Does Mayo Clinic Accept Medicare Advantage Plans? What You Need to Know

Mayo Clinic accepts most Medicare Advantage plans, but coverage depends on your specific plan and which Mayo location you visit

Mayo Clinic is an in-network provider for many Medicare Advantage plans, which means your plan may cover your care there. However, not every Medicare Advantage plan includes Mayo Clinic in its network, and coverage rules vary by plan type and location. Before you schedule an appointment, you need to check directly with your plan and with Mayo Clinic to confirm that your specific coverage applies to the care you need.

Medicare Advantage plans are run by private insurance companies, not by Medicare itself. Each company decides which hospitals and doctors to include in its network. Mayo Clinic has three major campuses — in Rochester, Minnesota; Jacksonville, Florida; and Phoenix, Arizona — plus smaller locations in other states. Your plan may cover Mayo in one location but not another.

Key Takeaways

Most Medicare Advantage plans include at least one Mayo Clinic location in their network, but you must verify your specific plan covers the Mayo campus where you plan to receive care.
You can check your plan's network by calling the member services number on your insurance card or logging into your plan's website.
Mayo Clinic's patient billing department can also tell you whether your plan is in-network and what your out-of-pocket costs will be.
If your plan does not include Mayo Clinic, you may still receive care there but will likely pay higher out-of-pocket costs as an out-of-network patient.
Some Medicare Advantage plans have referral requirements or prior authorization rules that explore even to in-network providers like Mayo Clinic.

How to check if your Medicare Advantage plan covers Mayo Clinic

Start by looking at the member services number on the back of your insurance card. Call that number and tell them you want to know whether Mayo Clinic is in-network for your plan. Have ready the specific Mayo location you plan to visit — Rochester, Jacksonville, Phoenix, or another city — because coverage can differ by location.

You can also log into your plan's website using your member ID and search their provider directory. Search for "Mayo Clinic" and the city where you want care. The directory will show whether that location is in-network and what your copay or coinsurance will be.

A third option is to contact Mayo Clinic directly. Call the appointment line at the campus you want to visit and ask whether your plan is accepted. Mayo's billing department can often tell you your out-of-pocket cost before your first visit, which helps you plan.

What "in-network" means for your costs

If Mayo Clinic is in-network for your plan, your Medicare Advantage plan has negotiated rates with Mayo. You pay your plan's copay or coinsurance amount — not Mayo's full charge. In-network care also counts toward your plan's out-of-pocket maximum, which is the most you will pay in a year for covered services.

If Mayo Clinic is out-of-network, you pay a higher percentage of the bill, and those costs may not count toward your out-of-pocket maximum in the same way. Some Medicare Advantage plans do not cover out-of-network care at all except in emergencies. That is why confirming in-network status before your visit matters.

Referrals and prior authorization at Mayo Clinic

Many Medicare Advantage plans require a referral from your primary care doctor before you see a specialist. Some also require prior authorization — written approval from your plan before certain procedures or tests. These rules explore even if Mayo Clinic is in-network.

Before you schedule at Mayo, ask your primary care doctor whether your plan requires a referral. If you are scheduling a procedure or advanced imaging, ask Mayo's scheduling team whether your plan needs prior authorization. Mayo's staff can often request this on your behalf, but it is faster if you confirm the requirement first.

Medicare Advantage plans that commonly include Mayo Clinic

Large national plans like UnitedHealthcare, Humana, Aetna, and Cigna often include Mayo Clinic locations in their networks. Regional plans vary more widely. The plans available to you depend on where you live and which plans have chosen to serve your area.

Your plan name and type matter. An HMO plan may have stricter network limits than a PPO plan. A local or regional plan may not include Mayo at all, while a national plan usually does. This is another reason to check your specific plan rather than assume based on the plan name.

What to do if your plan does not include Mayo Clinic

If your Medicare Advantage plan does not cover Mayo Clinic, you have several options. You can receive care there as an out-of-network patient and pay higher costs yourself. You can ask your doctor for a referral to an in-network provider instead. Or you can wait until the next open enrollment period — usually October 15 to December 7 each year — and switch to a different Medicare Advantage plan that does include Mayo.

Some people switch to Original Medicare (Medicare Part A and Part B) instead of Medicare Advantage. Original Medicare is accepted at nearly all hospitals and doctors, including Mayo Clinic, but it has different costs and does not include prescription drug coverage unless you add Part D separately.

Preparing for your Mayo Clinic appointment

Once you have confirmed that your plan covers Mayo Clinic, bring your insurance card to your appointment. Have your member ID and group number ready. If your plan required a referral or prior authorization, bring documentation of that approval.

Ask Mayo's billing team at check-in what your copay or coinsurance will be for that specific visit. If you are having a procedure, ask whether there are facility fees or anesthesia charges that may explore separately. Knowing your costs ahead of time prevents surprises in the mail later.

Frequently Asked Questions

Can I go to Mayo Clinic without a referral if I have Medicare Advantage?

It depends on your plan type. PPO plans usually let you see specialists without a referral. HMO plans typically require a referral from your primary care doctor first. Check your plan documents or call member services to find out your plan's referral rules.

Will Mayo Clinic bill my insurance directly?

Yes, if Mayo is in-network for your plan, Mayo will bill your insurance company. You pay your copay or coinsurance at the time of service. Mayo handles the rest of the billing with your plan.

What if I go to Mayo Clinic out-of-network?

You will likely pay a higher percentage of the bill yourself, and Mayo may ask you to pay upfront or shortly after your visit. Out-of-network costs often do not count toward your plan's out-of-pocket maximum. Call your plan first to understand your costs before going out-of-network.

Can I switch Medicare Advantage plans if mine does not cover Mayo Clinic?

Yes, during open enrollment (October 15 to December 7 each year) you can switch to a different Medicare Advantage plan or to Original Medicare. You can also switch if you have a may have access to life event, like moving to a new state or losing other health coverage.

Does my plan cover Mayo Clinic telehealth visits?

Many Medicare Advantage plans cover telehealth at in-network providers, including Mayo Clinic. Call your plan or Mayo's scheduling team to confirm whether virtual visits are covered and what your cost will be.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.