Mayo Clinic has begun notifying hundreds of patients enrolled in specific Medicare Advantage plans that they may need to change their health insurance to continue receiving care at the renowned medical center in Rochester, Minnesota. This change is set to take effect in 2025 and will impact fewer than 2,000 patients nationally, including fewer than 600 in Minnesota.
In letters sent this week, the clinic informed seniors that those with Medicare Advantage plans lacking network contracts will only be able to schedule appointments for 2025 if they secure new coverage that includes Mayo as an in-network provider. Patients can still utilize original Medicare for care at Mayo, although this may lead to significantly higher costs. The open enrollment period for Medicare starts on October 15.
Mayo Clinic reassured patients in a statement to the Minnesota Star Tribune, saying, “A substantial part of the care we provide every day will continue to be in service to patients who have Medicare.” The clinic emphasized that it is currently out-of-network for certain Medicare Advantage plans. Patients are encouraged to verify their access to Mayo during the open enrollment period.
Mayo will consider exceptions for seniors with rare conditions that require specialized treatments available at the clinic.
Many patients have expressed their frustration with this change. Mark Giorgini, 68, from Mendota Heights, stated that he has just started exploring his options and fears that switching to different coverage could be expensive. “I’m really disappointed by it,” he said. “It will have a significant impact on me.”
This announcement comes just before the Medicare open enrollment season, during which many Minnesota seniors may face disruptions as health systems reevaluate their network agreements with Medicare Advantage plans. While Mayo’s network status remains unchanged for various plans, the new policy will affect how appointments are scheduled for established patients covered by noncontract Medicare Advantage plans.
Among the Medicare Advantage plans operating in Minnesota, Blue Cross and Blue Shield, Humana, Medica, UCare, and UnitedHealthcare have confirmed that Mayo is in-network. In contrast, HealthPartners, Quartz, and Sanford Health Plan list Mayo as out-of-network. Allina Health Aetna did not immediately respond to requests for comment.
To assist patients in checking their insurance options, Mayo provided its tax ID number for operations in Rochester. “Each plan, even under the same insurer, has nuances in coverage,” the clinic noted. “It’s best for patients to check the specific plan they are interested in with our tax ID information to ensure the coverage will meet their needs.”
Medicare Advantage is becoming increasingly popular among seniors, allowing them to receive government-sponsored benefits through private managed care insurers. These plans often feature low premiums—sometimes as low as $0 per month—and additional benefits like dental and vision coverage. However, original Medicare may result in high co-insurance payments.
Many individuals with original Medicare opt for Medicare Supplement policies to cover costs not paid by the government program. These supplemental policies generally have higher premiums than Medicare Advantage plans, especially if seniors also purchase standalone Part D drug coverage, which is often included in lower-premium Medicare Advantage plans. While Medicare Supplements offer access to a broader range of healthcare providers nationwide, Medicare Advantage plans tend to have more restrictive networks.
In 2022, Mayo Clinic started enforcing a policy that prohibited scheduling appointments for new Medicare Advantage patients without contracts. This decision stemmed from rising demand from UnitedHealthcare Medicare Advantage patients using out-of-network benefits. An agreement was later reached between Mayo and UnitedHealthcare to maintain an in-network status.
The upcoming change will affect seniors who have received care at Mayo prior to 2022. According to the clinic, demand for appointments from patients with noncontract plans is hindering the availability of services for patients covered by negotiated in-network contracts.
“No one that we sent a letter to is being cut off from Mayo Clinic care,” a clinic official stated. “They have the opportunity to explore options that fit their needs.”
However, some patients remain skeptical. Giorgini has a Medicare Advantage plan from Aetna that is subsidized by his former employer. Switching plans could mean losing that subsidy. Although he could consider original Medicare, he is concerned about finding a Medicare Supplement policy due to potential pre-existing condition exclusions.
“If you’re going to Mayo, you essentially have a pre-existing condition, and supplemental plans can deny you,” he explained. “That leaves you on original Medicare with the typical gaps that [Medicare Supplement] plans usually cover.”
Geographic factors could also complicate matters. While Minnesota seniors have several Medicare Advantage plans with Mayo in-network, options in other states may be limited.
“Medicare Advantage plans are very complex and can be confusing,” the clinic stated. “We provided information to our patients on how they can work with their insurers to select an option that works best for them and ensures they can continue receiving care at Mayo Clinic.”
Related topics:
