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Horizon Elder Law & Estate Planning Blog

Tuesday, November 14, 2017

Top Ten Things You Need to Know About Planning for Medi-Cal

If you are considering your options for medical coverage in California, you may be looking at Medi-Cal and Covered California. In some cases, it may be in your best interests to talk with a Medi-Cal planning attorney before you start the process. To help you in your decision, here are the top ten things you need to know about planning for Medi-Cal:

  1. What is Medi-Cal? Medi-Cal is a program that provides health care coverage to eligible California residents at little or no cost. Low-income adults, seniors, families with children, pregnant women, persons with disabilities, children currently in foster care or former foster care children who are younger than 27 years can be eligible for Medi-Cal.
  2. What is the difference between Medi-Cal and Covered California? Both programs provide health care coverage, but Medi-Cal usually costs less than Covered California, and sometimes Medi-Cal coverage is free. Every Medi-Cal and Covered California health care plan provides “essential health benefits,” which include: outpatient and inpatient care, emergency care, maternity and newborn coverage, prescription drugs, mental health and substance abuse treatment, physical and occupational therapy and devices, lab work, preventative and wellness care, chronic disease management, and pediatric care, including oral and vision services.
  3. How much will Medi-Cal cost you? If you do have to pay a premium for Medi-Cal coverage, it is usually low, for example, $13 per child per month, up to a family maximum of $39 a month. Many people in Medi-Cal, however, do not have to pay any premiums, co-payments or out-of-pocket costs.
  4. Which should you apply for, Medi-Cal or Covered California? That depends on your unique situation. Many people find that they receive the same or similar services from Medi-Cal that they would get through Covered California, but at a lower cost. Talk with your local Medi-Cal agency office to find the plan that is best for you and your family.
  5. Can you keep your doctor if you enroll in Medi-Cal? If your doctor participates in Medi-Cal, you can keep your doctor. If not, no worries. About 130,000 health care providers throughout California, including doctors and dentists, participate in Medi-Cal.
  6. When can you enroll in Medi-Cal? You can apply for Medi-Cal at any time. There are no deadlines or open enrollment periods. Covered California, however, only lets you sign up during open enrollment periods.
  7. Can Medi-Cal cover your pregnancy? Yes, just make sure to mention on your application that you are pregnant. You can get coverage for prenatal care, labor and delivery, and post-partum services.
  8. Can Medi-Cal cover your baby? Yes. If you had Medi-Cal or the Medi-Cal Access Program when you gave birth, your baby automatically has coverage, but you should talk with your county worker to make sure your baby is registered. If you did not have coverage through Medi-Cal or Medi-Cal Access program during your pregnancy, you can fill out an application for your baby online or through your county worker.
  9. Will everyone in your family be in the same health care program? Not necessarily. Sometimes the parents qualify for Covered California, and the children are eligible for Medi-Cal. When you complete the Covered California application, the state agency will determine each family member’s eligibility.
  10. Will Medi-Cal take your assets? Some government assistance programs try to recover some of their costs after a benefits recipient dies. Medi-Cal will not seek payment during your lifetime. If you are over age 55 or in an institution, such as a nursing home, the state may make a claim against your assets to reimburse the costs of your care.

The laws surrounding Medi-Cal are complex and constantly changing. Request a consult with the professional Medi-Cal planning attorneys at Horizonlaw today to talk about your options.


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