Medi-Cal pays for “medically necessary” health care such as:
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. If you qualify for full Medi-Cal (Medi-Cal without a share of cost (SOC)), Medi-Cal will also cover your Medicare Part A and B deductibles and copayments, and pay your monthly Medicare Part B premium. Learn more.
If you have both Medicare and Medi-Cal, how you receive your benefits depends on the county you live in.
For Medicare benefits, you may choose fee-for-service Original Medicare in all counties, or a Medicare Advantage (MA) plan, if available in your county. 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 eligible 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.
Another type of MA plan designed for people with both Medicare and Medi-Cal is a “look-alike” or “mirror” D-SNP. While others on Medicare can join this type of MA plan, the premiums, copayments, and co-insurance are waived for those on Medicare and Medi-Cal. For more information on MA plans, see our Medicare Advantage section.
For Medi-Cal benefits, in some counties, you must join a Medi-Cal managed care plan, but in other counties, you may use fee-for-service Medi-Cal. If you are in a county where you can choose both fee-for-service Medicare and Medi-Cal, make sure your doctor or hospital accepts Medi-Cal as well as Medicare. Present both your Medicare card and your Medi-Cal Benefits Identification Card (BIC) to your doctors and other providers when receiving services, so that they can bill Medicare and Medi-Cal directly. Medicare and Medi-Cal will make payments directly to the providers.
If you enroll in a Medicare Advantage D-SNP or a D-SNP “look-alike”, you must see doctors and other providers in the plan’s network except for emergency and urgent care.
This is just page one of the training for Medi-Cal benefits, to help the dual eligible population.
To take the full course you must be contracted with 4 of the top carriers with Shop N Health and JSA. Please email Tamie Mongold to get contracted ShopAgency65@gmail.com