Millions of Americans rely on government insurance programs with essential healthcare needs. Both Medicare and Medi-Cal play a key role in managing healthcare costs in the U.S.
In California, some seniors can qualify for both Medicare and Medi-Cal coverage. They are called dual eligible or Medi-Medi beneficiaries. It is crucial that you understand the differences between Medicare and Medi-Cal and how they work together.
When you have Medicare Part A and B, Medicare will be your primary health insurance.
Medi-Cal will be your secondary insurance. It pays for the costs not covered by original Medicare and provides additional benefits.
What are the options for Medi-Medi beneficiaries?
Original Medicare (Part A, Part B and Part D)
Medicare Part A provides inpatient hospitalization, hospice and home health. Part B covers outpatient care, doctor visits, lab testing, durable medical equipment and preventive services.
Medicare Part D covers prescription drugs.
If you decide to stay with Original Medicare, you need to present both Medicare and Medi-Cal cards. With Original Medicare, you can choose any medical providers that accept Medicare and Medi-Cal. Also, you don’t need referrals to see a specialist. In Orange County, Medi-Medi beneficiaries also have a CalOptima Member card and a Part D Prescription Drug Plan card.
Medi-Medi beneficiaries that do not enroll in a Part D Plan or a Medicare Advantage Plan will automatically be enrolled in a Part D benchmark plan.
Also, Medi-Medi beneficiaries are automatically eligible for Extra Help, a program that helps pay for prescription drug co-payments.
Medicare Advantage Plan (Medicare Part C)
These plans are a type of Medicare plan offered by private health insurance companies. Medicare Advantage plans provide Medicare Part A and Part B benefits. In Orange County, many plans also include Part D and offers extra benefits such as dental, vision, hearing and transportation.
Medicare Advantage are either an HMO or PPO. Plan members are assigned a primary doctor and medical group. Also, you need referrals prior to seeing a specialist.
Medicare Advantage plans pay first, and Medi-Cal pays any remaining cost sharing amounts.
Medi-Medi beneficiaries need only present their Medicare Advantage plan card when seeking medical services.
Cal MediConnect (OneCare Connect)
Cal MediConnect is a type of health care plan that promotes coordinated healthcare and long-term services and supports for Medi-Medi seniors. In Orange County, Cal Optima offers OneCare Connect. This plan combines your Medicare and Medi-Cal services into one plan with additional benefits, including transportation, vision, dental, and care coordination.
With all your health and home care services coordinated together, members need to present one card.
Need Help with Your Medi-Medi options?
Skyline Benefit is an independent Medicare broker in Orange County with the expertise in both Medicare and Medi-Cal benefits.
We can help you with reviewing your Medicare and Medi-Cal coverage and finding the best option for you.