California’s medical assistance program, otherwise known as Medi-Cal, pays for “medically necessary” health care such as:
- Physician visits
- X-ray and laboratory tests
- Hospital and nursing-home care
- Adult day health services
- Home health care
- Certain prescription drugs excluded as a Medicare Part D benefit
- Prosthetic and orthopedic devices*
- Hearing aids*
- Medical equipment
- Ambulance services
- Hospice care
But there are several caveats to this coverage. First, Medi-Cal will only cover these costs and services if you use previously accepted Medi-Cal providers. And, if you qualify for full Medi-Cal benefits or have Medi-Cal with a share of cost (SOC) under $500, Medi-Cal will also cover your Medicare Part A and B deductibles and copayments, and pay your monthly Medicare Part B premium ($110.50 in 2010).
Share of cost (SOC)- “Share of cost is a term that refers to the amount of health care expenses a recipient must accumulate each month before Medi-Cal begins to offer assistance. Once a recipient’s health care expenses reach a predetermined amount, Medi-Cal will pay for any additional covered expenses for that month. Share of cost is an amount that is owed to the provider of health care services, not to the state.”
You can use Medi-Cal with either:
- Original Medicare
- Medicare Advantage (MA) plan
If you choose Original Medicare and fee-for-service Medi-Cal, make sure your doctor or hospital accepts Medi-Cal as well as Medicare. You must show both your Medicare card and your Medi-Cal Benefits Identification Card (BIC) to your doctor and other providers before receiving services, so they can bill Medicare and Medi-Cal directly. Medicare and Medi-Cal will make payments directly to the providers. Most dually eligible beneficiaries choose this option.
If you choose a Medicare Advantage (MA) plan and fee-for-service Medi-Cal, present your BIC to the network providers of the MA plan so they can bill Medi-Cal for any cost-sharing (i.e., deductibles, copayments and coinsurance).
For services covered only by Medi-Cal, such as long-term care in a nursing home, Medi-Cal is solely responsible. Medi-Cal may also pay for certain in-home services through In-Home Supportive Services (IHSS) when you need long-term care.
The bottom line is, yes Medi-Cal is confusing, time consuming and sometimes difficult to qualify for. The attorneys at the California Elder Law Center know these regulations inside and out and have decades of experience helping individuals just like you qualify for and receive all the benefits they need. Call 800-500-6700 for a free Medi-Cal benefits consultation with one of our expert attorneys. You can keep your home and other assets while also receiving excellent care.
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