Full dual eligibility in California
See how Medicare and full-scope Medi-Cal work together, how full dual differs from partial dual status, and what to check before choosing a coordinated plan.
Start with your current status
Choose the description that looks closest. This tool explains the next questions to ask; it does not determine Medi-Cal eligibility.
Likely full dual status
Medicare generally pays first for Medicare-covered care. Medi-Cal pays last and may help with Medicare cost sharing and additional services.
Usually partial dual status
A Medicare Savings Program may help with premiums and sometimes other Medicare cost sharing. It does not by itself provide all full Medi-Cal benefits.
Confirm before changing plans
Your Medi-Cal card alone may not show whether your benefits are full scope. Use an official source to confirm the coverage and aid status currently on file.
Full dual vs. partial dual
Your county and the state make the official Medi-Cal eligibility determination. Plan eligibility can also depend on your county, Medicare status, and current Medi-Cal category.
How the coverage fits together
Knowing which program handles each type of care makes plan comparisons and billing questions easier.
Medicare is the primary payer for Medicare-covered hospital, medical, and other covered services.
Medi-Cal may pay qualifying Medicare cost sharing and covers certain services Medicare does not cover.
Medicare drug coverage generally handles outpatient prescriptions. Full dual beneficiaries also qualify for Extra Help.
Depending on eligibility, Medi-Cal may cover long-term services and supports, dental, vision, transportation, and other benefits.
Compare the coverage path
California calls its integrated dual-eligible plans Medi-Medi Plans. They are a type of D-SNP, and availability varies by county.
Path A
Path B
Billing protection
A Medicare provider generally may not bill a full dual beneficiary for Medicare Part A or Part B deductibles, coinsurance, or copayments. Other charges can follow different rules.
Protect your eligibility
A change in Medi-Cal status can affect cost sharing and eligibility for a Medi-Medi Plan or D-SNP. Respond to renewal notices and report address or household changes through an official channel.
Visit BenefitsCalOfficial help and sources
Skyline Benefit can help compare Medicare plan choices. State, county, Medicare, and plan agencies make eligibility and benefit decisions.
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FAQ
A full dual beneficiary has Medicare and full-scope Medi-Cal. Medicare generally pays first for Medicare-covered services, and Medi-Cal pays last and may cover certain Medicare cost sharing and benefits Medicare does not cover.
No. A person who has a Medicare Savings Program but not full-scope Medi-Cal is generally considered a partial dual beneficiary. That status may help with certain Medicare costs but does not provide all full-scope Medi-Cal benefits.
A Medi-Medi Plan is a type of Medicare Advantage Dual Eligible Special Needs Plan designed to coordinate Medicare and Medi-Cal benefits through affiliated organizations. Availability and plan choices vary by county.
Not necessarily. Full dual beneficiaries may have different Medicare coverage paths. Compare provider access, prescriptions, pharmacies, benefits, prior authorization, and care coordination before making a change.
Providers generally may not bill full dual beneficiaries for Medicare Part A or Part B deductibles, coinsurance, or copayments. If you receive a bill, contact your plan or 1-800-MEDICARE and ask for help before paying it.
A change or loss of Medi-Cal can affect eligibility for a dual-eligible plan. Respond to Medi-Cal renewal requests, keep your contact information current, and ask your county or plan how a status change affects your coverage.
Skyline Benefit is an independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program.
We do not offer every plan available in your area. Currently we represent 11 organizations which offer 58 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
