Alyssa Lane
UC San Diego Health accepts some Medi-Cal plans, including fee-for-service (FFS) and some managed care plans. However, it's important to note that the list of accepted plans is subject to change and may be updated periodically. UC San Diego Health also specifies that Medi-Cal typically only covers specialty care referrals and does not provide primary care access. Students at UC San Diego with Medi-Cal insurance may need to rely on other health centres for primary care. Additionally, students with Medi-Cal insurance can consider applying for a UCSHIP grant to cover the cost of healthcare services offered by the university.
| Characteristics | Values |
|---|---|
| Does UC San Diego Health accept Medi-Cal insurance? | Yes, UC San Diego Health accepts Medi-Cal FFS and some Medi-Cal managed care plans. |
| What are the accepted Medi-Cal managed care plans? | Anthem Blue Cross AIM (Access for Infants and Mothers) HMO, Blue Shield Promise Medi-Cal HMO, Community Health Plan of Imperial Valley, CalOptima, Community Health Group (CHG) Medi-Cal HMO, Health Net, Molina Medi-Cal, Anthem MediBlue Coordination Plan Plus HMO, Blue Shield Total Dual D-SNP, SCAN Connections Cal MediConnect, Community Health Group (CHG) CommuniCare Advantage Cal MediConnect |
| What is the process to waive UC SHIP coverage? | Students must submit a waiver application prior to the start of each new academic year. The insurance plan must meet the university's health insurance requirements and provide unrestricted access to an in-network primary care provider, in-network hospital, and full non-emergency medical and mental health care within a reasonable distance of the campus. |
| What are the accepted insurance plans for enrolled students at UC San Diego? | Medi-Cal/Medicaid, Medicare, TRICARE/military, Veterans Affairs benefits, Covered California, or other U.S. federal or state exchange plans, or a UC employee health plan. |
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What You'll Learn
- UC San Diego Health accepts Medi-Cal FFS and some managed care plans
- Dual-eligible plans serve people eligible for both Medicare and Medi-Cal
- Students can waive UC SHIP coverage if they have other health insurance
- UC San Diego Health is contracted with most major insurance plans
- Primary care access is limited with some Medi-Cal plans
UC San Diego Health accepts Medi-Cal FFS and some managed care plans
UC San Diego Health's acceptance of Medi-Cal plans is beneficial for individuals who are dually eligible for both Medicare and Medi-Cal. This dual-eligible status allows individuals to access a range of healthcare services through the two programs. It is important to note that the list of accepted Medi-Cal plans is subject to periodic updates and changes, so it is advisable to verify the current status directly with the insurance provider or UC San Diego Health.
In the context of UC San Diego, there are separate considerations for students regarding health insurance. The university offers its Student Health Insurance Plan (UC SHIP) as a comprehensive health coverage option for enrolled students. Students with Medi-Cal coverage can choose to waive UC SHIP if they meet certain criteria, including having insurance that provides unrestricted access to primary care and mental health services within a reasonable distance of the campus or their place of residence. Students with Medi-Cal coverage may face challenges in fully accessing the required services, as mentioned in some student accounts, due to the limited network of providers accepting Medi-Cal.
To waive UC SHIP, students must submit a waiver application annually before the start of each new academic year. The university will then verify the student's active enrollment in their alternative health insurance plan throughout the year. If a student's insurance situation changes, and they no longer have active enrollment in a qualified health plan, they will be enrolled in UC SHIP and charged the cost of coverage for that term. Understanding the specific requirements and processes for waiving student health insurance is essential for students navigating their healthcare options while attending UC San Diego.
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Dual-eligible plans serve people eligible for both Medicare and Medi-Cal
UC San Diego Health (UCSD Medical Center) accepts some dual-eligible plans, which serve people eligible for both Medicare and Medi-Cal (formerly known as MediConnect). These plans are available to those enrolled in both Medicare and Medicaid, with Medicare acting as the primary source of health insurance coverage, and Medicaid providing supplemental coverage.
UCSD Medical Center accepts Medi-Cal fee-for-service (FFS) and contracts with several Medi-Cal managed care plans. However, these plans typically only cover specialty referrals and do not include primary care access.
- Anthem MediBlue Coordination Plan Plus HMO: Specialty referrals only, no primary care.
- Blue Shield Total Dual D-SNP: Specialty care only with a referral and authorization from the provider. No primary care access.
- SCAN Connections Cal MediConnect: Specialty services only with a referral and authorization from the provider. No new primary care access.
- Community Health Group (CHG) CommuniCare Advantage Cal MediConnect: Specialty referrals only, no new primary care.
- CalOptima: Specialty referrals only, no primary care access.
- Molina Medi-Cal: Specialty referrals only, no primary care access.
- Anthem Blue Cross AIM (Access for Infants and Mothers) HMO.
- Blue Shield Promise Medi-Cal HMO (formerly Care 1st): Specialty referrals; primary care limited to HIV patients only.
- Community Health Plan of Imperial Valley: Specialty referrals only, no primary care access.
- Community Health Group (CHG) Medi-Cal HMO: Specialty referrals only, no new primary care except for pediatric patients through UCSD Pediatrics Associates.
- Health Net: Specialty referrals only, no primary care access.
It is important to note that these lists may be subject to change and periodic updates.
