What is Medi-Cal? Medi-Cal is a government program that pays for health and medical care for seniors 65 and over who have low incomes and limited resources.
What does Medi-Cal do? Medi-Cal pays for:
- Health and medical services when you use a Medi-Cal doctor, provider, or facility.
- Medicare Part B premiums.
What does Medi-Cal cover?
- Adult day health services
- Ambulance services
- Dental care
- Doctor visits
- Hearing aids
- Home health care
- Hospice care
- Hospital and nursing home care
- Medical equipment
- Prescription drugs
- Prosthetic/orthopedic devices
- X-ray and laboratory tests
How many resources can I have? No more than $2,000 countable resources if you are single or $3,000 for a married couple. Countable resources include bank accounts, certificates of deposits, stocks, and bonds. Resources that are not counted include your home, one car, personal and household belongings, and certain life insurance and burial funds or policies.
How much income can I have? To be eligible for Medi-Cal with no share of cost, your monthly unearned* income must not be more than $1,133 for an individual, and not more than $1,579 for a married couple. (*More income is allowed for those who are working.)
- Those on SSI are automatically eligible for Medi-Cal.
- Those who have income over the Medi-Cal limit may still be eligible for Medi-Cal with a share of cost.
What is a share of cost? If your income is more than the Medi-Cal income limits, you can qualify for Medi-Cal, but you will have a share of cost.
- Share of cost is the share of your medical bills that you must incur before Medi-Cal pays the rest of your covered medical bills for that month.
- To find your approximate share of cost, subtract $600 for an individual ($934 for a couple) from the amount of your monthly income. The difference is what you will owe for your medical bills for that month.
- Resource limits for Medi-Cal with a share of cost are the same as those for regular Medi-Cal with no share of cost.
- If your medical bills for a month are less than the amount of your share of cost, Medi-Cal will not pay for any of your medical bills.
- Medi-Cal only pays during the months when your medical bills are more than your share of cost.
- Medi-Cal pays the Medicare Part B premium for individuals whose share of cost is less than $501.
The Qualified Medicare Beneficiary (QMB) program also pays Part A and Part B premiums for eligible beneficiaries
Medi-Cal and Medicare Part D
If you are covered by Medi-Cal, you may be entitled to extra help in paying for prescription drug cost under a Medicare Part D plan.
If you have full Medi-Cal benefits (no Share of Cost), you do not need to apply for extra help. You will be automatically enrolled. Extra help includes:
- No monthly premium in designated plans
- No deductible
- No coverage gap
- Co-payments between $1.10-$6.00
If you are not in a Part D plan, you will be assigned to a plan. You have the right to change plans monthly, if desired.
If you have Medi-Cal with a Share of Cost, you may qualify for extra help in one of two ways:
- Complete and return the Social Security application for extra help with prescription drug costs. Social Security will advise you if the application has been approved and what the benefits will be.
- If you meet your Share of Cost expenses in one month, you are entitled to receive extra help on prescription drug costs for the rest of the year. If the Share of Cost is met between July 1 and December 31, you will be considered eligible for extra help for the following year as well.
How do I apply for Medi-Cal benefits?
- Call the Contra Costa County Medi-Cal Center at 1-800-709-8348. Ask for the Medi-Cal intake line and say that you want to start your Medi-Cal application over the telephone.
- Have your Social Security number and birth date available.
- If you are eligible for Medi-Cal, your benefits will start on the date you called. If you do not start the application process by telephone, your benefits will start on the date you return your application to the address indicated on the form.
- Check “YES” in box 53 of the Medi-Cal application to start benefits up to three months before your application date.
- For information regarding the status of an application, call the Medi-Cal Service Center at 1-866-663-3225.
Adapted with permission from Legal Assistance for Seniors and HICAP of Alameda County
HICAP — Health Insurance Counseling and Advocacy Program of Contra Costa County 1-800-510-2020