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Medical & Medicare Coverage

Medicaid, a federal and state funded program, provides health insurance to low-income citizens. Medi-Cal is the state of California's Medicaid program. Medicare is the health insurance program administered on a federal level that is designed to work specifically for the elderly and disabled. Some elderly and disabled Californians who meet criteria qualify for both programs.

  1. Medi-Cal Eligibility

    • In general, there are strict income guidelines to qualify for most Medicaid programs, and Medi-Cal is no exception. Individuals and couples may bring in no more income than outlined at 100 percent of the federal poverty guidelines. The federal poverty levels change annually, and in 2010, 100 percent was $903 and $1,215 per month. Income includes things such as Social Security insurance benefits, payments from employment, alimony, child support, or any funds that can be expected on a regular basis.

      Eligibility is also contingent upon assets. Medi-Cal enrollees are limited to $2,000 in assets if single and $3,000 in assets if married.

    Medicare Eligibility

    • There are four populations who are covered by Medicare. Individuals who are 65 and older are eligible for Medicare. Second, those with disabilities who have been on Social Security Disability Insurance (SSDI) for at least 24 months are also eligible. Those diagnosed with amytrophic lateral sclerosis (ALS) are another Medicare-eligible class, and they are eligible once they start receiving SSDI payments. Finally, end-stage renal disease patients can begin their Medicare benefits once they either have a kidney transplant or begin dialysis treatment.

    Coverage

    • Both Medi-Cal and Medicare are comprehensive health care programs. Medicare has three major benefits available which are known as Part A (hospital coverage), Part B (medical coverage) and Part D (prescription drug coverage). Medicare is available nationwide.

      Medi-Cal is accepted only in California. However, Medi-Cal has many benefits that Medicare does not. These benefits include dental screenings, adult day health care, and transportation to and from medical appointments. Medi-cal also picks up the cost for several drugs that Medicare cannot cover by law, including benzodiazepines, barbiturates, drugs used to treat anorexia, vitamins and minerals, cold and cough medicines and over-the counter drugs.

    Coordination

    • In most Medicare and Medicaid literature, individuals covered by both Medicare and Medicaid are referred to as "dual eligible." Dual eligible's primary insurance coverage is Medicare. Any provider who needs payment will bill Medicare first. Any remaining costs such as a coinsurance and deductibles, or any Medicare uncovered services will be billed to Medi-Cal.

    Extra Help

    • Medi-Cal dual eligible are automatically enrolled into Extra Help, a federal program administered by the Social Security Administration that helps alleviate the many costs associated with the Medicare Part D prescription drug benefit. Extra Help beneficiaries pay no deductible or premium, and low co-payments at only $1.10 for generics and $3.30 for brand names, though these co-payments will typically be picked up by Medi-Cal's drug benefit.

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