Doctors taking Medicare but not Medigap?

[vic120]

Caveat, not an agent
and I don't know what is "right" in this discussion

But I think the thrust of sunny1ib's post is that the providers can't limit themselves to MAPD and refuse to take original Medicare patients.

That is what I was taught the reason why I fought so much when a few clients called after gettiing these letters

But no avail I spoke to several office managers They were not budging nor concerned when this change happened

I had a client call medicare same thing

I had several other agent in the area also confirm this as fact

So I assume I was taught wrong

 

[LostDollar]

Sure they can.

Still a free country. At least for now.

Caveat, not an agent.

An experienced agent posting above suggests otherwise.

It's not an issue of "free country", it is an issue of CMS rules.

I don't know exactly what "enrolled in Medicare" means, but..

If starting in 2019 Medicare providers:
Had to be "enrolled in Medicare" to provide Part C services
and
Accepting new Part C patients is equivalent to "accepting new Medicare patients"
and
Providers "enrolled in Medicare" and "accepting new patients" are required to accept patients enrolled in original Medicare,

Then your assertion may be incorrect. Although they run counter to most Villages comments we have seen here in the past, Sunny1ib's comments suggest that the FL providers saying they will take only the UHC mapd, and not original medicare, are not properly following Medicare rules. (@somarco also presented 1 case that seems to support the idea that they must take original Medicare.)

I think you should wait and hear more comment from @sunny1ib before you dismiss the concept out of hand.

 

[LostDollar]

So I assume I was taught wrong

Caveat, not an agent

Maybe not. Let's wait and see what additional discussion comes along.

 

[sunny1ib]

Hey Chazm - You are correct.

Somarco Sir, I am a cancer survivor too. I am too superstitious to go on a MAPD myself. I will be 5 yrs this July and I still have my port in place.

Lost Dollar, yes Sir. What I got out of my friend from UHC, they cannot stop taking Original Medicare. However, even if they did say they won't take Medicare Part B (the Mayo Clinic in Jacksonville used to NOT participate (THEY DO NOW)), the bill could still be submitted to Medicare and Medicare would review and pay based on their reimbursement rates, then they would submit to the Medigap plan. Sometimes, a client would have to submit to both Medicare and to the Medigap plan. Edit: I failed to mention: the patient would have one heckuva balance bill (extremely nauseating that)!

And as sshafran stated, providers can do whatever they want to do. If they want to exclude taking any specific insurance plan, it is their prerogative as it's a private practice.

I personally did not see and read the provider contract from The Villages, so I cannot attest to what it says. It would seem to me that that the upheaval and potential poor consumer posturing would not be the best of things for an Advantage plan running on an HMO or POS platform, as UHC would want to increase its membership. On top of that, UHC just has something like 78% of the Medigap population in Florida thru the AARP branded plans (is that right Chazm or any other Florida agent)? Kind of odd they would be pitting two divisions against one another, but then again - what do I know.

I will state that a client did call Medicare to complain about the practice because he and his wife did not want to give up their supplement plans. He was advised that if the providers were accepting an Advantage plan, then they should be accepting Original Medicare as well.

 

[goillini52]

That is what I was taught the reason why I fought so much when a few clients called after gettiing these letters

But no avail I spoke to several office managers They were not budging nor concerned when this change happened

I had a client call medicare same thing

I had several other agent in the area also confirm this as fact

So I assume I was taught wrong

You need to have Sunny call them for you.

 

[vic120]

Caveat, not an agent.

An experienced agent posting above suggests otherwise.

It's not an issue of "free country", it is an issue of CMS rules.

I don't know exactly what "enrolled in Medicare" means, but..

If starting in 2019 Medicare providers:
Had to be "enrolled in Medicare" to provide Part C services
and
Accepting new Part C patients is equivalent to "accepting new Medicare patients"
and
Providers "enrolled in Medicare" and "accepting new patients" are required to accept patients enrolled in original Medicare,

Then your assertion may be incorrect. Although they run counter to most Villages comments we have seen here in the past, Sunny1ib's comments suggest that the FL providers saying they will take only the UHC mapd, and not original medicare, are not properly following Medicare rules. (@somarco also presented 1 case that seems to support the idea that they must take original Medicare.)

I think you should wait and hear more comment from @sunny1ib before you dismiss the concept out of hand.

You must misunderstand me I said I was wrong because they are def not taking OG medicare or med supp

 

[vic120]

Hey Chazm - You are correct.

Somarco Sir, I am a cancer survivor too. I am too superstitious to go on a MAPD myself. I will be 5 yrs this July and I still have my port in place.

Lost Dollar, yes Sir. What I got out of my friend from UHC, they cannot stop taking Original Medicare. However, even if they did say they won't take Medicare Part B (the Mayo Clinic in Jacksonville used to NOT participate (THEY DO NOW)), the bill could still be submitted to Medicare and Medicare would review and pay based on their reimbursement rates, then they would submit to the Medigap plan. Sometimes, a client would have to submit to both Medicare and to the Medigap plan. Edit: I failed to mention: the patient would have one heckuva balance bill (extremely nauseating that)!

And as sshafran stated, providers can do whatever they want to do. If they want to exclude taking any specific insurance plan, it is their prerogative as it's a private practice.

I personally did not see and read the provider contract from The Villages, so I cannot attest to what it says. It would seem to me that that the upheaval and potential poor consumer posturing would not be the best of things for an Advantage plan running on an HMO or POS platform as UHC would want to increase the membership. On top of that, UHC just has something like 78% of the Medigap population in Florida thru the AARP branded plans (is that right Chazm or any other Florida agent)? Kind of odd they would be pitting two divisions against one another, but then again - what do I know.

I will state that a client did call Medicare to complain about the practice because he and his wife did not want to give up their supplement plans. He was advised that if the providers were accepting an Advantage plan, then they should be accepting Original Medicare as well.

My clients had AARP med supp plans previously I called the office manager then had clients call medicare, I then called FMO

No budging had to switch To UHC MA plan that was ll they take

 

[vic120]

You need to have Sunny call them for you.

 

[sshafran]

LD - a provider can't be an MAPD provider and have "opt-out" status with Medicare.

But it does not follow that they are required to accept a new patient who has original medicare just because they also accepted a new patient who has an MAPD plan.

https://www.cms.gov/Medicare/Provid...ds/opt-out-decision-matrix-[October-2015].pdf

 

[vic120]

LD - a provider can't be an MAPD provider and have "opt-out" status with Medicare.

But it does not follow that they are required to accept a new patient who has original medicare just because they also accepted a new patient who has an MAPD plan.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/opt-out-decision-matrix-[October-2015].pdf

Except we are not just talking about new patients I had existing patients who had to change

This was I believe around 2015 if I remember correctly

Had several with AARP medsupp's who were clients in the villages for at least 3 years prior to this change and were patients the whole time