Paul Sanchez
Medi-Cal is a government-funded health insurance program for low-income residents of California. It offers free or low-cost health care to those who qualify, with eligibility based on income and family size. Once enrolled, members receive a benefits identification card (BIC) and informational material about their chosen health plan. Members can access services like anyone with a private insurance plan, and can even start using their coverage before choosing a specific health plan.
| Characteristics | Values |
|---|---|
| Qualification Criteria | Income up to 138% of the Federal Poverty Level (FPL) for adults and 266% FPL for children |
| Notification | Packet of health plan options in the mail |
| Coverage Start | Before choosing a health plan |
| Plan Choice | Choose within 30 days, else Medi-Cal will choose for you |
| Plan Options | Dependent on the county of residence |
| Renewal | Annually on the original sign-up date |
| Changes to be Reported | Household changes to be reported within 10 days to the local county social services office |
| Cancellation | Call your local county office |
| Member Services | Available online and by phone |
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What You'll Learn
Income eligibility for Medi-Cal
Medi-Cal, California's Medicaid program, provides health coverage to people with low incomes and asset levels who meet certain eligibility requirements. To qualify for full Medi-Cal coverage, you must meet the income and asset requirements.
If you qualify for Supplemental Security Income (SSI), you automatically qualify for full Medi-Cal coverage. To qualify for SSI, you must be 65 or older, blind, or disabled. Your countable monthly income must not exceed $954.72 if you're an individual or $1,598.14 if you're a couple (higher income levels apply if you're blind). If you are 65 or older, or disabled, and are not eligible for SSI, you may still be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. To qualify through this program, you must be 65 or older or meet the Social Security definition of disability, even if you are blind. Additionally, you must have less than $2,000 in assets as an individual or $3,000 in assets as a couple.
It's important to note that not all income is considered when determining eligibility. For example, if you are married and your spouse is not applying for Medi-Cal, their income will not be counted towards your eligibility. Additionally, certain assets are exempt, such as your home, car, and personal belongings.
Once you qualify for Medi-Cal, you will receive a packet in the mail outlining the health plans available to you. You can start using your coverage even before choosing a specific plan. If you do not choose a health plan within 30 days, Medi-Cal will select a plan for you based on your county of residence.
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Medi-Cal health plan options
Medi-Cal is California's version of the Medicaid healthcare program. It provides free or low-cost health care coverage to California residents with limited incomes who meet the eligibility criteria, including income guidelines, regardless of their immigration status. When you qualify for Medi-Cal, you will receive information about the health plans you can choose from. If you do not choose a health plan within 30 days, Medi-Cal will choose one for you, based on the county you live in.
One of the largest Medi-Cal plans in California is L.A. Care Medi-Cal, which provides health care coverage to beneficiaries in Los Angeles County. As a member, you have access to all Medi-Cal benefits and services, including care coordination, referrals to specialists, 24-hour nurse advice via telephone, and Member Services assistance that is available 24/7, including holidays. L.A. Care also helps you find the right doctor, pharmacy, and health education programs to benefit your overall health. You can choose to get your healthcare from L.A. Care or one of their Plan Partners, such as Anthem Blue Cross and Blue Shield of California Promise Health Plan.
L.A. Care Health Plan provides comprehensive coverage of health benefits, ensuring access to essential health care services at no cost. This includes primary and specialist care, hospital and emergency services, vision and dental services, and more.
To see the plans available in your county, visit the Medi-Cal Managed Care Health Plan Directory.
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How to enrol in Medi-Cal
To enrol in Medi-Cal, you must first apply to see if you qualify for coverage. You can apply online on CoveredCA.com, in person, or by phone. The application will take about an hour to complete, and you can save your application and return to it later if needed.
Before starting your application, it is recommended that you have the necessary documents on hand to ensure a seamless enrollment process. You can also get free, confidential help with your application by phone or at one of the many enrollment centres with certified enrollers statewide.
Once you have submitted your application, you will receive a packet in the mail with health plans you can choose from if you qualify for Medi-Cal. You must choose a health plan within 30 days, or Medi-Cal will select a plan for you. You can start using your coverage before you have chosen your health plan. Your choices will depend on the county you live in, and you can see the plans available in your county by visiting the Medi-Cal Managed Care Health Plan Directory.
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Cancelling your Medi-Cal coverage
To cancel your Medi-Cal coverage, you must first provide a reason for withdrawing your application and discontinuing your coverage. For instance, if you've changed jobs and your new employer offers health insurance coverage, you may need to cancel your Medi-Cal plan. You can download the relevant form from the California Department of Health Care Services website and submit it to your local county office in person.
If you need to cancel your health or dental plan with more than 14 days' notice, you can do so by logging in to your Covered California account. Covered California requires at least 14 days' advance notice to process this request. It is recommended that you request plan termination to be effective at the end of the month. For example, to end coverage on June 30, you would need to call Covered California by June 16. It is not recommended that you request to cancel your insurance in the middle of the month, as your insurance company is not obligated to refund prorated monthly premiums.
If you need to cancel your health or dental plan with fewer than 14 days' notice, you can call the Covered California Service Center or contact your health or dental insurance company directly. These requests are handled on a case-by-case basis. If you need to cancel your vision plan, you must call the vision insurance company directly.
Once your Medi-Cal coverage is discontinued, you have 60 days to start new health insurance. To avoid a gap in your health insurance coverage, it is recommended that you enroll in a new plan as soon as possible.
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Medi-Cal member services
When you qualify for Medi-Cal, you will receive a packet in the mail with health plans to choose from. You can start using your coverage before choosing your health plan. If you do not choose a plan within 30 days, Medi-Cal will choose one for you, depending on the county you live in. You can switch your Medi-Cal plan at any time by calling Medi-Cal Managed Care Health Care Options or by completing a Choice Form.
Your county social services office will assist you when you need to renew your Medi-Cal plan. They will contact you if they need any information or send you a renewal form. For further assistance, you can contact your county's Medi-Cal office or the Medi-Cal Member Helpline.
Your health insurance company handles premium payments, ID cards, and benefits and eligibility. They can inform you of how you paid your service claims and help you find a covered medical provider or change your primary care physician.
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Frequently asked questions
You will receive a benefits identification card (BIC) in the mail, along with an informational packet explaining the available health plan options in your county and how to enrol. You can also call the Medi-Cal Member Helpline at 1-800-541-5555 for assistance.
If you are notified that you no longer qualify for Medi-Cal, call the service centre within 60 days to discuss your options. You can get free, confidential help from a certified enrolment counsellor.
You can switch your Medi-Cal plan at any time by calling Medi-Cal Managed Care Health Care Options at 1-800-430-4263 or by completing a Medi-Cal Choice Form.
To cancel your Medi-Cal coverage, call your local county office or request cancellation through Covered California.
