Basic Medicare Plans & Coverage in San Diego
What is Basic Medicare?
Medicare is a health insurance initiative backed by the US federal government designed to provide coverage to different segments of the population, including individuals who are 65 years old and above, people under 65 with disabilities, individuals diagnosed with amyotrophic lateral sclerosis (ALS), and those with end-stage renal disease (ESRD).
Basic Medicare consists of two main parts: Part A and Part B. Medicare Part A Plans primarily cover hospital stays, skilled nursing facility care, hospice care, and limited home health services in San Diego. Medicare Part B covers medical services like doctor visits, outpatient care, preventive services, and some medical supplies. While Part A is generally premium-free for most beneficiaries in San Diego, Medicare Part B Plans require a monthly premium. Medicare beneficiaries have the option to add supplemental coverage through private insurance plans, known as Medicare Advantage (Part C), or prescription drug coverage through a Medicare Part D Plan.
Medicare is divided into several parts. These parts are:
Medicare Part A Coverage– also known as Hospital insurance, provides comprehensive coverage for various healthcare services. These plans typically cover in-patient hospital care, limited in-patient skilled nursing facility care, certain home health care, and hospice care. Notably, individuals with 40 or more quarters of Social Security credits (equivalent to around 10 years of full-time work) who qualify for Social Security or Railroad Retirement benefits are exempt from paying a monthly premium for their Medicare Part A Plans, and many San Diego residents need the savings!
Medicare Part B Coverage – provides coverage for outpatient medical services. These plans help cover a portion of the Medicare-approved costs associated with various out-patient medical services. This includes doctors’ services, out-patient hospital care, laboratory tests, out-patient physical and speech therapy, ambulance services, certain medical equipment and supplies, as well as some home health care in San Diego. Medicare Part B Plan premium amounts may vary depending on different factors such as income and the year.
Medicare Part C Coverage– Medicare Advantage plans
Medicare Part D Coverage – Prescription Drug plans
How to Find Out What Original Medicare Covers:
Have a conversation with your doctor or healthcare provider to discuss why you require specific services or items, and whether Medicare will provide coverage for them. If your provider believes that Medicare might not cover something that is typically included, you will be asked to read and sign a notice stating that you may need to pay for the item, service, or supply.
Medicare.gov is also a great resource. There you can find lists of basic Medicare plans and coverage for seniors in San Diego and nationwide.
Not everything is covered by Medicare. If you require particular services that aren’t covered by Medicare, you’ll need to pay for them on your own, unless you have other insurance or you’re enrolled in a Medicare health plan that includes these services.
Medicare doesn’t cover certain things like:
- Long-term care
- Most dental care
- Eye examinations related to prescribing glasses
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
When Medicare does cover something, you usually have to pay for your deductible, coinsurance, and copayments.