I don't know about, but they're certainly harder to find than the larger medical offices.

 

[ShokWaveRider]

MA - "Private insurance companies manage Advantage plans. Medicare pays them a fixed monthly amount for each beneficiary’s expected healthcare costs."

Original Medicare - "With Original Medicare, you can go directly to the doctor or hospital of your choice, bypassing prior authorizations or referrals. The government is responsible for paying its portion directly to your provider and you cover the left-over costs. The only qualification for care is that the doctor you choose accepts Medicare."

Medicare Supplements - Cover the excess (Left Over Costs) and are insurance products, but a not restrictive, they cover all excess costs (20%) regardless of provider as long as Medicare is accepted and the Medicare deductible has been satisfied.

 

[MichaelB]

MA - "Private insurance companies manage Advantage plans. Medicare pays them a fixed monthly amount for each beneficiary’s expected healthcare costs."

Original Medicare - "With Original Medicare, you can go directly to the doctor or hospital of your choice, bypassing prior authorizations or referrals. The government is responsible for paying its portion directly to your provider and you cover the left-over costs. The only qualification for care is that the doctor you choose accepts Medicare."

Medicare Supplements - Cover the excess (Left Over Costs) and are insurance products, but a not restrictive, they cover all excess costs (20%) regardless of provider as long as Medicare is accepted and the Medicare deductible has been satisfied.

It’s not clear what your point is. With MA, the healthcare provider receives payment from an insurance company. With Medicare supplement, the provider received payment from an insurance company. With traditional Medicare, the provider receives payment from CMS.

In all three options, what is covered is exactly the same. In some cases MA may cover more, but in no case can it cover less. All 3 are Medicare. If you have an MA policy you have Medicare, your coverage is determined by CMS.

MediGap (Medicare supplemental) is also insurance provided by insurers. This does not mean it isn’t Medicare. Like MA, the coverage is regulated and mandated by law.

 

[ShokWaveRider]

It’s not clear what your point is.

My point is that in my opinion, and that of a lot of other smart folks is MA is an inferior product to traditional Medicare for a variety of reasons, limited networks, referrals and approvals being but a few. There is a reason it is nicknamed Medicare "Dis"Advantage. I guess that if one has no other option it is good.

There is one exception that if the MA is employer (or previous employer) sponsored, then it is a completely different scenario. Employer sponsored MA often offers way more coverage than those sold by celebrities to the general public.

 

[Irishgirlyc58]

If your mom is going on Medicaid if it is a managed care plan then she might be able to get one with Kaiser. It depends on the area and how Medicaid is administered in WA- or like California each county has different options for managed Medicaid(Medi-Cal in California)

 

[aja8888]

It is government funded. The coverage requirements are exactly the same.

Once again, the differences are MA may have more limited provider networks.

Yes, around here, the large Memorial Hermann Medical system dropped accepting MA patients in 2024 that are covered by Humana, but they will accept Medicare and my Humana Plan G supplement insurance.

They also will accept other MA insurance from certain insurance companies that meet their requirements.

 

[RetMD21]

My mom's medical office just notified us they will no longer accept her Medicare Advantage plan. She's also switching to Medicaid, so choosing a new plan is going to get messy.
....

It sounds like the Vancouver Clinic must have cut a deal with some of the MA providers. If you are going with them isn't it just a matter of selecting from the 5 they list on their web site? If her doctor is in a different group I would hope they would tell you which plans they'll accept. I may be missing something.

 

[Texas Proud]

It is government funded. The coverage requirements are exactly the same.

Once again, the differences are MA may have more limited provider networks.

As pointed out by others it is not 'exactly' the same...

The networks, deductibles, copays etc. are made up by the MA provider... and a Dr does not have to accept a MA plan if they accept medicare... but they have to accept patients with 'regular' medicare...

So, IMO, they are not even close to being exactly the same... I think what you are trying to say is that the MA is supposed to provide the exact same services as regular medicare... ie, if you can get the service in medicare you can get it in your MA plan... that is true in theory but not in practice...

 

[Tadpole]

My mom's medical office just notified us they will no longer accept her Medicare Advantage plan. She's also switching to Medicaid, so choosing a new plan is going to get messy.

Anyway, I started doing some research to see which plans are accepted at most of our local medical offices (for my own use in a few years). Except for the two main hospitals (Legacy and PeaceHealth), the two largest medical organizations in our area (Kaiser and The Vancouver Clinic) do NOT accept traditional medicare or supplement plans. They only take Medicare Advantage plans. There might be some independent offices somewhere in town, but Kaiser and TVC make up the vast majority of medical offices in our area.

