I cannot find a PCP taking new Medicare patients unless they have Advantage plans.

[CoopersDad]

My wife and I decided we want to go with a Medicare Supplement, not an Advantage plan.

The trouble is than in Santa Cruz County nobody seems to be taking new patients unless they have Advantage plans.

We've met with our local HICAP group, to no avail.

What happens when we go on Medicare this fall if we don't have a Primary Care Physician??

Thanks in advance for any suggestions for what to do or who to contact.

[gab13by13]

1. Check out Medi-Gap, it doesn't steal from Medicare.

[we can do it]

2. That's what Medicare supplement is.

[Silent Type]

3. Under original Medicare you don't have to have a PCP, though obviously you should. But if you don't have one,

you can still go to your old cardiologist, ob/gyn, etc., assuming they still accept Medicare patients.

[CoopersDad]

10. They don't take medicare patients, that's the problem.

Not here in this coastal community of California, but I hear it's tough all over.

[diane in sf]

4. I had the same problem up in Solano County. I was able to get a doctor with One Medical. They have a number

Of offices in northern CA. I think I’m paying $10 a month for them. The closest doctor they could give me that could see me in a decent amount of time, was in SF, but she was able to refer me to more local doctors for specialized treatment. I recently had a strep throat and absolutely no local doctors could see me. I didn’t want to drive down to SF or go to the local (bad) Sutter hospital and hang out with the gunshot and heart attack victims for hours. A friend referred me to an urgent care located in our local Safeway by the pharmacy. Was able to get an appointment within a couple hours, the nurse was great, no wait time, I was able to relax in the waiting room while my prescription was filled. When I used to belong to Kaiser, pre real Medicare, waiting for prescriptions often involved long lines. I recommend One Medical if you have one somewhere near, or something similar, and check out what your local urgent care may be.

[CoopersDad]

11. I have had great luck with Doctors on Duty....

...even under my current plan, better really than going to my PCP.

If they recognize Medicare it might have to do while I look for a PCP.

I'll look into "One Medical"!

I see there are some in San Jose, about 45 minutes away.

Thanks!

https://www.onemedical.com/locations/sf/?pediatric_services=false&sees_seniors=false

[Lonestarblue]

5. I'd like to see some research on this, but I suspect private equity has taken over a lor of primary care medical groups.

They like advantage plans because they can pressure doctors to require more unnecessary tests and patient visits to increase their profits.

Do you have any non-profit hospitals in your area that have networks of doctors? They might take original Medicare.

Here’s a website that might be helpful. https://doctor.webmd.com/providers/specialty/primary-care

Good luck!

[erronis]

6. I'll bet your suspicion is correct. Vulture capitalists take over primary care practices

so they can reap the benefits with their insurance company benefits on denial of services.

What a stinking system these capitalists have constructed.

[yellowdogintexas]

7. I am surprised there aren't a few doctors who accept Part B.

Part B has no networks and does not require a PCP. You may need to seek care in an adjacent county. One important thing about Part B is that the coverage is exactly the same no matter where you seek care. If I get sick on vacation, I can find a doctor. Advantage Plans have networks which have limited areas and going out of network is very expensive. Your supplement will pick up deductible and co-pays.

go here: https://www.medicare.gov/care-compare/?providerType=Physician and search for physicians. I just did a quick check and found 300 providers You can start with Providers and Services at the top of the page. Good Luck!!! FYI nearly all facilities accept Part A

My sister lives in KY but all the family's doctors are in Tennessee. When my brother in law was getting ready for Medicare, the agent who handled their existing insurance told them flat out they needed Part B because none of the networks in KY extended into Tennessee, whereas with Part B they can see anyone.

Good Luck!

[Silent Type]

8. +1. My experience is that docs are more likely to accept original Medicare; however, a lot do limit Medicare patients

because commercial insurance usually pays better than Medicare or MA. If they get too many original Medicare patients, they'll limit new patients with Medicare.

A lot of docs won't even sign up with the smaller MA plans, although the larger ones that have millions of beneficiaries/patients are more attractive.

[CoopersDad]

14. Thank you for the resource!

Tooba Khan is taking new patients and my current MD Brent Wentworth is listed there too.

"The Medicare-approved amount is the total the doctor or supplier can be paid. When a doctor accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible and coinsurance."

