Medi-Cal
What is Medi-Cal?
Medi-Cal is California's Medicaid program, a public health insurance program which provides needed health care services for certain individuals with limited income and assets. Those that may qualify for Medi-Cal include families with minor children, seniors, people with disabilities, children in foster care, pregnant women, and people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is funded by both the Federal and state government.
In Ventura County, contact the Human Services Agency at 1-866-904-9362 to learn more about applying for Medi-Cal.
Can I have both Medicare and Medi-Cal?
It is possible to qualify for both Medicare and Medi-Cal. People who are eligible for both programs are known as "Medi-Medi" or "Dual Eligible" beneficiaries. If you obtain hospital or medical services from providers who accept both Medicare and Medi-Cal, Medi-Cal will help pay for the deductibles, coinsurance, and copayments that Medicare does not cover.
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What is a Medi-Cal Share of Cost (SOC)?
Some people qualify for Medi-Cal with a Share of Cost (SOC) depending on their income and circumstances. A SOC is like a monthly deductible that must be met before Medi-Cal will pay for any covered medical expenses.
Example:
A Medi-Cal beneficiary has a SOC of $600.00. Her out-of-pocket medical expenses for the month would have to exceed $600 before Medi-Cal will pay.
In the month of June, the only medical service this beneficiary received was one doctor visit that cost $50. She had to pay out-of-pocket since she did not meet the Share of Cost (SOC) for the month.
In the month of July, this beneficiary was hospitalized for one day that cost $1000. The beneficiary pays the monthly, $600 Share of Cost and Medi-Cal pays the rest.
For more information, call HICAP at 1-800-434-0222 to schedule an appointment.
I have Medicare and Medi-Cal, "Medi-Medi." What covers my prescription medications?
"Medi-Medi" or "Dual Eligible" beneficiaries receive drug coverage under Medicare Part D. Beneficiaries with full Medi-Cal without a Share of Cost (SOC) automatically qualify for Low-Income Subsidy (LIS), Extra Help for Medicare Part D costs. Beneficiaries with a Medi-Cal Share of Cost may also be eligible for Low-Income Subsidy.
For more information, call HICAP at 1-800-434-0222 to schedule an appointment.
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What is Low-Income Subsidy (LIS) for the Medicare Part D Prescription Plan?
Low-Income Subsidy (LIS) offers help from Medicare to reduce prescription drug costs for those who meet the eligibility criteria. Those who qualify for Low-Income Subsidy have:
- Lower or no Part D plan premium.
- Discounted copayments.
- No coverage gap or "donut hole."
- The right to change Part D plans month-to-month
You qualify for the Low-Income Subsidy if you have Medicare and meet one of these conditions:
- You have full Medi-Cal coverage.
- You belong to a Medicare Savings Program (MSP). See information on Medicare Savings Programs below.
- Your income is below 150% of the Federal Poverty Level and you meet the LIS resource guidelines.
If you have Medi-Cal with a Share of Cost (SOC) or monthly deductible, you may still qualify for LIS even if your income is above 150% of the Federal Poverty Level. If you meet your SOC for any one month between January 1 to June 30, you are "deemed" eligible for the LIS program for the rest of the calendar year. If you meet your SOC for any one month between July 1 to December 31, you are also "deemed" eligible for LIS for the rest of the calendar year plus the following year.
For more information or to apply for Low-Income Subsidy (LIS), contact HICAP at 1-800-434-0222 to schedule an appointment.
What are Medicare Savings Programs (MSP)?
Medicare offers several Medicare Savings Programs (MSP) that assist people with low income and assets with their Medicare costs: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled & Working Individual (QDWI).
Though these are Federal programs, Medi-Cal administers them. A client may qualify for a Medicare Savings Program, however, but not qualify for Medi-Cal because the asset limits for MSP are higher than those for Medi-Cal.
Beneficiaries who qualify for MSP also automatically qualify for Low-Income Subsidy (LIS), extra help for their Part D prescription costs.
Qualified Medicare Beneficiary (QMB)
- Pays premiums for Medicare Part A (if applicable) and Part B for beneficiaries who meet the income and asset guidelines.
- Pays deductibles for both Part A and Part B.
- Pays the coinsurance or copays for Part A and B.
Specified Low-Income Medicare Beneficiary (SLMB)
- Pays the Medicare Part B premium for beneficiaries who meet the income and asset guidelines.
Qualifying Individual (QI)
- Pays the Medicare Part B premium for beneficiaries who meet the income and asset guidelines.
Qualified Disabled & Working Individuals (QDWI)
- Pays the Medicare Part A premium only for beneficiaries who meet the income and asset guidelines.
- Beneficiary must have had Social Security and Medicare benefits because of a disability, but lost them because they returned to work and their earnings exceeded the allowable limit.
For more information or to apply for a Medicare Savings Program (MSP), call HICAP at 1-800-434-0222 to schedule a one-on-one appointment.