In terms of student health services, UC San Diego offers the UCSHIP grant, which covers the cost of doctors within the area who accept Medi-Cal. Students with a zero Expected Family Contribution (EFC) may qualify for an additional grant to cover the entire year's cost.
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Students can waive UC SHIP coverage if they have other health insurance
UC San Diego Health and UC San Diego Medical Group are contracted with most major insurance plans. They accept some Medi-Cal plans, including fee-for-service (FFS) and some managed care plans.
UC SHIP (University of California Student Health Insurance Plan) is a mandatory, cost-effective healthcare coverage plan for all UC students, including undergraduate and graduate students, as well as their eligible dependents. It includes a wide range of services such as medical, pharmacy, dental, vision, mental health, and substance use disorder support. Students are automatically enrolled in UC SHIP at the start of each academic year, but they can waive this coverage if they have other health insurance that meets the waiver criteria.
Waiver criteria require that the student's health plan provides unrestricted access to an In-Network Primary Care Provider (PCP) within 50 miles of campus. Students must submit an online waiver application with supporting documentation, such as an electronic copy of their current insurance card and a Summary of Benefits and Coverage (SBC) document, during the waiver period each academic year. An approved waiver application will be valid for the remainder of the academic year.
Students at UC San Diego have reported difficulties accessing care with Medi-Cal due to the distance from campus, and some have chosen to add UC SHIP to have better access to doctors within the area that accept their insurance.
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UC San Diego Health is contracted with most major insurance plans
UC San Diego Health also accepts individual and family group PPO plans (Platinum, Gold, Silver, or Bronze) bought directly through Blue Shield or Covered California. They also contract with several managed care plans for those eligible for both Medicare and Medi-Cal, formerly known as MediConnect. These include Anthem MediBlue Coordination Plan Plus HMO, Blue Shield Total Dual D-SNP, and SCAN Connections Cal MediConnect.
For students at the University of California San Diego, there is also the option to enrol in UC SHIP, which satisfies the university's health insurance requirement. To waive UC SHIP coverage, students must have other health insurance coverage that meets the university's criteria, including unrestricted access to an in-network primary care provider and in-network hospital, as well as full non-emergency medical and mental health care within a reasonable distance of the campus.
It is important to note that the list of accepted insurance plans at UC San Diego Health is periodically updated and subject to change. Therefore, it is always advisable to verify coverage with your insurance company and provide the appropriate tax ID numbers for UC San Diego Medical Group (physicians) and UC San Diego Health/UCSD Medical Center (hospitals).
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Primary care access is limited with some Medi-Cal plans
UC San Diego Health (UCSD Medical Center) and UC San Diego Medical Group are contracted with most major insurance plans, including some Medi-Cal plans. However, primary care access is limited with specific Medi-Cal plans.
The following is a list of Medi-Cal plans that UC San Diego Health accepts, along with their limitations regarding primary care access:
- Medi-Cal FFS: This plan is accepted for specialty referrals only, and there is no primary care access.
- Anthem Blue Cross AIM (Access for Infants and Mothers) HMO: While this plan is accepted, primary care is limited to HIV patients only.
- Blue Shield Promise Medi-Cal HMO (formerly Care 1st): Similar to the Anthem Blue Cross AIM plan, this plan offers specialty referrals, but primary care is restricted to HIV patients.
- Community Health Plan of Imperial Valley: Specialty referrals are accepted under this plan, but there is no access to primary care.
- CalOptima: This plan only allows specialty referrals, and no primary care access is available.
- Community Health Group (CHG) Medi-Cal HMO: While this plan offers specialty referrals, there is no new primary care access for adults. However, pediatric patients can receive primary care through UCSD Pediatrics Associates.
- Health Net: With this plan, members can only access specialty referrals, and primary care is not available.
- Molina Medi-Cal: This plan is limited to specialty referrals, and those enrolled do not have primary care access.
- Anthem MediBlue Coordination Plan Plus HMO: Specialty referrals only, with no primary care access.
- Blue Shield Total Dual D-SNP: This plan provides specialty care, but only with a referral and authorization from the member's provider or Blue Shield. No primary care access is available.
- SCAN Connections Cal MediConnect: This plan offers specialty services with referrals and authorizations, but there is no new primary care access.
- Community Health Group (CHG) CommuniCare Advantage Cal MediConnect: While specialty referrals are accepted, this plan does not provide new primary care access.
It is important to note that these lists of accepted Medi-Cal plans and their limitations regarding primary care access are subject to change and may not be exhaustive. Additionally, as mentioned in a UC San Diego-related forum, individuals with Medi-Cal as their primary insurance have found it challenging to access nearby medical services, often having to travel significant distances to find doctors who accept their insurance.
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Frequently asked questions
Yes, UC San Diego Health accepts Medi-Cal fee-for-service (FFS) and some Medi-Cal managed care plans.
Some of the accepted Medi-Cal managed care plans include Anthem Blue Cross AIM (Access for Infants and Mothers) HMO, Blue Shield Promise Medi-Cal HMO, and Molina Medi-Cal.
To verify your insurance coverage, contact your insurance company and provide the appropriate tax ID number. For UC San Diego Medical Group (physicians), the tax ID number is 23-7064656, and for UC San Diego Health/UCSD Medical Center (hospitals), it is 33-0599494.
