Medi-Cal: Medicare in California
Medi-Cal is a Medicare program in the state of California that provides health insurance coverage to people with insufficient income. There are many ways on how to qualify for Medicare in California. Its beneficiaries are either "Medi-Medis" or "Dual-eligibles".
It covers a wide range of health care services such as:
* Laboratory and X-ray tests.
* Health care services during "Adult Day".
* Orthopedic and Prosthetic devices.
* Ambulance services.
* Hospice care.
* Physician home or community visit.
However, Medicare in California only covers these services if the beneficiary relied on providers accepting Medi-Cal. During the payment process, Medicare serves as the "Primary payer" for certain benefits while Medi-Cal is the "Secondary payer". Enrollees who already qualified for full will cover the deductibles of Medicare Parts A & B and will pay their monthly premium for Parts C and D.
It can be used in two ways:
* Medicare Advantage Plan - Here, enrollees are required to present both their Medi-Cal ID and Benefits Identification Card (BIC) to their doctor or providers before receiving their benefits paid by their coverage.
* Original Medicare - This "Fee-for-service" requires the approval of the doctor or hospitals accepting Medicare. Enrollees are also required to present their ID and BIC in this process.
It serves as the "sole payer" when it comes to providing long-term services like nursing home care. It can optionally pay for some "at-home care" services through the In Home Service Support (IHSS), one of the long-term services preferred by many households.
In July 2009, Medi-Cal started to expand their coverage by including orthopedic and prosthetic devices, follow-up visits and initial appointments with a podiatrist. In addition, it pays for hearing aids, excluding the ones for laboratory tests. As of 2010, the coverage for Medicare beneficiaries living at nursing homes are still paid by Medi-Cal.
it offers the following special programs:
1. Aged & Disabled Poverty Level Program (A&D PLP) - Individuals aged 60 and above who cannot qualify for the Supplementary Security Income (SSI) program can still obtain their Medi-Cal through the A&D PLP. The qualification requirements are:
* Aged 65 and above and experiencing disabilities, physically or mentally.
* Have less than $1,130 monthly income if they're single or 1,500 if married.
* Have less than $2,500 individual assets ($4,000 for a couple). However, this requirement is not counted by SSI (as stated by the Medi-Cal Qualification Chart).
2. SSI Program - Enrollees qualifying for SSI will automatically get their health care coverage. Here, the enrollee's monthly income should not exceed $900 (for an individual) or $1,400 (for a couple). Note: higher income levels and extra benefits apply for blind individuals.
The 250% California Working Disabled (CWD) program is dedicated in helping disabled persons employed in various Californian offices to qualify for Medi-Cal without spending their regular income. Qualified CWD enrollees no longer need to pay their entire monthly premium coverage. The monthly premiums in CWD range from $20 - $200 per month (individual) and $30 - $370 (couple).
It covers a wide range of health care services such as:
* Laboratory and X-ray tests.
* Health care services during "Adult Day".
* Orthopedic and Prosthetic devices.
* Ambulance services.
* Hospice care.
* Physician home or community visit.
However, Medicare in California only covers these services if the beneficiary relied on providers accepting Medi-Cal. During the payment process, Medicare serves as the "Primary payer" for certain benefits while Medi-Cal is the "Secondary payer". Enrollees who already qualified for full will cover the deductibles of Medicare Parts A & B and will pay their monthly premium for Parts C and D.
It can be used in two ways:
* Medicare Advantage Plan - Here, enrollees are required to present both their Medi-Cal ID and Benefits Identification Card (BIC) to their doctor or providers before receiving their benefits paid by their coverage.
* Original Medicare - This "Fee-for-service" requires the approval of the doctor or hospitals accepting Medicare. Enrollees are also required to present their ID and BIC in this process.
It serves as the "sole payer" when it comes to providing long-term services like nursing home care. It can optionally pay for some "at-home care" services through the In Home Service Support (IHSS), one of the long-term services preferred by many households.
In July 2009, Medi-Cal started to expand their coverage by including orthopedic and prosthetic devices, follow-up visits and initial appointments with a podiatrist. In addition, it pays for hearing aids, excluding the ones for laboratory tests. As of 2010, the coverage for Medicare beneficiaries living at nursing homes are still paid by Medi-Cal.
it offers the following special programs:
1. Aged & Disabled Poverty Level Program (A&D PLP) - Individuals aged 60 and above who cannot qualify for the Supplementary Security Income (SSI) program can still obtain their Medi-Cal through the A&D PLP. The qualification requirements are:
* Aged 65 and above and experiencing disabilities, physically or mentally.
* Have less than $1,130 monthly income if they're single or 1,500 if married.
* Have less than $2,500 individual assets ($4,000 for a couple). However, this requirement is not counted by SSI (as stated by the Medi-Cal Qualification Chart).
2. SSI Program - Enrollees qualifying for SSI will automatically get their health care coverage. Here, the enrollee's monthly income should not exceed $900 (for an individual) or $1,400 (for a couple). Note: higher income levels and extra benefits apply for blind individuals.
The 250% California Working Disabled (CWD) program is dedicated in helping disabled persons employed in various Californian offices to qualify for Medi-Cal without spending their regular income. Qualified CWD enrollees no longer need to pay their entire monthly premium coverage. The monthly premiums in CWD range from $20 - $200 per month (individual) and $30 - $370 (couple).
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