Medicare Basics: FAQs, coverage and more

When it comes to emergency, it is important to know the difference between the ER and urgent care and their nearest locations.

Urgent care centers are available when the primary care physician is not available, and ideal for non-emergency care such as cough, sore throat, body aches, colds, sinus infections, allergies, eye irritations, muscle sprains, nausea, vomiting or diarrhea.

Emergency rooms are for life threatening or disabling conditions such as stroke, heart attack, severe injuries from an accident, a loss of consciousness, uncontrolled bleeding, poisoning, or sudden severe abdominal pain.

Most Medicare Advantage plans cover ambulance services at a reduced rate. However, the original Medicare plan will only cover 80% of the Medicare approved ambulance charge. Medicare Part B covers the cost of an ambulance in emergency situations if the trip meets the following criteria:

• Ambulance is medically necessary.

• It’s the only safe way to transport the patient.

• It’s going to a Medicare-approved location such as hospital, skilled nursing facility or back home after care.

• The destination is the nearest qualifying facility available to provide the treatment.

• The transportation company meets the Medicare standards.

Most Medicare plans include yearly routine annual eye exams that can detect heart disease, diabetes and more.

Most Medicare plans include some dental care, which is one of the most expensive healthcare items. Dental care can detect things like cancer, nutrition issues and osteoporosis, just to name a few. To confirm the coverage, people can call their preferred dentist and find out about their accepted dental plans.

People with certain disabilities and a licensed assistance dog may be eligible to receive $50 a month from the State of California. For more information, call 916-657-2628 or go to www.cdss.ca.goc/ assistance-dogs.

When it comes to vaccinations, Medicare covers vaccinations against shingles, tetanus, diphtheria, pertussis (whooping cough), hepatitis A and B, flu shots, pneumococcal and covid and more. According to the Inflation Reduction Act, beginning in 2023, adult vaccines recommended by the Centers for Disease Control and Prevention are free for Medicare beneficiaries with prescription drug coverage. Whereas people need to have a Medicare Advantage plan that includes Part D prescription drugs, or a stand alone Part D prescription drug plan to get free vaccines. However, one in 11 Medicare beneficiaries do not have a prescription drug plan therefore they will have to pay for certain vaccines.

Some may not see a need in a prescription drug plan right now because they don’t take any medications, but as mentioned above, Part D prescription drug plan covers more than just everyday medications. If people don’t sign up for a Part D prescription drug plan when you they first take Medicare, they’ll be subject to a late enrollment penalty if they decide to sign up for a plan later. Certain exceptions apply.

To learn more about Medicare, contact the insurance broker specializing in Medicare, Sandra Teel at 657-204-4224 or 909-856-9379.