People with Medi-Cal may get coverage for services that Medicare may not or may partially cover, like basic vision and hearing, dental, non-emergency transportation, incontinence supplies, personal care, and home-and community-based services. How do I qualify? Your income and resource levels must meet the state eligibility requirements.
What is Medicare and Medi-Cal in California?
Medicaid, called Medi-Cal in California, is a joint federal and state program that helps pay medical costs for people with limited income and/or resources (assets). Some people qualify for both Medicare and Medi-Cal. What does Medi-Cal cover? If you have Medicare and full Medi-Cal coverage, most of your health care costs are covered.
What is the difference between Medicare Part D and Medi Cal?
Prescription Drugs If you are receiving both Medicare and Medi-Cal benefits, the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage prescription drug plan to get these benefits.
Is Medi Cal funded by the state or federal government?
Medi-Cal is financed equally by the state and federal government. Apply for Medi-Cal and get answers to Frequently Asked Questions. Local county office listing to apply for Medi-Cal; All County Welfare Directors Letters; and other county information.
Does Medicare cover prescription drugs instead of Medi-Cal?
If you are receiving both Medicare and Medi-Cal benefits, the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage prescription drug plan to get these benefits.
How is Medi-Cal different than Medicare?
Medicare provides health coverage to individuals 65 and older or those with a severe disability regardless of income, whereas Medi-Cal (California's state-run and funded Medicaid program) provides health coverage to those families with very low income, as well as pregnant women and the blind, among others.
What does Medi Medi cover?
These benefits may include dental plans, corrective vision coverage for exams and eyeglasses, additional podiatry benefits, hearing exams, hearing aids and fittings,and transportation to and from medical appointments.
What kinds of Medi-Cal care are not paid Medicare?
Some of the items and services Medicare doesn't cover include:Long-Term Care. ... Most dental care.Eye exams related to prescribing glasses.Dentures.Cosmetic surgery.Acupuncture.Hearing aids and exams for fitting them.Routine foot care.
What coverage do you get with Medi-Cal?
Medi-Cal covers most medically necessary care. This includes doctor and dentist appointments, prescription drugs, vision care, family planning, mental health care, and drug or alcohol treatment. Medi-Cal also covers transportation to these services.
Does Medi Medi cover dental?
Medi-Cal offers comprehensive preventative and restorative dental benefits to both children and adults. You can find a Medi-Cal dentist on the Medi-Cal Dental Provider Referral List, or by calling 1-800-322-6384.
Do I need to enroll in Medicare if I have Medi-Cal?
If you have Medi-Cal, you must enroll in a Medicare Part D drug plan. Medi-Cal will pay your Medicare Part B premium if you have full Medi-Cal or a Medi-Cal share of cost (SOC) of less than $500. Medi-Cal pays for your Medicare copayments and deductibles.
Does Medicare cover 100% of costs?
According to the Centers for Medicare and Medicaid Services (CMS), more than 60 million people are covered by Medicare. Although Medicare covers most medically necessary inpatient and outpatient health expenses, Medicare reimbursement sometimes does not pay 100% of your medical costs.
Which of the following services would not be covered under Medicare Part B?
But there are still some services that Part B does not pay for. If you're enrolled in the original Medicare program, these gaps in coverage include: Routine services for vision, hearing and dental care — for example, checkups, eyeglasses, hearing aids, dental extractions and dentures.
Can you bill a Medi cal patient for non covered services?
Healthcare providers are prohibited by law from billing people with Medi-Cal for charges not covered by their insurance.
Does Medi-Cal cover surgery?
With Medicaid for California, if you qualify and apply, can help you pay for doctor's visits, medication, dental screenings, rehabilitation, surgery, visits to the hospital and more.
What are the two types of Medi-Cal?
This guidebook explains the two kinds of Medi-Cal: Regular Medi-Cal and Medi-Cal Health Plans.
Does Medi-Cal cover emergency room visits?
Medi-Cal does cover emergency services for enrolled members, and if you show your BIC to emergency room staff, Medi-Cal will pay for the services you receive.
What is the difference between Medicare and Medi-Cal?
Medi-Cal is California's Medicaid health care program. Medi-Cal pays for a variety of medical services for children and adults with limited income and resources. Medicare is a federally funded insurance program for eligible participants 65 or over.
What is a HICAP?
HICAP is the California Health Insurance Counseling and Advocacy Program which provides individualized one-on-one assistance, education and community outreach for Medicare beneficiaries of any age and persons soon to be eligible for Medicare. HICAP services are free and confidential.
What is Medicare Patrol?
Senior Medicare Patrol (SMP) helps Medicare beneficiaries avoid, detect, and report health care fraud.
Does Medicare cover 100% of the cost of a medical insurance?
Medicare does not cover 100% of all costs and you may wish to purchase other Medicare-related insurance products such as Medicare Advantage or a Medicare Supplement policy. The following links provide useful information on Medi-Cal, Medicare, and Medicare-related insurance products.
What is the Difference Between Medi-Cal and Medicare?
The primary differences between Medicare and Medi-Cal are the eligibility requirements regarding residency, income and assets.
Is Medi-Cal the same as Medicaid?
Medicaid is a federal and state program that provides a way for low-income people to have healthcare coverage. Each state runs and manages its own Medicaid program.
Can You Have Medi-Cal and Medicare Coverage?
You can be eligible for and have both Medicare and Medi-Cal. This is known as dual eligibility. People who are dual-eligible may be over 65 or have a disability, plus have an income level that meets the criteria for Medi-Cal.
Sources
Medi-Cal Eligibility and Covered California – Frequently Asked Questions. CA.gov.
