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.

Medicare cards 2018

Parts A & B

Medicare D AARP sample

Part D

Let’s look at what each part of Medicare covers:

Part A
medicare-A-hospital

  • Hospital care
  • Home health
  • Skilled care in a skilled Nursing facility

Part B – outpatient medical care includes
medicare-B-various

  • Physician services’
  • Ambulance
  • X-rays and laboratory services
  • Mental health
  • Emergency care
  • Medical equipment

Part D—prescription drugs
medicare-D-drugs

 


Medi-Cal is your secondary insurance. Medi-Cal closes the gaps in Medicare coverage and provides additional benefits not covered by your Medicare.

Medi-Cal Cards 2018Medi-Cal –

  • 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 –

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Option 1: Original Medicare  + Part D prescription drug plan (PDP) + Medi-Cal health plan

Medicare cards 2018

You see any Medicare Part A or B provider of your choice.

Medicare D AARP sample

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.

Medi-Cal Cards 2018

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.

Option 2: Medicare Advantage Plan + Medi-Cal health plan

Medicare Advantage

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

Medi-Cal Cards 2018

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.

Option 3: Enroll into a Cal MediConnect Plan

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.