My Medicare Plan won't be offered in 2025 -- UGH!

[b2bailey]

I've had the same UHC Supplemental plan for nearly 10 years, and it has served me well. I was willing to pay nearly $200/month for the flexibility it offered.

Earlier this year I moved to Santa Cruz County CA. When I tried to find a doctor -- any and all doctors -- I was told "Not accepting any new Medicare patients."

There are only two medical systems. Either one would require I sign up for their Advantage Plan.
I chose the hospital affiliated system, Dominican / Dignity Health. (Previously a Catholic Hospital).
It took nearly 6 months to see my new Primary Care Physician. I liked her. Received a referral to Orthopedics for previously diagnosed rotator cuff injury. Waiting for MRI appointment. Doc was able to look at prior MRI from a year ago and said surgery will be required.

And then... Today I receive letter telling me this Advantage plan will no longer be available.

Thankfully I have a Medicare insurance agent I know and trust. I've left a message for him -- but I'm guessing he has hundreds of clients in my position.

I'm tempted to just go to Original Medicare. Anyone have only that coverage?

 

[Luanne]

What do you consider Original Medicare? Just Part B?

We both have Medicare supplements, mine is Accendo which is part of CVS and my husband has Mutual of Omaha. I got mine through an independent agent and my husband got his through AON which is the company that administers retiree health care for the company I worked for.

 

[DrQ]

I've had the same UHC Supplemental plan for nearly 10 years, and it has served me well. I was willing to pay nearly $200/month for the flexibility it offered.

Earlier this year I moved to Santa Cruz County CA. When I tried to find a doctor -- any and all doctors -- I was told "Not accepting any new Medicare patients."

Wow, are you saying that the medical corporations have organized to accept only Medicare Part C which is either affiliated or organized by their practice? If that is the case, I see anti-trust issues. I find it hard to see how you can accept one flavor of "medicare", but not the other.

 

[rapmarks]

Not having a supplement would scare me.

 

[jackio]

Many people I know have part B Medicare and purchase the AARP supplement. Is that the one you originally had?

 

[Luanne]

It sounds like @b2bailey 's biggest problem is finding doctors in Santa Cruz that accept medicare patients who might take one of the supplemental plans.

 

[WinniWoman]

I've had the same UHC Supplemental plan for nearly 10 years, and it has served me well. I was willing to pay nearly $200/month for the flexibility it offered.

Earlier this year I moved to Santa Cruz County CA. When I tried to find a doctor -- any and all doctors -- I was told "Not accepting any new Medicare patients."

There are only two medical systems. Either one would require I sign up for their Advantage Plan.
I chose the hospital affiliated system, Dominican / Dignity Health. (Previously a Catholic Hospital).
It took nearly 6 months to see my new Primary Care Physician. I liked her. Received a referral to Orthopedics for previously diagnosed rotator cuff injury. Waiting for MRI appointment. Doc was able to look at prior MRI from a year ago and said surgery will be required.

And then... Today I receive letter telling me this Advantage plan will no longer be available.

Thankfully I have a Medicare insurance agent I know and trust. I've left a message for him -- but I'm guessing he has hundreds of clients in my position.

I'm tempted to just go to Original Medicare. Anyone have only that coverage?

Wait. You have an Advantage plan, not a Medigap supplement?

A lot of places are starting to not accept Advantage plans. There are some good ones, but few and far between.

I like having. Medigap plan myself. But in terms of doctor shortages, that’s another issue that’s getting worse. Our hospital system just got rid of three long time , ours being one of them, and we’re in limbo.

 

[Passepartout]

Our Medicare Advantage provider, who had been closely associated with the one major hospital/medical group, has stopped selling policies here, leaving us in the lurch. We think we've found a fall-back, but it's going to be a hassle as some of DWs ongoing cancer meds have to get a special dispensation to be covered.

