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California Medicare Coverage: What's Included & What's Not

Understanding what Medicare covers and what it does not is crucial for managing your healthcare needs effectively. This guide provides a clear overview of the Medicare coverage available in California, helping you navigate what is included in your plan and what additional coverage you might need.

Medicare Part A: Hospital Insurance

What's Included:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

What's Not Included:

  • Long-term care
  • Private room (unless medically necessary)
  • Personal care items like razors or slipper socks

Medicare Part B: Medical Insurance

What's Included:

  • Doctors' services
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs and walkers)
  • Preventive services (like flu shots and screening tests)

What's Not Included:

  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them

Medicare Part C: Medicare Advantage

What's Included:

  • All benefits of Part A and Part B
  • Often includes additional benefits like dental, hearing, vision, and wellness programs

What's Not Included:

  • Services not approved by the plan
  • Care received outside the plan’s network (unless it's an emergency)

Medicare Part D: Prescription Drug Coverage

What's Included:

  • Outpatient prescription drugs covered under specific plan formularies

What's Not Included:

  • Drugs not listed on the plan’s formulary
  • Over-the-counter medications
  • Some prescriptions like cosmetic drugs

Medigap: Supplemental Medicare Insurance

What's Included:

  • Helps cover costs like copayments, coinsurance, and deductibles that are not covered by Original Medicare

What's Not Included:

  • Extended services like dental, vision, hearing, or private nursing

Key Considerations

  • Networks and Referrals: With Medicare Advantage plans, you generally need to use healthcare providers in the plan's network and may need referrals for specialists.
  • Additional Costs: Be aware of potential out-of-pocket costs, such as deductibles and copayments, that you may incur even with coverage.
  • Enrollment Periods: Ensure you enroll during designated enrollment periods to avoid penalties and coverage gaps.

Getting the Help You Need

If you're unsure about what your Medicare plan covers or if you need additional coverage, it's wise to consult with professionals. Vizion Integrated Insurance Agency can provide guidance tailored to your specific needs, helping you make the most of your Medicare coverage in California.

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