What is the second option for Medicare?
Option 2: Medicare Advantage Plan + Medi-Cal health plan. You enroll into a Medicare Advantage managed care plan; Your Medicare Parts A, B and D benefits are assigned to the plan; While you are in the plan, you must use plan providers to obtain medical care; You pay $1-3 for each prescription per month.
What are the benefits not covered by Medicare?
Provides benefits not covered by Medicare such as –. Hearing aids. Incontinence supplies. Dental services. Vision care. Medical transportation. In Home Supportive Services care at home. Nursing home care. There are different ways to use your Medicare and Medi-Cal benefits.
How much does Medicare pay for each prescription?
You pay $1-3 for each prescription per month. Covers your Medicare Part A and B copayment. Provides additional Medi-Cal benefits such as medical transportation, incontinence supplies, and personal care in a nursing home.
What is Medi-Cal insurance?
Medi-Cal is your secondary insurance. Medi-Cal closes the gaps in Medicare coverage and provides additional benefits not covered by your Medicare.
Does Medi-Cal manage Medicare?
Your Medi-Cal health plan will only manage most of your Medi-Cal benefits. The Medi-Cal health plan will be responsible for authorizing the Medi-Cal benefits you need. Cal MediConnect Plans manage your Medicare and Medi-Cal benefits within one health plan.
Does Medicare Part D affect your ability to use Medicare?
You enroll into a Medicare Part D plan that only provides drug coverage you pay $1-3 for each prescription per month. Your Part D plan does not affect your ability to use your Medicare. Covers your Medicare Part A and B copayments. Provides additional Medi-Cal benefits such as medical ...
Can I get medical care outside of Medi-Cal?
You can receive medical services outside your Cal MediConnect plan only for emergency care or if you need urgent care outside your service area. The Cal MediConnect plan may provide additional benefits such as dental services that are not covered by Medi-Cal.
What is Medi-Cal insurance?
As your secondary insurance, Medi-Cal: Pays your Medicare Part A and B copayments and deductibles. Provides benefits not covered by Medicare such as dental care, hearing aids, long term care in a nursing home and at home, incontinence supplies and non-emergency medical transportation to medical appointments.
What is SSI linked to?
Supplemental Security Income (SSI) linked Medi-Cal. The Supplemental Security Income (SSI) Program pays benefits to adults age 65 and older and to younger adults with a disability. To qualify for SSI, you must have limited income and resources. Persons who qualify for SSI benefits automatically qualify for Medi-Cal.
How much is a burial fund?
A burial fund of up to $1,500 each for you and your spouse's expenses; and. Life insurance policy you own with a maximum face value of $1,500 or less per person. The following resources are counted to determine eligibility for SSI: Money in the bank; A second home; and. Other property.
What to do if hearing aid is stolen?
If the hearing aid was stolen, you must provide a copy of a filed police report. Learn more about Medi-Cal's hearing aid benefit.
What is Medi-Cal in California?
Medi-Cal is California’s Medicaid program. Medi-Cal provides health insurance coverage to low-income Californians. There are several Medi-Cal programs with different eligibility requirements. The material presented in this section of the website provides information on Medi-Cal eligibility and benefits for adults who are elderly, age 65 and older, ...
Do I need prior authorization for Medi-Cal?
You must obtain prior authorization from Medi-Cal or your Medi-Cal managed care health plan before you can use this Medi-Cal benefit. You will also need a prescription from your physician that explains the medical condition causing the incontinence and the type of incontinence supplies you need.
Does Medi-Cal cover transportation?
If you are in a Medi-Cal health plan, the plan must authorize transportation services. If you cannot travel alone, Medi-Cal will cover transportation for someone to travel with you, such as a spouse, parent or guardian.
What is Cal MediConnect?
Cal MediConnect is a type of health care plan that promotes coordinated healthcare and long-term services and supports (LTSS) for seniors and people with disabilities who are eligible for both Medicare and Medi-Cal, sometimes referred to as “dual eligible beneficiaries” or “Medi-Medis”.
What is the difference between Medicare and Medi-Cal?
When you have Medicare Parts A and B, Medicare is your primary insurance and pays for most of your medical care. Medi-Cal is your secondary insurance. It pays for costs not covered by Medicare and provides additional benefits not covered by Medicare.
What is private health insurance?
Purchase private health insurance that charges a premium, like prescription drug, dental, or vision plans. Use the amounts you pay for Medicare co-payments, deductibles, prescription drug costs, and other health related services, such as dental or vision.
What is Medicare for people over 65?
Medicare is health insurance for: People 65 or older. People under 65 with certain disabilities. People of any age with End-Stage Renal Disease (ESRD) – permanent kidney failure requiring dialysis or a kidney transplant. People of any age with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
What is a medicaid program?
What is Medi-Cal? Medicaid, called Medi-Cal in California, is a joint federal and state program that helps pay medical costs for people with limited income and/or resources (assets). Some people qualify for both Medicare and Medi-Cal.
What is a share of cost?
Share of cost (SOC) works similar to a monthly insurance deductible. You must meet your monthly SOC before Medi-Cal starts to pay. You will get billed for medical related services until you meet your share of cost. You DO NOT have full Medi-Cal benefits until you meet your share of cost.
Does Medicare require a referral to a specialist?
With Original Medicare you can choose any medical provider that accepts Medicare and Medi-Cal, no referrals to a specialist is needed. In addition to the Medicare and Medi-Cal card, beneficiaries also have a CalOptima Member Identification card and a Part D Prescription Drug Plan card. Medi-Medi beneficiaries that do not enroll in a Part D Plan ...