what does medi cal cover vs 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.

Full Answer

Is Medi-Cal same as Medicare or Medicaid?

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. 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.

What are the advantages of Medicaid versus Medi Cal?

Medi-Cal, the Medicaid program in California, provides health coverage to people with low-income and asset levels who meet certain eligibility requirements.Medi-Cal can supplement Medicare services and help pay Medicare premiums, deductibles and copayments.In certain cases, Medi-Cal may also be used to pay private health insurance premiums.

Does Medi-Cal ever pay secondary if Medicare is primary?

Medi-Cal will only cover these costs and services if you use providers that accept Medi-Cal. If you have both Medicare and Medi-Cal, Medicare is the primary payer (meaning Medicare will pay first for Medicare-covered benefits) and Medi-Cal is the secondary payer.

Can a provider Bill a Medi-Cal patient?

Yes. To bill Medi-Cal, a provider must complete the appropriate enrollment forms. For questions on which forms to use, contact the Out-of-State Provider Unit at (916) 636-1960. If a provider chooses not to enroll, they may bill the patient. However, an enrolled Medi-Cal provider cannot bill a Medi-Cal-eligible patient for a covered service.

Does Medi-Cal cover what Medicare doesn t?

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.

What does Medi Medi pay for?

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.

Do I need 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.

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. Read more in “Covered Benefits” on page 12.

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.

Can I have Medicare and Medi-Cal together?

If you chose Option 1, original Medicare or Option 2, a Medicare Advantage plan, you are required to enroll into a Medi-Cal health plan. Your enrollment in a Medi-Cal health plan will not limit your ability to use your Medicare coverage.

Does Medi-Cal pay Part B premiums?

The State of California participates in a buy-in agreement with the Centers for Medicare and Medicaid Services (CMS), whereby Medi-Cal automatically pays Medicare Part B premiums for all Medi-Cal beneficiaries who have Medicare Part B entitlement as reported by Social Security Administration (SSA).

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.

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.

How much is Medi-Cal per month?

How much are the premiums? The premiums for Medi-Cal for Families are $13 for each child and no more than $39 per family per month.

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.

Can I get Kaiser through Medi-Cal?

Free or low-cost coverage All of our available doctors accept Kaiser Permanente members with Medi-Cal coverage. Get care from a doctor or specialist – including appointments, exams, and treatment. Your child can get regular check-ups – including shots and vaccines.

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...

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...

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.

What Is Medicare?

Medicare was signed into law by President Johnson in 1965 as a federal health insurance program designed to assist Americans over the age of 65 pay for their medical costs.

What Is Medi-Cal?

Medi-Cal provides health coverage to low-income individuals and families for free or at significantly lower cost than those plans offered through Covered California.

Contact Canopy Health to Learn More

At Canopy Health, we pride ourselves on advocating for the health and wellness of the entire Bay Area, regardless of an individual’s age, health status, or income. Please contact us today at 888-8-CANOPY to learn more about our healthcare network and insurance offerings.

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.

Who provides information about Medi-Cal?

Information about Medi-Cal, resources for applying and eligibility are provided by the Department of Health Care Services.

What is Medi-Cal in California?

Medi-Cal is California’s Medicaid program . Medicaid is partly funded by the federal government and partly by the state. In California, Medi-Cal provides unified health insurance benefits that cover all necessary medical expenses up to the program’s limits.

What is Medicare for seniors?

Medicare is the federal health insurance program that provides broad-based coverage for inpatient care, outpatient treatment, doctors’ visits, preventive care and medical testing . Medicare is limited to seniors aged 65 and older and disabled individuals. People from any state can qualify for the program.

Can I sign up for Medi-Cal online?

California residents who need low- or no-cost health coverage can sign up for Medi-Cal online or through an intake worker at their county’s office of human services. Once approved, benefits may be retroactively applied to medical expenses incurred over the prior few months. Medi-Cal benefits include some services that aren’t covered by Medicare, such as non-emergency transportation to and from medical appointments.

Is Medicare available in California?

citizens and permanent legal residents. Medi-Cal beneficiaries must be residents of California and may be of any age, while Medicare is open to all eligible U.S. residents aged 65 and over. Individuals receiving Social Security or Railroad Retirement Board disability benefits and those with certain chronic medical conditions qualify for Medicare coverage before age 65. Medi-Cal participation requires verification of income and assets. Individuals whose income is higher than the no-cost threshold but lower than the program cutoff may qualify for share-of-cost coverage.

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.

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.

What is a Cal MediConnect plan?

Cal MediConnect Plans manage your Medicare and Medi-Cal benefits within one health plan.

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.

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.

How many parts does Medicare have?

Medicare has 3 parts—Part A, B and D.

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 ...

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 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 the CMC plan for Orange County?

The CMC plan for Orange County residents is OneCare Connect, offered by Cal Optima. This plan combines your Medicare and Medi-Cal services into one plan with additional benefits, including transportation, vision, dental, and care coordination.

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 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 ALS?

People of any age with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

How many cards do you need for home health?

With all your health and home care services coordinated together, members have one card to present at medical appointments and one phone number to call with any questions.

What is Medi-Cal for Medicare?

Medi-Cal (for People with Medicare) Medi-Cal, the Medicaid program in California, provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. While there are several ways to qualify for Medi-Cal, this section focuses only on Medi-Cal beneficiaries who also qualify for Medicare — individuals who are ...

What determines if you qualify for Medi-Cal?

If you meet the asset requirements, your income determines the Medi-Cal program for which you qualify. See next section.

What is Cal MediConnect?

Cal MediConnect is a demonstration program with the goal of integrating care for people with both Medicare and Medi-Cal. The demonstration is happening in 7 selected counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara, and began on various dates depending on the county.

What is the best Medicare plan for dual eligibles?

If you choose an MA plan, the MA plan that works best for people with both Medicare and Medi-Cal is the Special Needs Plan (SNP) for dual eligibles or D-SNP. If you’re enrolled in a D-SNP, you do not have copays, coinsurance or premiums associated with other types of MA plans.

How much does Medicare pay for generic drugs in 2021?

With Medicare Part D drug coverage, you must make copayments of no more than $1.30 for generic drugs and $9.20 brand name drugs in 2021. The Low-Income Subsidy (LIS) program, also known as the “Extra Help” program, will pay for part or all Medicare Part D drug-benefit plan premiums, depending on the plan in which you are enrolled. Learn more about the Extra Help program and the Medicare Part D drug benefit.

What is Medicare Part D?

2. 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.

How to find out if you qualify for Medi-Cal?

To find out if you qualify for one of Medi-Cal’s programs, look at your countable asset levels. You may have up to $2,000 in assets as an individual or $3,000 in assets as a couple. Some of your personal assets are not considered when determining whether you qualify for Medi-Cal coverage . For example, assets that do not count are: