does mayo clinic accept medicare assignment

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Does Mayo Clinic accept Medicare?

If you’re struggling to understand Medicare, Connie can help. Ask Connie your question; a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.

Dear Connie,

I am turning 65 and retiring soon. I’ve been going to the Mayo Clinic and want to keep going there. Does Mayo Clinic accept Medicare? If so, which Medicare plan should I be on?

Many thanks, Barbara from Surprise, Arizona

Need Help Deciding The Right Medicare Coverage For You?

Dear Barbara,

Understandably, you would want to visit a hospital for your healthcare needs.

Funded by the Mayo Foundation, the Mayo Clinic is one of the top hospitals in the United States. They practice integrated medicine in which specialists across departments work together to assess your condition and provide the care you need based on your situation and medical history. The Mayo Clinic is also recognized for its treatment of complex medical conditions. Depending on your health needs, Mayo Clinic may be the best fit for you.

Mayo Clinic may accept Medicare patients who have Original Medicare ( Medicare Part A and Medicare Part B ) and Medicare Supplement plans (Medigap) in all their hospitals. Mayo Clinic does not require doctor referrals for patients to receive care services. However, Medicare requires you to have a doctor’s referral to receive treatment at the Mayo Clinic. You may need to fulfill preauthorization requirements before going to the Mayo Clinic. Medicare health insurance is not accepted for primary care services at the Mayo Family Clinic.

Agent tip: “The Mayo Clinic does not accept Medicare Advantage plans. They will still treat you in the event of an emergency if you are enrolled in a Medicare Advantage plan, but they do not provide routine care.“

The Mayo Clinic has contracts with private insurance companies, but they do not accept Medicare Advantage plans. They will still treat you in the event of an emergency if you are enrolled in a Medicare Advantage plan, but they do not provide routine care. Since you indicated you would like to see the Mayo Clinic, a Medicare Supplement plan in Arizona may be the best option.

Connie Health can help you find a Medicare Supplement plan that can allow you to visit the Mayo Clinic. Connie Health has a plan comparison tool that sorts your many plan options. Our technology will compare available plans tailored to your needs – quickly narrowing your choices.

If you’d like help ensuring that you pick a plan that best fits your needs, a local licensed Connie Health agent can help. Call (623) 223-8884 (TTY: 711), and an agent will find a Medicare insurance plan that fits your needs.

At the Mayo Clinic, Medicare typically pays 80% of the cost for covered services after you meet the Part B deductible ($240 for 2024). The Mayo Clinic may give you an Advance Beneficiary Notice to tell you that you may have to pay for a test if Medicare does not cover it. Medicare pays for tests they deem medically necessary to diagnose and treat illnesses and injuries. Mayo Clinic will give you an Advance Beneficiary Notice that will help you decide whether to pay for it yourself or not perform the service.

There are many more ways to take care of your health. Mayo Clinic offers a free e-newsletter with the latest information on health care. The Surprise Senior Center has arts and crafts and fitness activities for you to socialize with others. The Surprise Senior Center offers the SilverSneakers program, an online video workout program free for seniors who have the program as part of their Medicare Advantage plan.

I hope this information has been helpful. Everyone should have access to quality care and the services they need. At Connie Health, we want to guide you to make the best healthcare decisions. We want to help you live a healthier and happier life. I wish you the best. Please call us at (623) 223-8884 with additional questions.

Mayo Clinic Coordination of Benefits (COB) – Patient Guide.

Mayo Clinic and Medicare. 

Last updated: February 27, 2023

Frequently Asked Questions

No. The Mayo Clinic does not accept Medicare Advantage plans.

The Mayo Clinic may accept Medicare patients who have Original Medicare and a Medicare Supplement plan in all their hospitals. They require that you have a doctor’s referral to receive treatment. You may also need to fulfill reauthorization requirements before going to the Mayo Clinic.

Read more by Sammy Menton

I am an Arizona Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I enjoy coaching youth and high school sports, watching sports, and spending time with family. I also like taking road trips and vacationing anywhere that has a beach.

Related Posts

• Visiting Mayo Clinic

Does Mayo Clinic take Medicare?

For those of us who live in the U.S., this is a complicated issue. Whether or not Mayo Clinic takes Medicare comes up frequently. The short answer is yes, Mayo Clinic, on all campuses, does take Medicare. But here is where it gets sticky. It depends on the Medicare Plan you have.

If you have what is sometimes called "Traditional Medicare" then you have Medicare Part A (for hospitalization) and Part B (for outpatient). You also selected another Plan that covers the gap of what Part B does not cover. I have Transamerica Insurance for my Part G supplemental plan. It's very cumbersome however I chose traditional Medicare because it allows me to go anywhere in the U.S. that accepts Medicare. I don't need any prior authorization.

If you chose a Medicare Advantage Plan then you are in a network of hospitals and medical providers and have a managed care plan. You have Medicare Parts A and B but also C (Medicare Advantage Plan) that includes all of your medical services including prescriptions. However, Medicare Advantage Plans have networks so like the type of health care plan you probably had before you retired you have to get prior authorization for some services from your insurance company and you cannot go outside of your network or it will cost you a lot of additional money. Many people go with these Medicare Advantage Plans because the monthly cost is reasonable, it's easy to sign up, and if you live in a large urban area you'll have lots of choices of where you can go. But, if you want to go outside of your network, like Mayo Clinic then you'll have to check to see if your Medicare Advantage plan lets you go to Mayo Clinic.

Confused? It's mind-boggling. I figured all of this out when I signed up for Medicare shortly before I retired.

If you want to know if Mayo Clinic takes your Medicare Plan, you can call the business office at any campus and explain what kind of insurance coverage you have. They will help. I have experienced THE best service when I've contacted Mayo Clinic for insurance and billing questions. https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/contact-us

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Interested in more discussions like this? Go to the Visiting Mayo Clinic Support Group.

Has anyone been fortunate to get into Mayo Family practice/ Internal Medicine if you have traditional Medicare? I would love to transition all my care to an integrated system like Mayo with one complete medical record. Thoughts?

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Nicom, Yes my wife and I patients since 2006. We were originally in a special program called Medallion Program with a traditional insurance program. When we voluntary came out of that program we were over 65 and went into Primary Care and under Medicare and my secondary payer plan. Each Mayo Clinic has it's own policies on number of Medicare patients.

Mayo Jacksonville (and the only one I can comment on) did take my wife and I under Medicare. Some of my friends who are on Medicare tried to get into Mayo but could not.

Mayo's like other specialty hospitals are classified under Medicare as specialty providers. Medicare allows them to charge more and thus be paid more as a result. There is a drastic reduction in what a provider has to agree as approved charge under Medicare. And I mean drastic. I can see why Medicare is restricted. I would like to see Medicare pay more as again it is a drastic reduction in what amount a provider has to accept and what they agree to accept under medicare assignment.

I read a post about Medicare Advantage being linked to Medicare Assignment and are very different. When Mayo accepts Medicare (not Medicare advantage) they are agreeing to medicare assignment. Which means they agree to accept the approved amount for the service provided.

Try and if don't make it asked to be put on waiting lists. If you make it I would suggest a secondary Medicare supplement plan to help pay the deductibles and co-pays under medicare.

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Here follows my understanding of Mayo+Medicare: In 2015, Mayo AZ, did not "accept Medicare assignment". This meant that Mayo was able to charge patients 15% more than the Medicare Part B approved charges. However, this meant Mayo billed the patient and the patient submitted a claim to an insurer. If the patient had a medigap supplement F or G, the entire bill was paid after deductible. If the patient had, eg, medigap N, the patient had to kick in the 15%. If the patient had an 'advantage plan' (Part C), the bill may not have been covered - the patient was potentially responsible for the entire bill.

Now, Mayo is sending out this notice about Advantage plans which states that it "accepts" traditional Medicare. This is a bit ambiguous, unfortunately. The phrase "accept Medicare assignment" is the term of art that means: the provider will bill Medicare directly and accept the Medicare approved reimbursement as payment in full (ie, will not charge the 15% Part B excess). Of course the patient is responsible for any part of the Medicare approved reimbursement not covered by Medicare+medigap supplement, eg, deductibles, copays, etc.

The government site medicareDOTgov (as a newly joined poster, this site prevents my including links) indicates that Mayo AZ does indeed "accept Medicare assignment". This is good to know because it means cheaper medigap supplements like N cover all Mayo charges: eg, in my location medigap G is about 35% more than N.

It would be great if Mayo would confirm my understanding. Unfortunately, a call to the customer service line rings & rings after wading through the menu.

I received this useful response from Mayo's Katelin T in account services:

"Hello Mark,

Thank you for contacting Mayo Clinic Patient Account Services. We apologize for the delay in responding to your message.

It is true, a few years ago Mayo Clinic Arizona started accepting Medicare B's assignment and no longer charges the additional 15%. This would be true for all 4 specific departments you listed and all of Mayo Clinic Arizona."

In Mayo Clinic Jacksonville: If you are looking for an Internal Medicine or Family Physician doctor as a new patient with Medicare they don’t accept you. The other specialists do as well but it depends which Medicare you have. I have Medicare (A&B) & never had problems. We have been patients of Mayo since 2009 and there was no chance for me to get an Internal or Family physician there. Medicare doesn’t pay too much to these doctors. So I had to get a physician outside Mayo Clinic. The schedulers in Mayo told me that they could add my name to a 2-yr waiting list to get one Physician. Ridiculous! Also even Mayo is good every time you ask for an appointment with a specialist they schedule you with a Nurse practitioner. Seldom you can see the specialist. I am a RN so I am not going to tell another nurse what is my health issue, I know what it is. She takes notes and asks the same question I want to ask the specialist and then the NP say: “I will pass this on to the specialist so he/she checks what is going on and I will call you.” Well…the NP is just a messenger. Waste of money. I wish Mayo Clinic would stop hiring so many NP. It is not goid for the patients.

Sorry you feel that way re NP’s. I think that some of best practitioners are NP’s. I won’t bore folks with the examples but will comment that I have been an RN since 1966…am Master’s prepared…taught for 20 years and practiced in NY, Chicago, Michigan and for past decades in Wisconsin. Worked in Psych, Public Heath, Med Surg,Gynecology, private duty, nursing homes, home health, school nursing,occupational health,burn units,doctor’s offices in allergy and industrial settings, and Hospice was on Wisconsin Nursing Exam Council for 8 years. Needless to say, I am very critical re who is providing my…and family’s …care. I …and family…and friends go to NP’s and are getting highest level of care.

tdrell, I am not familiar with post on NP's.

But want to pass on to you I am a patient at Mayo Jacksonville since 2006. I see a lot of NP and Advanced NP. I have a great dermatologist APN and same for ENT APN. And also at EP.

What I see is any question or concern they get concurrence with MD of that section.

I am very happy with my APCN I am not sure of the correct name but is something like Advanced Practice Care Nurse which means went through an additional training and can also prescribe medications. Mine are fantastic. I know in ENT almost all the MDs are surgeons and thus doing surgeries and very limited patients.

You should be aware of this info : my husband has NSCLC I requested info about getting a 2nd opinion from the Mayo Clinic. I have an HMO advantage plan. The representative of the Mayo Clinic that I had the luck of the draw to speak to said, we are not contracted with your HMO. I understand that. I then asked what about if I self pay, her answer was , because we are not contracted with your insurance the federal government does not allow us to offer that. Hmmm? I cannot find a federal law that says that anywhere! What if I didn't have insurance , is there a federal law that doesn’t allow them to offer self pay to me then either!? To top all this off, when I requested the procedure of my insurance to request the second opinion with Mayo, my carriers insurance representative told me, I will check for you, but the Mayo Clinic is not accepting any patients from our insurance plan. I asked why would that be? He said, and I am not kidding, I’m not sure, I think they don’t like working with our insurance??!! Oh my goodness! Really!?! Presbyterian senior plan needs to be aware of his response!!!

I called the Mayo clinic today and still was denied scheduling an appointment, however , the woman said because they are contracted with Medicare we cannot offer self pay to you with an advantage plan. I guess that's the federal law the first woman was trying to tell me. I said what if I was uninsured, or insured and didn't want to use my insurance and wanted to self pay? Her answer to that was, we would know by your age that you would have some kind of coverage and they only accepted Medicare. If they couldn't pull up our information under Medicare they would know we had an advantage plan , and they only have a contract with Medicare. The woman kept talking to me like I was kindergartner! I kept telling her that I understood what she was saying. What I could not understand is why they would turn away a patient, a patient that was willing to pay out of pocket. Why are they turning away money?? ,

