There are medical care services, items and drugs that are not covered by DaVita VillageHealth plan. For example:
View or download a copy of the Evidence of Coverage
- Services that aren't covered under the Original Medicare Plan.
- Routine care of any kind, such as homemaker services, dental cleanings and fillings, routine chiropractic care, screening exams, hearing exams and foot care.
- Meals delivered to your home.
- Charges for services by providers that do not participate with Medicare or do not accept assignment.
- Hospital and medical services received outside of the service area of DaVita VillageHealth, except under special circumstances including an emergency or illness while traveling.
- Prescription medications are available from out-of-network pharmacies only under limited circumstances, such as illness while traveling outside of the plan's service area where there is no network pharmacy. You may also incur an additional cost for drugs received at an out-of-network pharmacy.
- Medications that are available without a prescription or over-the-counter drugs.
- Medications that are considered barbiturates and benzodiazepines.
View or download a copy of the Evidence of Coverage
Disclaimer
If you are eligible for Medicaid, the state may be required to cover Medicare cost-sharing that you would otherwise be required to pay. These amounts may differ based on what kind of Medicaid coverage you have. Benefits, co-payments, coinsurance and premiums may change on January 1, 2009. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.Plan Benefits
PDF Downloads
- Summary of Benefits
[pending approval] - Evidence of Coverage
[pending approval]
