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Old 04-09-2016, 03:59 PM
 
Location: Ponte Vedra Beach FL
14,617 posts, read 21,399,889 times
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Quote:
Originally Posted by Travelassie View Post
Ok, you're in a concierge practice, I will ask you. Does your PCP or other docs you may see in that practice take your Medicare or other insurance as at least partial payment for services, or do they not take third party payments at all and you have to pay out of pocket for any services from them? Just wondering how that worked.
Our only out-of-pocket apart from the concierge fee is for things Medicare doesn't cover. Mostly some small lab charges (which don't make much rhyme or reason to me). Which anyone on Medicare would pay anywhere. Our Medigap policies (my husband has discontinued plan J and I have plan F) - pick up everything else - including the Mayo "excess Medicare charges".

One thing I recommend these days is for people who are new to Medicare or in a position to change if currently on Medicare is to get a Medigap plan like plan F. Because I think the "bumper to bumper" coverage you get with it will disappear as an option in the next few years. It's always easier to "trade down" than "trade up". Robyn

P.S. We pay about $180/month for our Medigap policies here in NE Florida. I understand they might cost as much as 40% more where you live in south Florida. Not sure.
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Old 04-09-2016, 05:38 PM
 
216 posts, read 371,556 times
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Quote:
Originally Posted by baileyvpotter View Post
One Medical has only seven locations in the states, all of which are in large cities. Another
observation is that most of the doctors who saw patients were very young, few accepted new
patients and the others were "virtual only."
I have switched doctors a few different times at two different locations in NYC and never had an issue with selecting a new primary.
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Old 04-10-2016, 05:06 AM
 
4,899 posts, read 6,190,243 times
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^^^You would have more options and choices since you're in NYC!
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Old 04-10-2016, 07:26 AM
 
Location: SW Florida
14,852 posts, read 11,986,213 times
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Quote:
Originally Posted by reed303 View Post
Re Medicare & "concierge" providers, Medicare has explanatory information at https://www.medicare.gov/coverage/concierge-care.html

Basically says you pay any concierge fee out of pocket, and all the normal rules apply re "accepting assignment" or "participating". (Assuming they take Medicare patients at all)
Thanks for the links. Seems that Medicare doesn't pay concierge fees, those are out of pocket. As for what it might cover, it depends on whether or not the doctor accepts Medicare payments. I don't see too many concierge providers accepting Medicare assignment, but some could be Medicare providers.
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Old 04-10-2016, 07:55 AM
 
Location: SW Florida
14,852 posts, read 11,986,213 times
Reputation: 24631
Quote:
Originally Posted by Robyn55 View Post
Our only out-of-pocket apart from the concierge fee is for things Medicare doesn't cover. Mostly some small lab charges (which don't make much rhyme or reason to me). Which anyone on Medicare would pay anywhere. Our Medigap policies (my husband has discontinued plan J and I have plan F) - pick up everything else - including the Mayo "excess Medicare charges".

One thing I recommend these days is for people who are new to Medicare or in a position to change if currently on Medicare is to get a Medigap plan like plan F. Because I think the "bumper to bumper" coverage you get with it will disappear as an option in the next few years. It's always easier to "trade down" than "trade up". Robyn

P.S. We pay about $180/month for our Medigap policies here in NE Florida. I understand they might cost as much as 40% more where you live in south Florida. Not sure.
I'm guessing those lab fees would be from non-Medicare participating providers ( as in perhaps Mayo-associated clinical labs that your docs prefer to use?) Or providers that accept Medicare payments but not Medicare assignment.

It's great that your Medicare/Medigap policies do a decent job of covering your out of pocket costs for medical care, and I'd agree with you about the Medigap plan F policies. I think the costs of Medigap policies depend on where the policyholder is located in the state, and for most insurance companies, the age of the policyholder. Could be it also depends on the prior medical history of the policyholder when he/she applies for the policy, although I'm not sure about that, but they do ask about things like smoking, and general medical history on the applications.

$180 a month sounds pretty reasonable for plan F Medigaps, I priced a number of those policies for my mother a couple years ago when I was finally successful in convincing her she was paying too much for the plan she had- it was with Mutual of Omaha and she was paying somewhere in the range of $350-375/month for that coverage. She wanted a plan F and we looked at several companies, and ended up with a BC/BS of FL policy and I think at age 89 the cost for that policy is $270 a month or something in that range. This is in SW Florida. It's gone up about $10 a month each year that she's had the policy, and that's due to her age.

