Frequently Asked Questions : Medi-Cal and Covered California Eligibility

Medi-Cal Health Coverage

1.       What is Medi-Cal?

Medi-Cal is California’s low-income health insurance coverage. It provides Californians with full coverage healthcare for low or no cost. Medi-Cal can be enrolled into by Californians who meet the income and household size eligibility requirements. Medi-Cal can provide coverage for Adults, Children, Pregnant Women and Families.  Unique to California, Medi-Cal applicants can have higher incomes up to 138% of the federal poverty level and still be eligible. If you are eligible for Medi-Cal and apply through Covered California, your application will automatically be sent to your local county for processing.

2.       How Much is Medi-Cal?

For most people on Medi-Cal there is no monthly premium, co-insurance or out of pocket costs for their health services. A smaller number of households will have a low cost monthly premium of $13 per child or up to $39 a month for the whole family.

3.       Are there differences between Medi-Cal and Covered California?

Medi-Cal is health insurance similar to Covered California but may provide benefits through different healthcare networks and providers. Both Covered California and Medi-Cal provide coverage for the 10 main “essential health benefits”. These essential benefits are :

• Outpatient (Ambulatory) services 
• Emergency services 
• Hospitalization 
• Maternity and Newborn care 
• Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment 
•  Prescription Drugs 
• Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices 
• Laboratory services 
• Preventive and wellness services & chronic disease management 
• Children’s (Pediatric) services, including oral and vision care.

4.   What are the types of health plans available through Medi-Cal?  

Medi-Cal offers health insurance coverage that is Managed by one of 21 health plans. These plans will vary from one county to another, depending on where you live. In many counties there are private plans that are offered through Medi-Cal and Covered California. These plans can be:

• Anthem Blue Cross
• Kaiser
• Healthnet
• Molina

Additionally, there are plans specifically run by the government and administered by local counties. The plan benefits are the identical in each county in California, but the enrollment process may differ slightly.

5.       Does Medi-Cal allow me to keep my doctor

Although Medi-Cal providers contract with 400 hospitals and 130,000 doctors not all participate with every plan in every county. Many doctors accept both Covered California and Medi-Cal coverage but not all. It would be important to check with your doctor if they will accept either your Covered California or Medi-Cal plan.

6.       Can different people in the same household be eligible for Covered California and Medi-Cal at the same time?

Yes, because of the way that Medi-Cal Eligibility works it means, in many cases, children will be eligible for Medi-Cal while adults will be eligible for coverage through Covered California. Another situation could be that if members of the same household have different citizenship status’. They both may be eligible for Medi-Cal based off income and household size, but only one may be able to enroll in Medi-Cal because of their citizenship status.

7.       Can somebody decline Medi-Cal and enroll into a Covered California Plan?

Yes, it is possible to enroll into a Covered California plan instead of Medi-Cal. But in most cases it will mean that you will not be eligible to receive monthly financial assistance. Additionally for consumers who are concerned about public charge, which means enrollment into Medi-Cal can affect their eligibility for US citizenship, they may apply for health coverage outside of Medi-Cal or Covered California.

8.       What is the Deadline for enrollment into Medi-Cal

There is no specific deadline or open enrollment period to enroll into Medi-Cal. It is possible for anybody to apply for Medi-Cal at any time, as long as they are residents of California. Covered California on the other hand, does have a specific Open Enrollment Period from November 1st through January 31st.

9.       If a household’s income increases and they lose eligibility for Medi-Cal, can they apply for Covered California?

Yes, if a household’s income increases and they lose eligibility for Medi-Cal they will have a Special Enrollment Period of 60 Days to apply for coverage through Covered California or directly through an insurance company. There are additional qualifying life events that will qualify a person for a Special Enrollment Period through Covered California:

• Permanently moved to/within California 
• Lost or will soon lose their health insurance, including Medi-Cal eligibility (also known as loss of Minimum Essential Coverage (MEC)
•  Had a baby or adopted a child
• Got married or entered a domestic partnership
•  Domestic violence survivors (If married, the abuser’s income is not counted if the survivor lives apart and is unable to file a joint tax return.)
• Returned from active duty military service
• Released from jail or prison
• Gained citizenship/lawful presence
• Federally Recognized American Indian/ Alaska Native
• Other qualifying events as identified on the Covered California portal

10.   If I own a car will I be denied from Medi-Cal?

After the passage of the Affordable care act, the eligibility requirements for Californians under the age of 65 changed. These new changes eliminated the asset requirement for people under the age of 65 . This means owning a car or a house or having cash in savings will not count against your eligibility for Medi-Cal. Currently Medi-Cal eligibility is based on income only. If your income is within the limits for Medi-Cal eligibility, then you will be able to apply regardless if you have a car or other sorts of assets.  

11.   Can enrolling in Medi-Cal affect my Assets?

Under current rules Medi-Cal only tries to recover assets from individuals who are over the age of 55 years old and are residing in a skilled nursing facility or Nursing home. Medi-Cal will not seek repayment for those costs from your estate during your lifetime or during the lifetime of your spouse or disabled children under the age of 21. For people under the age of 55 Medi-Cal will not seek repayment from your assets for any nursing facility services you received under the age of 55.

12.   Will all members of my family qualify for the same Medi-Cal plan?

It’s possible that all members of your household will qualify for the same plan through Medi-Cal. But, because of the difference in income eligibility for children, adults, and seniors, it’s possible that household members may be eligible for Medi-Cal, Covered California and Medicare only, at the same time.

13.   If I am pregnant can I get health coverage during my pregnancy?

It is possible to get Medi-Cal coverage during your pregnancy, if you fall within the eligibility guidelines. But under Covered California rules, pregnancy is not a qualifying life event. Although having a baby is. Your eligibility will depend on your income and household size information.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.