 

[DrQ]

It sounds like @b2bailey 's biggest problem is finding doctors in Santa Cruz that accept medicare patients who might take one of the supplemental plans.

It sounds like she has dropped her supplement in favor of a Medicare (dis)Advantage plan. If it has been less than a year, she might be able to get back her Medicare Supplement under the "try it" provision.

The problem is finding a practice that accepts "classic" Medicare. The supplement does not have an issue with being accepted, it is just submitted as a secondary payor.

 

[easyrider]

The only reason we took Medigap plan g was that it was explained to us that after a couple of years of an Advantage plan at no cost, the medigap plan g would go through the process of underwriting and might be denied coverage due to a pre-existing condition.

Bill

 

[b2bailey]

Wow, are you saying that the medical corporations have organized to accept only Medicare Part C which is either affiliated or organized by their practice? If that is the case, I see anti-trust issues. I find it hard to see how you can accept one flavor of "medicare", but not the other.

Yes, I am amazed that they are allowed to say --No New Medicare patients. For ten years I enjoyed having a Supplement Plan which allowed me to see ANY doctor, with no referral needed for Specialist. Quite a shock to learn that same plan would not allow me to make an appointment with any doctor in this County.

 

[b2bailey]

Many people I know have part B Medicare and purchase the AARP supplement. Is that the one you originally had?

Yes, I had AARP United Healthcare Supplement. Loved it.
Even though it cost me $200 / I liked the ease and flexibility.

 

[b2bailey]

It sounds like she has dropped her supplement in favor of a Medicare (dis)Advantage plan. If it has been less than a year, she might be able to get back her Medicare Supplement under the "try it" provision.

The problem is finding a practice that accepts "classic" Medicare. The supplement does not have an issue with being accepted, it is just submitted as a secondary payor.

Yes, there was no prior problem with my AARP UHC Supplement for ten years. However, when I moved here -- I could not find a single doctor that would accept me as a patient with that supplement.

 

[b2bailey]

Our Medicare Advantage provider, who had been closely associated with the one major hospital/medical group, has stopped selling policies here, leaving us in the lurch. We think we've found a fall-back, but it's going to be a hassle as some of DWs ongoing cancer meds have to get a special dispensation to be covered.

This sounds like what I am experiencing.

 

[b2bailey]

It sounds like she has dropped her supplement in favor of a Medicare (dis)Advantage plan. If it has been less than a year, she might be able to get back her Medicare Supplement under the "try it" provision.

The problem is finding a practice that accepts "classic" Medicare. The supplement does not have an issue with being accepted, it is just submitted as a secondary payor.

It wouldn't do me any good to go back to my original Supplement Plan.
I only switched to the local Medicare Advantage Plan so that I could see a doctor.

 

[VacationForever]

Time to move?

 

[b2bailey]

Time to move?

After living away from Santa Cruz for ten years, I moved back to help my granddaughter and family with their "2 under 2" It wasn't my original intention, but we moved into a house together. Most of the time I'm happy to be sharing space with them, after living alone since my husband
died 10 years ago. So, no, moving isn't an option.

 

[SusanRN]

Yes, I am amazed that they are allowed to say --No New Medicare patients. For ten years I enjoyed having a Supplement Plan which allowed me to see ANY doctor, with no referral needed for Specialist. Quite a shock to learn that same plan would not allow me to make an appointment with any doctor in this County.

Unless I am misunderstanding, it is the *doctors* declining to accept Medicare insurance, not Medicare declining to accept the doctors. That is nothing new. Some doctors believe Medicare payment rates are too low and there are enough patients around with employer-based insurance or who can pay privately so they don't need Medicare patients.
And, yes, it might be best to get back on Medicare now, if you can, or you will need to be medically underwritten, which can be difficult if you have had any medical conditions arise in the last three years or you are on certain medications (or so I learned when I successfully did it last year at 72).
I found these lists of primary care docs accepting Medicare in Santa Cruz. It's a start. Good luck.