@raygregvic This isn't a problem just at Mayo; you'll run into this anywhere at providers who are not in your insurance network. They have to accept lower payments from Medicare. Medicare has a deductible and once that is met, the patient no longer pays out of pocket when there is a Medigap plan. Medicare determines what the acceptable fees are, and usually these are lower than with private insurance. The Medigap plans cover what Medicare doesn't. Medicare "advantage" plans promise all kind of perks to get people to sign up for them, but they are not as widely accepted as real Medicare. My PT has told me that the "advantage" insurance scrutinizes everything they pay for, even years later, and then can come back to providers and can take the money back. The providers waste excessive administrative time providing records and then are stuck working for free and can't pay their operating costs. I do not blame providers for not wanting to accept these plans. HMO plans dictate that they will only pay for providers in their network and they control your choices. The plan that is portable to every state is real Medicare. It might be worth considering changing to real Medicare next time during the enrollment time. I'm sorry it didn't work out for you. I had a friend who was seen at Mayo and had surgery scheduled, and then the "advantage" plan would not pay for surgery and they picked out a surgeon somewhere else and told the patient that is all they would cover. She had no choice what so ever. She has switched to real medicare now. Before I chose my Medigap plan to go with Medicare, I called Mayo billing to know what plans they accept.

I have original Medicare (Part A,B) and I am at Mayo Rochester. For my lung cancer, I was called by the actual Pulmonologist (not scheduling) within hours of receiving my scans and was offered a next day appointment - I have something complex. However, while I live in Minnesota, I live two hours away from Rochester so I am not eligible to have a primary care doctor at Mayo. Mayo explained to me that this was because the people who do live close by would not be able to have primary care doctor if people farther away were given access. This is logical, and for small things or in an emergency I do not want to drive 2 hours especially in the winter!

Sorry in advance-- this post turned into a vent about the so-called "Advantage" plans.

The "Advantage" plans come with many disadvantages. The biggest one is that you have to commit to using the doctors and facilities in their network.

It is not Mayo Clinic's fault that you have chosen a network that does not include them. That's why your Advantage plan is less expensive-- it doesn't include all of the best facilities in the USA or even all of the ones in your area.

The "Advantage" plans are good only IF you are not sick now and IF you never, ever get really sick. Most of us at some point before we die will get really sick.

Personally, I think the "Advantage" plans should be outlawed. Their marketing is slick. They don't tell outright lies, but they lie by omission, by not telling you that you can't go out of network, for example. And the "certified insurance consultants" that you can call for advice are NOT impartial. They only represent certain companies in your area. They don't have to tell you all of your options. They lure you in with bells and whistles (free gym membership!), and then can deny payment for the tests that your doctor says you need.

You give the insurance company a lot of control over your health care when you sign up for an "Advantage" plan.

By federal law, every state government must provide free Medicare counseling. In my state, the county government is responsible. I called my local library, and they gave me the contact information. The county medicare counselors were very, very helpful, and they are completely impartial since they are not paid by the insurance companies.

Good luck and health to us all.

U my friend absolutely right, I agree 💯 that these Advantages plans should be outlawed. It is so sad that they take ADVANTAGE of folks. no pun intended. It’s so frustrating how the system works especially for TP patients.

Agree with your comments on NP. And Mayo also uses them or PAs. For my cancer, I have always been seen by my Pulmonologist, and Radiation Oncologist. I had meetings with surgeon also.

Mayo is a teaching and research institution. So, one can expect to see Interns and Resident doctors. Outside my cancer doctors, in other specialty areas I have found that either a resident/Intern or a PA/NP comes in first to collect information. Then the supervising Mayo on staff doctor comes in and goes over things. This happened with my Cardiac stent both for the first time and a new issue 18 months later. (I did my stent at Mayo to assure good communications between specialists since it would impact my cancer treatments. ) For Endocrinologist, I saw first an Intern and then the Mayo staff doctor. However, in Gastroenterology they set up evaluations with Nurse and Intern doctor.

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Does Mayo Clinic accept Medicare?

Does mayo clinic accept medicare? Discover Medicare coverage, billing, and navigating acceptance at Mayo Clinic for peace of mind in receiving necessary care.

Hospital services

Your Mayo Clinic medical claims will be filed if you are in hospital, and you will receive a Medicare Summary Notice while processing your claim.

Health clinic services

Regardless of whether or not they participate with Medicare Part B, all Mayo Clinic locations will be billed by Medicare for all services rendered. Claims will be made to Medicare Part B and supplementary or secondary insurance companies on your behalf. In some instances, you may get Part B and supplemental or secondary insurance payments directly. However, this means that patients are responsible for reimbursing Mayo Clinic for any expenses they receive and unpaid balances.

Medicare assignment

In accordance with federal regulations, it is necessary for the medical centre to support Medicare assignments for certain services (for example, clinical laboratory, drugs, and biologicals).

Medicare supplemental insurance crossover

If your claims did not transfer over from Medicare to your additional or Medigap insurance, please contact the agency that administers your supplemental or Medigap insurance.

