Does Mayo Clinic Accept Your Medicare Advantage PPO Plan?

Mayo Clinic's Medicare Advantage PPO Coverage

Mayo Clinic accepts many Medicare Advantage PPO plans, but not all of them. Whether your specific plan is accepted depends on which Mayo Clinic location you visit, which insurance company issued your plan, and which network that company has contracted with in that region. You cannot assume your Medicare Advantage PPO will work at Mayo Clinic just because it works at other hospitals.

The clearest way to know is to call Mayo Clinic's scheduling line directly with your insurance card in hand, or to log into your insurance company's website and search for Mayo Clinic in the provider directory. Both methods take about 10 minutes and give you a definitive answer before you schedule an appointment.

Key Takeaways

Mayo Clinic contracts with some Medicare Advantage PPO plans but not others, and coverage varies by location and insurance company.
Your insurance company's provider directory is the fastest way to confirm whether Mayo Clinic is in-network for your specific plan.
If Mayo Clinic is out-of-network, you may still be treated there, but you will pay higher out-of-pocket costs unless you have out-of-network benefits.
Mayo Clinic has three main locations (Rochester, Minnesota; Jacksonville, Florida; and Phoenix, Arizona), and network status can differ between them.
If your plan does not include Mayo Clinic, you can ask your insurance company about switching plans during the annual open enrollment period.

How to Check If Your Plan Covers Mayo Clinic

Start with your insurance company's online provider directory. Log into your plan's website using your member ID, search for "Mayo Clinic" or the specific location you plan to visit, and look for an in-network designation. This takes two to three minutes and is the most current source of information.

If you do not use online tools or want to confirm by phone, call the customer service number on the back of your insurance card. Have your member ID ready. Tell the representative which Mayo Clinic location you plan to visit (Rochester, Jacksonville, or Phoenix) and ask whether that location is in-network for your plan. Write down the representative's name and the date of the call in case you need to reference it later.

You can also call Mayo Clinic's scheduling department directly at 1-800-66-MAYO (1-800-666-2296). They handle calls from patients with many different insurance plans and can often tell you on the spot whether your plan is accepted, though they may ask you to verify coverage with your insurance company afterward.

What In-Network and Out-of-Network Mean for Your Costs

If Mayo Clinic is in-network for your plan, you pay the copay or coinsurance amount your plan specifies. For most Medicare Advantage PPO plans, this means a copay per visit (often $20 to $50) plus any coinsurance for procedures or imaging. Mayo Clinic bills your insurance company directly, and you are not responsible for the difference between what Mayo Clinic charges and what your insurance pays.

If Mayo Clinic is out-of-network, you typically pay a higher percentage of the bill yourself, even after insurance pays its share. Many Medicare Advantage PPO plans do cover out-of-network care, but at a higher cost to you — often 30% to 50% coinsurance instead of 10% to 20%. Some plans have an out-of-network deductible you must meet first. Check your plan documents or call your insurance company to learn your out-of-network benefits before you schedule.

A few Medicare Advantage PPO plans do not cover out-of-network care at all except in emergencies. If that is your situation and Mayo Clinic is not in-network, you would pay the full bill yourself unless you change plans.

Mayo Clinic's Three Main Locations and Network Differences

Mayo Clinic operates three major medical centers: Rochester, Minnesota (the original and largest); Jacksonville, Florida; and Phoenix, Arizona. Each location has its own network contracts with insurance companies. Your plan might be in-network at Mayo Clinic Rochester but out-of-network at Mayo Clinic Phoenix, or vice versa.

When you check your provider directory or call your insurance company, always specify which location you plan to visit. Do not assume that acceptance at one location means acceptance at another. If you are considering travel to multiple Mayo Clinic locations, check coverage for each one separately.

What to Do If Mayo Clinic Is Out-of-Network for Your Plan

If Mayo Clinic is out-of-network and your plan does cover out-of-network care, you can still be treated there. You will pay more out of pocket, but the care itself is available. Before you schedule, ask Mayo Clinic's financial counselor for an estimate of your costs. Bring your insurance card and a list of any procedures or tests you expect to have. The counselor can give you a rough idea of what you will owe.

If your plan does not cover out-of-network care except in emergencies, or if the out-of-network costs are too high, you have two options. First, you can look for an in-network provider in your area who offers similar specialty care. Second, you can wait until the annual Medicare Advantage open enrollment period (October 15 to December 7 each year) and switch to a different plan that includes Mayo Clinic in-network. You cannot switch plans outside this window unless you have a may have access to life event, such as moving to a new state.

Questions to Ask Your Insurance Company

When you call your insurance company to confirm coverage, ask these specific questions:

Is Mayo Clinic [specific location] in-network for my plan?
What is my copay or coinsurance for a specialist visit at an in-network facility?
If Mayo Clinic is out-of-network, what is my out-of-network coinsurance percentage?
Do I have an out-of-network deductible, and have I met it this year?
Are there any prior authorization requirements for the type of care I need?

Write down the answers and the name of the representative you spoke with. If there is a discrepancy later, you have documentation of what you were told.

Prior Authorization and Other Requirements

Even if Mayo Clinic is in-network for your plan, some procedures or specialist visits may require prior authorization. This means your insurance company must approve the care in advance. Mayo Clinic's scheduling staff usually handles prior authorization requests on your behalf, but the process can add one to three business days before your appointment is confirmed.

When you call to schedule, tell the scheduler what type of care you need. They will let you know whether prior authorization is required and will submit the request to your insurance company. You do not need to do this yourself, but it helps to know it may happen so you are not surprised by a delay.

Some Medicare Advantage PPO plans also require you to choose a primary care physician and get a referral before seeing a specialist. Others do not. Check your plan documents or ask your insurance company whether a referral is needed for the Mayo Clinic specialist you plan to see.

Frequently Asked Questions

Can I go to Mayo Clinic without checking my coverage first?

You can, but it is risky. If Mayo Clinic is out-of-network and your plan does not cover out-of-network care, you could receive a bill for thousands of dollars. Checking takes 10 minutes and prevents this problem. Always verify before you schedule.

What if my insurance company says Mayo Clinic is out-of-network but Mayo Clinic says it is in-network?

This occasionally happens because of delays in updating provider directories. Ask both your insurance company and Mayo Clinic to send you written confirmation of the network status. If they disagree, ask your insurance company to escalate the question to their network management department. Do not schedule until you have written confirmation from your insurance company.

Can I switch Medicare Advantage plans to get Mayo Clinic coverage?

Yes, but only during the annual open enrollment period from October 15 to December 7. You can also switch if you move to a new state, lose your current coverage, or experience certain other may have access to events. Contact Medicare at 1-800-MEDICARE (1-800-633-4227) to learn whether you may have access to to switch outside the open enrollment window.

Do I need a referral to see a specialist at Mayo Clinic?

It depends on your specific plan. Some Medicare Advantage PPO plans require a referral from your primary care physician before you see a specialist; others do not. Check your plan documents or call your insurance company to find out. If a referral is required, ask your primary care doctor to send it to Mayo Clinic before your appointment.

What if I have a medical emergency at Mayo Clinic?

Emergency care is covered by nearly all Medicare Advantage plans, regardless of whether the facility is in-network. If you need emergency treatment, go to the nearest emergency department. Tell the staff about your insurance, and they will bill your plan. You may still have an out-of-pocket cost depending on your plan, but the care will not be denied.

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.