Makes me realize what a good deal my husband and I have with our Medicare and the secondary insurance provided by the federal employees BC/BS ( he's a retired federal employee). The BCBS policy is a continuation of the insurance we had when he was working with the VA, and the premiums are the same as for current employees. Currently we're paying about $510/monthly for "Self Plus One" coverage for both of us, so I figure that's not much different than you'd pay for some Medigap Plan F policies ( $255/month each), and it includes a prescription drug plan. They also tell us that in the event we needed medical services not covered by Medicare, this secondary plan would kick in and pay for those services according to the terms of their contract for federal employees ( copays and deductibles would apply), so that's some peace of mind when you think about it. The only out of pocket expenses we have with this besides the premiums, are the prescription copays, and I'm facing the need for a couple rather pricey drugs so that's a big help. And the insurance is good anywhere we go.
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Old 04-10-2016, 12:44 PM
 
Location: Wisconsin
25,597 posts, read 56,289,029 times
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Quote:
Originally Posted by Travelassie View Post
I'm guessing those lab fees would be from non-Medicare participating providers ( as in perhaps Mayo-associated clinical labs that your docs prefer to use?) Or providers that accept Medicare payments but not Medicare assignment.
Robyn's policy covers charges for any Medicare provider. There are two types of these:
  • participating - accepts assignment and the Medicare fee schedule allowed charge;
  • nonparticipating - does not accept assignment so Medicare allows that provider to charge 15% above 95% of the fee schedule (allowed) charge - effectively 9.2% higher than the Medicare allowed charge. Medicare then pays 80% of the lower 95%, the supplement (G/F) pays the rest.
Fees not covered by Medicare and supplement for either a participating or nonparticipating Medicare provider are typically for a service not covered such as (a) either the test has been performed too frequently as in Medicare will pay for this test once a year, not once a month, or (b) it is not a covered service at all.

Quote:
Originally Posted by Travelassie View Post
Could be it also depends on the prior medical history of the policyholder when he/she applies for the policy, although I'm not sure about that, but they do ask about things like smoking, and general medical history on the applications.
Health only matters if one is applying for a Medigap outside their Initial Open Enrollment or Special Enrollment Period (such as when one moves). Some states like NY are also guaranteed issue states so one can never be denied or charged more because of health no matter when one applies. Only a few states are GI, however.

Quote:
Originally Posted by Travelassie View Post
$180 a month sounds pretty reasonable for plan F Medigaps, I priced a number of those policies for my mother a couple years ago when I was finally successful in convincing her she was paying too much for the plan she had- it was with Mutual of Omaha and she was paying somewhere in the range of $350-375/month for that coverage. She wanted a plan F and we looked at several companies, and ended up with a BC/BS of FL policy and I think at age 89 the cost for that policy is $270 a month or something in that range. This is in SW Florida. It's gone up about $10 a month each year that she's had the policy, and that's due to her age.
Robyn isn't 70 yet, so her premium is lower. Pricing method of the policy matters - and age can affect the premium depending on the company and the state. In Robyn's case, UHC in FL uses issue-age pricing which is somewhat higher than community but lower than attained-age. In WI, UHC is community-rated and provides discounts for younger enrollees:

https://www.medicare.gov/find-a-plan...-policies.aspx

Quote:
Originally Posted by Travelassie View Post
Makes me realize what a good deal my husband and I have with our Medicare and the secondary insurance provided by the federal employees BC/BS ( he's a retired federal employee). The BCBS policy is a continuation of the insurance we had when he was working with the VA, and the premiums are the same as for current employees. Currently we're paying about $510/monthly for "Self Plus One" coverage for both of us, so I figure that's not much different than you'd pay for some Medigap Plan F policies ( $255/month each), and it includes a prescription drug plan. They also tell us that in the event we needed medical services not covered by Medicare, this secondary plan would kick in and pay for those services according to the terms of their contract for federal employees ( copays and deductibles would apply), so that's some peace of mind when you think about it. The only out of pocket expenses we have with this besides the premiums, are the prescription copays, and I'm facing the need for a couple rather pricey drugs so that's a big help. And the insurance is good anywhere we go.
Yes, generally employee-retiree plans are preferable to a Medigap/supplement for exactly this reason.
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Old 04-10-2016, 06:06 PM
 
Location: Ponte Vedra Beach FL
14,617 posts, read 21,399,889 times
Reputation: 6794
Quote:
Originally Posted by Travelassie View Post
Thanks for the links. Seems that Medicare doesn't pay concierge fees, those are out of pocket. As for what it might cover, it depends on whether or not the doctor accepts Medicare payments. I don't see too many concierge providers accepting Medicare assignment, but some could be Medicare providers.
Down in south Florida - where we still have friends - a lot of concierge doctors won't deal with Medicare or insurance at all. Up here in NE Florida - Mayo will still deal with many private insurance plans and Medicare.

I don't know of any doctors anywhere in Florida these days who accept "Medicare assignment". Which means accepting what Medicare pays - and not requiring patients to pay co-pays/deductibles in some way/shape/form (either out of pocket or through a Medigap policy). That stuff pretty much disappeared in most of Florida years ago. Robyn
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Old 04-10-2016, 06:22 PM
 
Location: Ponte Vedra Beach FL
14,617 posts, read 21,399,889 times
Reputation: 6794
Quote:
Originally Posted by Travelassie View Post
I'm guessing those lab fees would be from non-Medicare participating providers ( as in perhaps Mayo-associated clinical labs that your docs prefer to use?) Or providers that accept Medicare payments but not Medicare assignment.