Medicare patients must complete an Advanced Beneficiary Notice (ABN) which discusses payment restrictions and estimates medical costs before receiving specific services. Signing the ABN conveys financial liability if Medicare denies payment. Eye exams, foot care, hearing aids, preventive care, and elective treatments are free from the ABN requirement however, individuals are responsible for all non-covered services.

You can call 800-633-4227 for non-covered service and item questions (toll-free).

Medicare plans

Privately contracted Medicare Advantage plans cover all of your Medicare Part A and Part B benefits. Generally, Medicare Advantage plans provide prescription drug coverage, too and Medicare Advantage plans fall into five broad categories;

• Cost-based,
• Medicare Medical Savings Account.

Out-of-network plans mean higher out-of-pocket expenditures. Typically, Medicare Advantage plans to process the same as Medicare and Mayo Clinic campuses have restricted specific Medicare Advantage options.

• Mayo Clinic’s Arizona campus: All Medicare Advantage Plans except PPO/Cost share/HCPP contracts may not be seen, and self-pay patients are not eligible.
• The Mayo Clinic in Florida : Medicare Advantage HMO patients without authorization will not be seen and they do not allow self-pay patients.
• Rochester, Minnesota’s Mayo Clinic campus : Medicare Advantage HMO plans without authorization may not be seen by patients and they cannot examine patients on a self-pay basis.

You must obtain authorization from your health insurer before scheduling visits at the Mayo Clinic.

The Mayo Clinic’s campuses in Arizona and Florida have refused to work with non-contracted Medicare Advantage plans due to administrative and financial difficulties. Please see your Medicare Advantage plan for a list of in-network doctors.

Decisions by Medicare on reimbursement

To dispute a Medicare denial, please call Mayo Clinic’s Patient Account Services.

• 800-660-4582 (toll-free)
• Arizona: 480-301-7033
• Florida: 904-953-7058
• Rochester, Minnesota: 507-266-5670

You can appeal a disallowed charge if the notice under “Appeals Information” on the last page of your Medicare Summary Notice tells you how to do so. Within six months of receiving notice of refusal, an appeal must be made with the appropriate administrative law judge. Generally, the Mayo Clinic is unable to advocate on your behalf on Medicare non-assigned services.

You will continue to receive monthly statements until your account is paid in full, and patients must apply for public medical assistance (Medicaid).

Bundled Payments for Care Improvement program

Mayo Clinic is helping implement the Bundled Payments for Care Improvement Advanced Model, although the program is only now in effect, and all affected patients were contacted for feedback, you wouldn’t be eligible to receive care in a participating region if you did not receive a letter.

Our mission is to provide high-value and high-quality care.

• Visit the CMS BPCI Advanced Website at http://www.innovation.cms.gov/initiatives/bpci-advanced .
• Mayo Clinic Patient Account Services 1-844-217-9591
• Call 1-800-MEDICARE-1 (1-800-663-4227). For TTY callers, contact 1-877-486-2048

Additional Information about Medicare

To learn more about Medicare, see our website NewMedicare.com . You can also inquire about your Arizona Medicare Part B claims for health services by calling Medicare at 800-633-4227. (Toll-free).

About Danny Carington

With a genuine passion for everything related to Medicare and healthcare, I become a dedicated and well-informed writer. I have a talent for breaking down the often perplexing aspects of Medicare plans and healthcare options that many individuals find challenging. Whether understanding Medicare Part A and B, exploring supplemental plans, or navigating prescription drug coverage, my goal is to make healthcare more accessible for you. In terms of research, I go beyond the surface. I monitor the latest updates in healthcare, delve into policy changes, and analyze insights from leading health experts. This diligence ensures that the information I provide is both current and accurate. Please note I'm AI-Danny, a writer powered by artificial intelligence. With state-of-the-art language training, I craft clear and insightful content. Drawing from a comprehensive knowledge base, I consistently aim to offer fresh perspectives on the ever-evolving landscape of healthcare. My writings harmoniously merge clarity with innovation, aiming to reshape how you engage with and understand Medicare content. But to me, writing isn't just about delivering facts. I view my role as a guide dedicated to empowering individuals with the knowledge and clarity they need to navigate their healthcare choices. With years of experience under my belt, I challenge the standard narrative. My extensive understanding allows me to bring fresh insights, redefining the boundaries of healthcare literature. Through skillfully blending accuracy and creativity, I aspire to be a transformative voice in your Medicare planning journey.

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