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Adding Concierge Care to my Medicare and Medicare Advantage Supplement

Conan

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We're both on Medicare.

In 2020 we'll be paying Medicare Part B premiums of 2 * $144.60 = $289.20/month ($3,470/year) [not counting IRMAA tax that we also have to pay this year].

And we'll be paying Medicare Advantage Supplement premiums (which include the cost of Part D coverage, again not counting IRMAA tax) of $103.01 (partially subsidized by a former employer) + $174.31 (for the spouse) = 277.32/month ($3,328/year).

Plus $1,200 for dental insurance for two.

Those add up to $8,000/year for two, plus IRMAA tax. Our out-of-pocket for medical care is essentially zero (until we add concierge benefits described below). Out-of-pocket for prescription drugs will cost about $1,500/year for two. Dental out-of-pocket will be around $2,500 based on past experience. So our total healthcare budget for 2020 is $12,000 plus IRMAA taxes plus the concierge.

The medical climate in our state has changed radically in the last few years. Five hospitals in our area are affiliated into a single operation, now the third-largest employer in the state, and the same operator has rolled up 1,000 or so individual physicians into its multi specialty group clinic. Our primary physician was one of those rolled up, and he lasted a year before retiring. Our next primary physician, a different practice but again one of the 1,000, just announced that he's retiring too. After some looking, we found a third physician who is not currently among the 1,000 and who is open to new patients.

The new physician offers an optional concierge service, and we interviewed the doctor about one of us signing on to it. Basically, if you're not in the concierge program, you're likely to wait longer for an appointment and more often than not you'll be seeing a physician's assistant. With the concierge program you can reach the doctor day and night (via text to your doctor's cellphone), same-day appointments are the norm, and you'll always see the doctor in person who will give you all the time you need. Medicare and insurance coverage remains the same, and one of us will pay a flat $2,500 per year for concierge privileges.

On the scale of things this looks like money well spent. What do you-all think?
 

Janann

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one of us will pay a flat $2,500 per year for concierge privileges.

On the scale of things this looks like money well spent. What do you-all think?

It just depends on what you need and want from your healthcare services. I've never had the need to contact my doctor at 3 a.m., and I've never had the need to see my doctor on the same day while avoiding the physician's assistant. Whether it is money well spent just depends on your personal health issues and the importance of seeing the same health care provider (your doctor) every time.
 

bogey21

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You have proven the obvious. Medicare is no free lunch. Personally I wouldn't spend the $2,500 for concierge privileges. But then I always get to see my PCP whenever I have an appointment. She also answers emails promptly. If I have an emergency she sets me up with her PA (who is excellent). After seeing me the PA discusses my case with my PCP who then communicates what we need to do (if anything) via email. Sure beats $2,500...

Personally I would keep looking for the right PCP...

George

PS When I had trouble finding a new PCP because many weren't taking new Medicare patients I searched under Speciality: Geriatics...
 
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Panina

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Seems you are paying to get priority. If you have the money, it is great to have.

One of my friends has it because without it she never got call backs. She does have an autoimmune disease and access is important.

Unfortunately for those who cannot afford it or choose not to get it, at theses places that offer it, they are not treated the same.
 

Luanne

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Our doctor went to a concierge practice awhile ago. Dh and I opted NOT to pay for this service. So, we do see a PA, which is fine because most of the time that is who we were seeing anyway. We haven't noticed any decline in service.

A friend of ours who has the same doctor did opt to buy into the concierge service. I haven't had a chance to ask him if it's been worth it.
 

Passepartout

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SO FAR, concierge service hasn't hit the boonies where we live. I suppose this is subject to change. We get in to see our PCPs and specialists usually within a day or two, and if necessary, a PA or another doc in the same practice that day.
Whether or not it's cost effective to pay for access, is up to you. One thing is sure, if a majority if their patients sign up, more doc's will see the economic benefit (who wouldn't want extra income without doing more work?) and more docs will sign up, and/or the price will increase.

I don't see how, overall, ALL patients will get better treatment. This will only continue the trend that the wealthy have health care and the less so get priced out.

In our area, the primary medical care provider has set up "Urgent Care' facilities. In those you will be seen by appropriate care personnel. It might not be your PCP, and following triage, it might be a PA. My experience has been going to one of these with chest pain on a Sunday. I was seen instantly, and plopped into a wheelchair and transported into the ER. My PCP found about it the next day. If I'd had his cell phone # to text, the only result would have been more delay. It's likely the outcome would be the same, but I'd have spent the cost of this concierge service for no discernible benefit.

Jim
 

Luanne

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One more comment about the concierge service we were offered. Dh went to the meeting that our doc held, I wasn't able to go. Basically dh's comment was "So I'm going to pay extra for the service I should be receiving".