It's great that your Medicare/Medigap policies do a decent job of covering your out of pocket costs for medical care, and I'd agree with you about the Medigap plan F policies. I think the costs of Medigap policies depend on where the policyholder is located in the state, and for most insurance companies, the age of the policyholder. Could be it also depends on the prior medical history of the policyholder when he/she applies for the policy, although I'm not sure about that, but they do ask about things like smoking, and general medical history on the applications.

$180 a month sounds pretty reasonable for plan F Medigaps, I priced a number of those policies for my mother a couple years ago when I was finally successful in convincing her she was paying too much for the plan she had- it was with Mutual of Omaha and she was paying somewhere in the range of $350-375/month for that coverage. She wanted a plan F and we looked at several companies, and ended up with a BC/BS of FL policy and I think at age 89 the cost for that policy is $270 a month or something in that range. This is in SW Florida. It's gone up about $10 a month each year that she's had the policy, and that's due to her age.

Makes me realize what a good deal my husband and I have with our Medicare and the secondary insurance provided by the federal employees BC/BS ( he's a retired federal employee). The BCBS policy is a continuation of the insurance we had when he was working with the VA, and the premiums are the same as for current employees. Currently we're paying about $510/monthly for "Self Plus One" coverage for both of us, so I figure that's not much different than you'd pay for some Medigap Plan F policies ( $255/month each), and it includes a prescription drug plan. They also tell us that in the event we needed medical services not covered by Medicare, this secondary plan would kick in and pay for those services according to the terms of their contract for federal employees ( copays and deductibles would apply), so that's some peace of mind when you think about it. The only out of pocket expenses we have with this besides the premiums, are the prescription copays, and I'm facing the need for a couple rather pricey drugs so that's a big help. And the insurance is good anywhere we go.
No - the lab fees don't have anything to do with the nature of the provider. It's just that Medicare sometimes doesn't cover X/Y/Z. For no reason that seems particularly rational to me. Like Medicare doesn't cover some vitamin deficiency tests my PCP orders from time to time. Still - on my part - I'm talking $5 here and $7 there. Not a big deal.

There are 3 regional Medigap policy rates in Florida (at least when it comes to our UHC AARP policy). South Florida - north Florida - and a small part of the Panhandle (in order of most to least expensive). South Florida is on the order of 40% more expensive than north Florida (the rural Panhandle rate is even cheaper than north Florida - but who lives in Hamilton County?).

Can't even start to evaluate the medical stuff you have. It's hard enough to evaluate what I have! Robyn
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Old 04-10-2016, 06:33 PM
 
Location: Ponte Vedra Beach FL
14,617 posts, read 21,399,889 times
Reputation: 6794
Quote:
Originally Posted by Ariadne22 View Post
...Robyn isn't 70 yet, so her premium is lower. Pricing method of the policy matters - and age can affect the premium depending on the company and the state. In Robyn's case, UHC in FL uses issue-age pricing which is somewhat higher than community but lower than attained-age...
I really don't understand all the fine print when it comes to pricing. I pay more than my husband does - even though he's older than I am. Because I'm a smoker - and he isn't.

My father switched from a very ancient non-standardized Medigap policy to a plan F policy last year - when he was 96. And is currently paying about $20 more than he was paying in the past - about $265/month. I think we're all getting our money's worth out of our Medigap policies. Robyn
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Old 04-10-2016, 06:34 PM
 
Location: State of Transition
102,075 posts, read 107,068,415 times
Reputation: 115874
Quote:
Originally Posted by PhxBarb View Post
Yesterday I got a letter in the mail from my beloved family care doc, who said he is going to "limit" his practice, reduce his patients and only accept those who sign up for his VIP service. First come, first served. Then a wait list. I don't know what the yearly fee will be, but regardless, I am not paying it. He has been my Medicare doc for a while, although I usually see his PA because it's faster. He also saw my 102 year old Mom, and she was the oldest patient he ever had, he said.

Yes, I like him alot. And I think he likes me also. He says he will be more involved with each patient, take more time with them, and will be a better doctor this way. I am appalled at this decision. This seems to be a way to make more money, not offer a better practice. I have already been satisfied with my experience. And I do not need another bill. Maybe he wants to weed out the Medicare Advantage plan patients, don't know.

So, good bye fine doctor. I guess you will have enough people signing up, but I won't be one of them.
That's what they're supposed to do, anyway. I've found that this varies a lot by state. In some states, certain insurance companies reimburse horribly, so that doctors have to book 5 patients for the same half hour. (How they explain this to insurance, I have no idea.) In other states, docs are able to give each patient their full 15 mins or half hour, giving the patient their full attention.


It seems to me doctors shouldn't be charging Medicare patients and extra fee. Is that even legal, or ethical?
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