If you do not join Cal MediConnect, you must have a Medi-Cal health plan or a PACE plan. Below is more information about Medi-Cal health plans.
What is a Medi-Cal Managed Care Plan?
It’s a health plan that coordinates your Medi-Cal services, including provider visits, medicines, hospital care, and special equipment to help you manage your health.
Your Medicare benefits will not change.
When you have a Medi-Cal Managed Care plan, your Medicare benefits won’t change. You can still go to your Medicare hospitals and providers. They do not have to contract with your Medi-Cal plan to be paid for the services they provide you. If you have problems getting your Medicare services, call 1-800-MEDICARE (1-800-633-4227) immediately. Or call your Medicare Advantage plan, if you are in one.
What will change when I have a Medi-Cal Managed Care plan?
The Medi-Cal Managed Care plan will manage all of your Medi-Cal benefits, including your long-term services and supports (LTSS). If you receive Medi-Cal covered medical supplies and equipment, such as insulin pumps, the plan must provide these. However, you must get them from suppliers in the plan’s network.
These services will NOT change when you have a Medi-Cal Managed Care plan:
• In-Home Supportive Services (IHSS)
• Community-Based Adult Services ( CBAS)
• Multipurpose Senior Services Program (MSSP)
• Nursing facility services
You always have the right to hire, fire, and manage your IHSS providers.
Will I be charged for my Medi-Cal LTSS or my Medicare services?
You should not receive a bill for your LTSS or Medicare services. Billing you is called “balance billing.” This is illegal under both federal and state law. You are not responsible for co-pays, co-insurance, or deductibles for any Medi-Cal or Medicare services you receive.
There are only two exceptions when it is OK for you to be billed:
• Your Medicare prescription drug plan can charge you drug co-pays at the Extra Help level.
• Some people with Medi-Cal pay a monthly share-of-cost.
For information about share-of-cost, call your county Medi-Cal office.