Medi-Cal Facts For Seniors

MediCal Facts For Seniors

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What is Medi-Cal?

Medi-Cal is the California name for Medicaid.  This is a federal and state funded health coverage program for persons with low incomes and limited assets. 

There are many Medi-Cal programs, but most HICAP clients are in the Aged and Disabled Federal Poverty Level program which provides health and medical care for both seniors 65 and over and disabled persons who qualify because of limited resources and income. 

See below for details about resource limits and income.

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 for those with full scope Medi-Cal with no share of cost.

What does Medi-Cal cover?

Adult day health services Hospice care
Ambulance services Hospital and nursing home care
Dental care Medical equipment
Doctor visits Prescription drugs
Eyeglasses Prosthetic/ orthopedic devices
Hearing aids X-ray and laboratory tests
Home health care

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. IRA’s, 401K’s and other tax-qualified retirement plans don’t count as resources if you’re taking monthly distributions. However the income from the distributions are counted as income.

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 $1,240 for an individual, and not more than $1,665 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 if they meet the resource requirements.

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.
  • A Share of cost is likely a monthly deductible. It is not something you have to pay every month. If you don’t incur any medical bills, you do not have to pay anything.
  • 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 to the extent that you have medical bills.
  • 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 any month in which you meet your share of cost.

Click here for information on how to eliminate your Share of Cost.

Other Assistance Programs

There are other assistance programs which can also help with some of your Medicare costs. One is the Qualified Medicare Beneficiary (QMB) program which  pays Part A and Part B premiums for eligible beneficiaries. Other programs pay the Part B premiums and help with Part D costs. Click here to learn more about QMB and other Medicare Savings Programs.

For those with income and assets too high for Medi-Cal or a Medicare Savings Program, there is Extra Help for Part D. See Medi-Cal and Part D below to learn more about Extra Help.

We have a chart to help determine eligibility for all the Low Income Assistance programs. Click here to view the chart.

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) or a Medicare Savings Program, 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 for those with full Extra Help
  • No coverage gap
  • Co-payments between $1.20-$3.60 for those with full, no Share of Cost Medi-Cal

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:

  1. 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. You can get an application from Social Security or apply online at SSA.gov.
  2. 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.
 Income Limits for Extra Help*  $1,485/mo single; $2,003/mo couple
 Resource Limits for Extra Help**  $13,640 single; $27,250 couple

*monthly withdrawals from IRAs and other tax-qualified retirement plans are not counted as income, but the value of the plan is counted as a resource. More income is allowed for those who are working.
**Resources that are not counted include your home, one car, personal and household belongings, and certain life insurance and burial funds or policies.

Click here for more information about Extra Help.

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. You can apply online or download a Medi-Cal application at:
www.dhcs.ca.gov/Services/medi-cal/pages/applyformedi-cal.aspx.

  • 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 866-663-3225.

Adapted with permission from Legal Assistance for Seniors and HICAP of Alameda County

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