This really surprised me as I always viewed Medicare/Supplements as the "gold standard" accepted everywhere. However, short of going to one of the main hospitals for all medical care (not convenient) or finding an independent medical office, it seems Medicare Advantage is the only real option in these parts.

I saw you are in WA state. Me too. Is this a local thing? My doctor retired and his ex-clinic got swallowed into Optum. I began a search for another doctor in that wasn't Peacehealth. My nurse relative tried to set me up with her clinic and they would not take me because they only take Medicare Advantage plans. No mention of a particular MA plan, just made it sound as if any MA would do. But never Medicare A&B + Supplemental of any flavor. They finally let me in after my relative begged but only because one ARPN agreed to it and only her. I've never had an ARPN for my primary doctor and don't know if it matters.

 

[youbet]

Employer sponsored MA often offers way more coverage than those sold by celebrities to the general public.

In fact, employer/union sponsored MA plans often offer superior coverage (both benefits and networks) than traditional Medicare.

 

[FargoI]

MA is proper and official Medicare. The policy must, by law, cover everything traditional Medicare covers, without exception. The most notable differences are MA policies may have different networks that are more limited.

MA plans are also notorious for having narrow 'in-network' providers as well as high rates of denial for expense ancillary tests or procedures coupled with a high rate of prior authorizations being denied. Numerous articles on this from independent sources (google search traditional Medicare vs. Medicare advantage).

 

[grayv]

The Vancouver Clinic) do NOT accept traditional medicare or supplement plans.

I thought this was unusual, so I looked at their website. It shows that they take tricare, so I wonder why they don't take regular medicare.

https://www.tvc.org/patients/insurance/

 

[mountainsoft]

It sounds like the Vancouver Clinic must have cut a deal with some of the MA providers. If you are going with them isn't it just a matter of selecting from the 5 they list on their web site? If her doctor is in a different group I would hope they would tell you which plans they'll accept. I may be missing something.

In my mom's case, yes, I would normally just choose one of the other plans they do accept. Unfortunately, mom is running out of money and will be going on Medicaid. That will introduce another level of restrictions as to which plans we can choose. I can't apply for anything until her assets get low enough, so I'm on hold till next month.

 

[mountainsoft]

I saw you are in WA state. Me too. Is this a local thing? My doctor retired and his ex-clinic got swallowed into Optum. I began a search for another doctor in that wasn't Peacehealth. My nurse relative tried to set me up with her clinic and they would not take me because they only take Medicare Advantage plans. No mention of a particular MA plan, just made it sound as if any MA would do. But never Medicare A&B + Supplemental of any flavor. They finally let me in after my relative begged but only because one ARPN agreed to it and only her. I've never had an ARPN for my primary doctor and don't know if it matters.

I'm not sure if it's local or not. Like you, TVC accepts several MA plans, just not regular Medicare/Supplement. That really surprised me. Oh, and PeaceHealth here DOES accept regular medicare, at least at the main hospital. I'm not sure about any of the smaller PeaceHealth offices.

At least in my local area, regular medicare seems more restrictive than the "in network" limitations of MA plans. That's so contradictory to what I've heard about regular Medicare/Supplements.

 

[mountainsoft]

I thought this was unusual, so I looked at their website. It shows that they take tricare, so I wonder why they don't take regular medicare.

https://www.tvc.org/patients/insurance/

The list of accepted providers is much shorter for 2025:

https://www.tvc.org/patients/medicare-advantage/

 

[MichaelB]

I'm not sure if it's local or not. Like you, TVC accepts several MA plans, just not regular Medicare/Supplement. That really surprised me. Oh, and PeaceHealth here DOES accept regular medicare, at least at the main hospital. I'm not sure about any of the smaller PeaceHealth offices.

At least in my local area, regular medicare seems more restrictive than the "in network" limitations of MA plans. That's so contradictory to what I've heard about regular Medicare/Supplements.

Dual eligibility will be beneficial for your DM, it will help pay for the deductibles and drugs. She will likely be subject to a smaller network, but it may not be any smaller than the traditional Medicare network and will be less expensive.

Sorry for the earlier hijack of your thread, but it is relevant. There is way too much misunderstanding and generalization. Medicare Advantage plans cannot be all categorized as “good or bad”.

The coverage provided by the MA plan is exactly the same as a traditional Medicare. The biggest difference is “which providers are in network” and in your case that looks to have limited impact.