I wonder if I just got bad information from Dignity staff over the phone on this question.

The Medicare-approved amount is the total the doctor or supplier can be paid. When a doctor accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible and coinsurance.

[Bobstandard]

9. The two main providers in Santa Cruz are big into Medicare Advantage

Dignity Health system is one of the three big providers in Santa Cruz, Sutter Health and Kaiser being the other two. My Personal Care Provider is with Dignity but I also have gotten care for decades from a Doc who ended up with Sutter. You can’t believe the number of mailers, phone calls and texts I get from them urging me to switch to Medicare Advantage. I moved slightly out of Santa Cruz County a few years ago and they found out about it.

During my last visit my PCP said this to me: “Dignity Health has told me to tell you that you should find another PCP closer to where you live.” We went on to discuss what a nightmare the corporate takeover of the health care system has become. And incidentally, Dignity can’t currently make me switch, though we both worry that’s coming.

Apparently the investment fund overlords of the big healthcare providers have determined that they can make a bunch more money by taking advantage of the Advantage system. It was Set up, after all, to mollify the big Insurers who would lose out when Obamacare became law. The insurers and the health care systems see mutual advantage in working together to more fully privatize the health care system. Taking the long game, as they always do, they’re trying to make it so miserable for Obamacare and Medicare patients that we’ll all switch. It seems to be working. (Thom Hartmann writes extensively on this if you want the sordid details).

Of course, If Trump gets in, kiss decent, affordable health goodbye entirely.

[CoopersDad]

12. Thanks, I'm also with Dignity for now...

But they tell me I'll be dropped unless I get an Advantage plan.

My wife and I need to enroll at the end of summer, she doesn't have a PCP here at all but got an appointment with the one doctor we found taking new patients.

That appointment is in November by which time our school provided Anthem plan will have terminated.

We will both be without a Primary Care Physician.

[AnnaLee]

13. It is becoming a widespread problem

My doctor's private clinic was purchased by Optum. When I look at the available doctors, many of them are listed as taking only Medicare Advantage patients. My doctor then retired so I had to look for another.

My insurance company has been trying to push Medicare people using their supplement policies into United Healthcare Advantage plans. They deny (with the newly formed call center) that they are practically using trickery to get people to switch. The trickery is an embed of the advantage plan into the supplement plan. That embedded ad?, if mouse clicked, takes the reader to a sign up of the advantage plan. I requested they unembed the advantage from the regular plan handbook, but they have not. Many others on my plan were complaining about this also.

I will lose my eligibility for CHAMPVA if I sign up for any advantage plan. That eligibility, so far untapped, is a valuable asset should I need it.

[lillypaddle]

15. I thought a supplemental plan

was about as good as you can get. I have an AARP Advantage Plan (HBO - POS) through United Healthcare. My premiums are $29 a month. I've looked into getting a supplemetal because most of them will pay almost everything that Medicare doesn't pick up, but the premium was close to $300.

Have you talked to your insurance plan administrator to ask what the deal is?

[CoopersDad]

16. I've met twice with our HICAP advisor. Advantage Plans are not the same as Medigap Supplements.

I'm told and many agree that Advantage plans can raise prices, drop you, and all kinds of bad things happen.

Medigap, on the other hand, permits more options in more places nationwide.

Don't take my work for it though: https://www.insurance.wa.gov/sites/default/files/documents/ma-medigap-compare-chart_0.pdf

[lillypaddle]

17. I would take a supplemental plan in an instant

IF I could afford it. Here is what I know about my coverage with the UHC Advantage plan:

Includes drug coverage; most all of my prescriptions are paid for 100% with Symbicort needing a $125 payment for a 90 day supply, luckily they will let you pay it out, interest free.

I have been covered since 2012. Among other things, I have heart failure, COPD, and various other ailments. Never have I felt as though I would be dropped.

They have good dental coverage, yes, even with only my $29 month premium payment. And they pay for glasses and hearing aids.

Max out of pocket is $4,500/year. That is still less than payments for a supplemental plan would be.

Good luck to you in finding something that works well for you.

[CoopersDad]

18. Excellent! Let's hope we both see continued affordable coverage.

Different plans for different needs, my sister loves her Advantage plan!

[Mysterian]

19. Best health care in the world!

USA! USA! USA!