What is Medi-Cal Insurance?

wiseGEEK Writer

Medicaid is an insurance program jointly operated by the US federal government and each state government. In California, this program is called Medi-Cal insurance. It helps to cover most or all of the costs of health care and dental care, for people who apply and who meet its eligibility requirements.

Doctor taking notes
Doctor taking notes

Usually, people must have a very low income or they may qualify if they’re disabled or seniors. Often, participation in other programs help to define eligibility. Those who receive supplemental security income or participate in the food stamps program usually automatically qualify. Medi-Cal insurance is also offered to foster kids.

Where people apply for Medi-Cal insurance can vary. Some apply at the same offices that administrate food stamps and welfare programs. Others apply at offices where they’d also apply for a social security card. In phone books, toward the front, people can look for Health and Human Services Departments in the county and begin by calling them to see if they accept applications. Alternately, the California government has a website devoted to Medi-Cal and it lists where to apply by county.

When people receive full Medi-Cal insurance, they pay nothing for program participation and can see any doctor who accepts it. Finding a doctor may be challenging. Unfortunately Medicaid notoriously reimburses less than any other insurance, so doctors are paid very little for accepting it. It is possible to find providers that take patients on the federal Health and Human Services website, and those who already have a relationship with a doctor should check there first. Many doctors continue to see established patients even if their insurance switches to Medicaid.

Full Medi-Cal insurance means people usually don’t have payments of any kind. They see a doctor, and they don’t pay for it: not even deductibles, copayments or percentages. It is possible for some people of low income to also be carrying insurance. In these cases, Medi-Cal may be used as secondary insurance and can cover the costs an insurance plan doesn’t cover, such as deductibles or copayments.

There are some other ways that Medi-Cal may work. When people make a fairly low income, but not poverty level, the state has the discretion to step in and offer some assistance. This might be available as share of cost (SOC). In other words Medicaid covers some of the costs but the person who qualifies for SOC may have to pay for some medical care too. Those people who typically think they won’t qualify should check if they are uninsured and a medical emergency occurs. They may indeed qualify for SOC that could significantly reduce medical debt.

Another type of Medi-Cal may apply for low-income seniors who also qualify for Medicare. Medicare is split into several parts, designated by letter. People automatically qualify for some of these parts, like Part A, for free, but need to pay fees to get total medical coverage. When seniors, those 65 and over, have lower incomes, they may get help from the program to pay for coverage of other parts of Medicare.

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