Medicare Doctors in Reseda, CA

Medicare is a federally funded health insurance provided in the United States for certain individuals, specifically those aged 65 and older, folks with particular disabilities, and those with End-Stage Renal Disease. Medicare coverage is divided into several parts, each designed to cover specific health-related services. Part A, widely known as hospital insurance, covers inpatient hospital care, hospice care, skilled nursing facility care, and potentially home health care. This part subsidizes pay for the services and supplies needed during a covered hospital stay or post-hospital care. Part B, referred to as medical insurance, covers outpatient care, doctor services, preventive medical services, and supplies. It includes coverage for medically necessary services to treat a disease or condition, such as outpatient surgeries, lab tests, and doctor visits. Part B also covers many preventive services, like screenings and vaccines, to prevent illness or detect health conditions at an early stage. Part D provides prescription drug coverage and is run by private insurance companies that follow rules set by Medicare, and as such, also covers many recommended shots or vaccines. Medicare rarely covers every expense, and there are typically out-of-pocket costs associated with coverage, such as deductibles, copays, and insurance premiums. Certain services like long-term care, cosmetic surgery, dental care, eye exams for prescribing glasses, and hearing aids are not covered by Medicare.

Unfortunately, Medicare does not typically cover 100% of the costs associated with visiting a doctor. For those enrolled in Medicare Part B, which covers physician visits and outpatient services, there is usually a standard annual deductible that patients must meet before Medicare begins to pay its share. Once the deductible is met, Medicare generally covers 80% of the approved amount for the doctor’s services, leaving the patient responsible for the remaining 20%, this is known as coinsurance. It is important to note that Medicare only covers services deemed medically necessary and the doctor must be enrolled in Medicare and accept Medicare assignments. For additional coverage, individuals may opt for supplemental insurance, like a Medigap policy, which can help cover the remaining 20% of coinsurance and other out-of-pocket expenses not covered by traditional Medicare. Patients should also verify whether their doctor accepts Medicare to ensure that their visits are covered and to understand any potential out-of-pocket costs that may incur, ensuring they have a full understanding of their healthcare coverage.

While Medicare does provide a broad range of healthcare services, there are specific areas and services it does not cover. Most notably, Medicare does not typically cover long-term care, also known as custodial care, which includes extended stays in nursing facilities or in-home custodial services. Routine dental care, such as cleanings, tooth extractions, fillings, and dentures, is also excluded, along with routine vision and hearing exams associated with prescribing glasses or hearing aids. Furthermore, it doesn’t cover cosmetic surgery unless it is deemed medically necessary. For example, one medically necessary cosmetic procedure may be reconstructive surgery for an injury. Under Medicare Parts A and B prescription drugs are also not covered. Instead, they require enrollment in a separate Part D plan or a Medicare Advantage plan that does cover prescription medication. Such holes in insurance coverage make it crucial for you to review plan details and even consider supplemental insurance policies to make up for the items not included in traditional Medicare if needed.

Finding a physician who accepts Medicare and is a great fit for you can be challenging at times as some private practices and even some large medical facilities do not accept it, making it all the more important to ensure any clinic you seek accepts your insurance plan. Asking friends, family, coworkers, and other trusted sources in general if they know a physician who accepts Medicare can be a great first step. Researching online through clinics’ websites and calling to see if they accept Medicare is another viable route to find physicians. For those searching for a doctor in the Reseda, California area, Rachman Medical Group does accept Medicare, and we are excited to meet you and provide quality care. We serve patients from Reseda CA, San Fernando CA, Twin Lakes CA, Hidden Hills CA, Burbank CA, and BEYOND!