As I've said, we've noticed no decline in service. I did have some issues getting in to see someone over the holidays as one of the PAs was out. I could have gotten an appointment a few days out, or taken my chance as a walk in (but I was told that didn't look too good). Another option available to us is a wonderful urgent care clinic that Medicare covers. They are a very good option for evenings and weekends when our doctor's office is closed.
 

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I'm curious how others rate the capability of the PAs they have dealt with. I have interacted with only 2 of them but honestly found both very capable...

George
 

Conan

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One more comment about the concierge service we were offered.... Basically dh's comment was "So I'm going to pay extra for the service I should be receiving".

True, which why I think the rollup of most of the area physicians into one big bunch of clinics is pertinent. The chief executive of the supergroup is paid $1.1 million/year, and their job as I see it is to make sure the 1,000 physicians keep their time spent per patient to a minimum for the sake of "efficiency."
 

Panina

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I'm curious how others rate the capability of the PAs they have dealt with. I have interacted with only 2 of them but honestly found both very capable...

George
Overall my experience with PAs are good but they really don’t know me or my history like my doctor does. I hate having to bring everything to their attention.
 

Luanne

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I'm curious how others rate the capability of the PAs they have dealt with. I have interacted with only 2 of them but honestly found both very capable...

George
The PA that sees dh and I is very good. And of course he is still "monitored" (that may not be the correct term) by the doctor. I had a bunch of tests run to find out what was causing some issues I was having. When he finally figured out what it was we were walking out of his office and encountered the doctor. PA's comment was "We finally figured out what it was". I got the impression the doctor had been linked in all along. Also, our PA is VERY well thought of among the medical community in our area.
 

Janann

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I'm curious how others rate the capability of the PAs they have dealt with. I have interacted with only 2 of them but honestly found both very capable...
I haven't seen an MD in years, with the exception of the MDs at the urgent care clinic for the occasional sinus infection. The PA at my internist's office knows me far better than the MD at this point. I've been very happy with the PAs that I have seen at two specialist offices. My general impression of PAs is that they are more interested in the ordinary patient than many MDs.

Lately when I call for a doctor appointment, the scheduler says something like: you can see the PA in two weeks, or the MD in two months. I'm happy with a PA, and its hard to know if I'll be able to keep an appointment that is two months away. But full disclosure, all of my medical issues are fairly routine and I don't feel like I need to see an MD for every issue.
 

VacationForever

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We are patients of one of the best PCPs in our area and there was an article about concierge service and he was interviewed. In the article he said if he went the concierge route, many of his patients would not be able to afford to stay with him and for that reason, he opted to remain accessible to everyone. He is a concierge doctor with the MGM group but not for regular patients. He is such a people's doctor. He is also the chairman of the board in a hospital within the medical group. We have also developed a good relationship with his medical assistant and scheduler and we always get to see him the same day if we have an urgent medical issue. If he does go the concierge route, we will pay to remain with him as we have not had a PCP as good as him. In the meantime we count our blessings to have him as our doctor.
 

rapmarks

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I'm curious how others rate the capability of the PAs they have dealt with. I have interacted with only 2 of them but honestly found both very capable...

George
Found PA and nurse practitioner to be highly knowledgeable and have seen many
 

artringwald

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When my MIL was still alive, she was seeing several specialists for multiple problems. Her primary care doctor acted as her advocate, followed up with all the specialists, and helped her understand the choices she had. That doctor was so good, that he became our doctor too. Fast forward 25 years. We had trouble getting an appointment with that doctor, and he always seemed rushed when he saw us. Last year he left to start his own concierge practice. He's good, but not worth $2000/year on top of our other insurance. If our medical problems start get complicated, and we have to see multiple specialists, we might reconsider.
 

Passepartout

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We are patients of one of the best PCPs in our area and there was an article about concierge service and he was interviewed.
How do you know? I mean how do you address the Doc who graduated LAST in his/her class? Doctor, is the answer.. We ALL think we have the best Doc available, but REALLY, there's no way to know. As long as you have confidence that you are getting the care that you expect, and that you have some say- so in the decisions, what more can you ask?
 

VacationForever

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How do you know? I mean how do you address the Doc who graduated LAST in his/her class? Doctor, is the answer.. We ALL think we have the best Doc available, but REALLY, there's no way to know. As long as you have confidence that you are getting the care that you expect, and that you have some say- so in the decisions, what more can you ask?
The article was after we have him as a doctor and we were definitely not influenced by some article when we selected him. He is the best because besides knowing his stuff, he refers us to the best specialists in their fields. The specialists which I am now seeing are heads and shoulders above specialists which I was seeing who had no clue with what they were doing - overdosing me on drugs which did not work, and specialists who did nothing because they did not know what to do or just did not care. PCPs are more important to one's well being than most realize. PCPs need to get feedback from patients and other doctors and network with the best who is out there.
 
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