I have Medicare and Medi-Cal. How does my insurance coverage work together?
When you have Medicare Parts A and B, Medicare is your primary insurance and pays for most of your medical care.
Medicare has 3 parts—Part A, B and D.
Parts A & B
Let’s look at what each part of Medicare covers:
- Hospital care
- Home health
- Skilled care in a skilled Nursing facility
Part B – outpatient medical care includes
- Physician services’
- X-rays and laboratory services
- Mental health
- Emergency care
- Medical equipment
Part D—prescription drugs
Medi-Cal is your secondary insurance. Medi-Cal closes the gaps in Medicare coverage and provides additional benefits not covered by your Medicare.
- Pays your Medicare Part B premium
- Covers your Medicare copayments
- Provides benefits not covered by Medicare such as –
- Hearing aids
- Incontinence supplies
- Dental services
- Vision care
- Medical transportation
- In Home Supportive Services care at home
- Nursing home care
There are different ways to use your Medicare and Medi-Cal benefits. Let’s review your health care options –
You see any Medicare Part A or B provider of your choice.
You enroll into a Medicare Part D plan that only provides drug coverage you pay $1-3 for each prescription per month.
Your Part D plan does not affect your ability to use your Medicare.
Covers your Medicare Part A and B copayments.
Provides additional Medi-Cal benefits such as medical transportation, incontinence supplies, and personal care in a nursing home.
You enroll into a Medicare Advantage managed care plan;
Your Medicare Parts A, B and D benefits are assigned to the plan;
While you are in the plan, you must use plan providers to obtain medical care;
You pay $1-3 for each prescription per month
Covers your Medicare Part A and B copayment.
Provides additional Medi-Cal benefits such as medical transportation, incontinence supplies, and personal care in a nursing home
If you chose Option 1, original Medicare or Option 2, a Medicare Advantage plan, you are required to enroll into a Medi-Cal health plan.
Your enrollment in a Medi-Cal health plan will not limit your ability to use your Medicare coverage.
Your Medi-Cal health plan will only manage most of your Medi-Cal benefits. The Medi-Cal health plan will be responsible for authorizing the Medi-Cal benefits you need.
Now, that we have reviewed how original Medicare or a Medicare Advantage plan work with a Medi-Cal health plan, let’s look at your 3rd option for using your Medicare and Medi-Cal.
Cal MediConnect Plans manage your Medicare and Medi-Cal benefits within one health plan.
How Does a Cal MediConnect Plan Work?
- Working with your primary care doctor, you will get all your Medicare and Medi-Cal covered services from your Cal MediConnect plan providers.
- You can receive medical services outside your Cal MediConnect plan only for emergency care or if you need urgent care outside your service area.
- The Cal MediConnect plan may provide additional benefits such as dental services that are not covered by Medi-Cal.