Medicare Family Medicine Doctors in Santa Cruz, CA - Medicare Status, Address, Contact

Medicare Family Medicine Doctors in Santa Cruz, California. Find all Family Medicine physicians who accept medicare assignments in Santa Cruz, California

www.medicarelist.com

Page 6 | Best Medicare Doctors Near Me in Santa Cruz, CA | Zocdoc

Find Medicare Doctors in Santa Cruz, California & make an appointment online instantly! Zocdoc helps you find Doctors in Santa Cruz and other locations with verified patient reviews and appointment availability that accept Medicare and other insurances. All appointment times are guaranteed by...

www.zocdoc.com

 

[b2bailey]

Unless I am misunderstanding, it is the *doctors* declining to accept Medicare insurance, not Medicare declining to accept the doctors. That is nothing new. Some doctors believe Medicare payment rates are too low and there are enough patients around with employer-based insurance or who can pay privately so they don't need Medicare patients.
And, yes, it might be best to get back on Medicare now, if you can, or you will need to be medically underwritten, which can be difficult if you have had any medical conditions arise in the last three years or you are on certain medications (or so I learned when I successfully did it last year at 72).
I found these lists of primary care docs accepting Medicare in Santa Cruz. It's a start. Good luck.

Medicare Family Medicine Doctors in Santa Cruz, CA - Medicare Status, Address, Contact

Medicare Family Medicine Doctors in Santa Cruz, California. Find all Family Medicine physicians who accept medicare assignments in Santa Cruz, California

www.medicarelist.com

Page 6 | Best Medicare Doctors Near Me in Santa Cruz, CA | Zocdoc

Find Medicare Doctors in Santa Cruz, California & make an appointment online instantly! Zocdoc helps you find Doctors in Santa Cruz and other locations with verified patient reviews and appointment availability that accept Medicare and other insurances. All appointment times are guaranteed by...

www.zocdoc.com

Thank you. I will try calling names on first list tomorrow.
The second list -- only came up with doctors located in a neighboring county -- too far from here.

 

[SusanRN]

I noticed that some on that list are "accepting Medicare assignments". I wasn't sure what that meant, so I looked it up. Be sure to read this;

Does Your Doctor Accept Medicare’s Approved Amount?

You’ll pay less if your doctor accepts assignment

www.aarp.org

 

[jp10558]

I'm surprised the government allows doctors to not accept medicare patients TBH.

 

[VacationForever]

I'm surprised the government allows doctors to not accept medicare patients TBH.

It's pure economics and doctors should not be forced to accept Medicare patients.

 

[TheHolleys87]

It's pure economics and doctors should not be forced to accept Medicare patients.

Yes. Medicare pays discounted rates, and Federal law is such that when overall Medicare costs increase, reimbursement for doctors and other clinicians is cut. Doctors are facing a 2.8% pay cut in 2025, and it will be the fifth straight year that reimbursement has been cut, despite staff salaries, rent, utilities, etc. increasing.

A doctor with too many Medicare patients can find it hard to cover their overhead. That’s why some doctors won’t accept new Medicare patients.

 

[VacationForever]

While reimbursements are reducing for doctors and other clinicians, Medicare Advantage payments from the government to MA plans are expected to increase by 3.70 percent on average from 2024 to 2025. This is an increase of over $16 billion in 2025 compared to 2024 in expected MA payments. It means that it is going to drive more people to buy Medicare Advantage plans. It's is really bad.

 

[b2bailey]

I haven't heard back from my Insurance guy, but I was able to speak with a local HICAP person through local Senior Services. I feel much relieved.
There are other Advantage plans available that will allow me to stay in my network. OR, I can bite the bullet and return to a medigap policy plus separate drug plan for approx $200/month. No worries about underwriting approval because my Advantage plan was discontinued. I'm leaning that way. And now that I am an established patient, the doctors will continue to see me.