You can find many answers here if you have questions about your Medi-Cal benefits. Medi-Cal is California’s health care program for low-income families and individuals. It may cover all or part of your health care needs for free or at a reduced cost. You can apply at any time during the year for Medi-Cal.
What is Medi-Cal?
Medi-Cal is the state health care program for people with low incomes. The program pays for various medical services and supports to help keep you healthy. Millions of Californians need long-term services and support because they have chronic conditions or disabilities. Medi-Cal provides them through a patchwork of programs known as waivers and carved-out services. The 58 county human services departments administer the state’s public insurance program. The program helps 14 million Californians and is financed equally by the state and federal governments. Medi-Cal seeks to recover its costs from the estates of deceased recipients and the assets of those over age 55 or in institutions.
How do I apply for Medi-Cal?
Members of the same family may be eligible for different health coverage programs. For example, parents could be eligible for premium assistance tax credits through Covered California while their children qualify for Medi-Cal. You can apply for Medi-Cal using a Single Streamlined Application, available online and in many languages. You can also get assistance completing the application for Medi-Cal in San Bernardino at your local county social services office or online. If you receive your BIC, you will be mailed information about your plan options (managed care or Fee-for-Service Medi-Cal). You must choose a health plan within 30 days, or the county will select one. You can search for your managed care plan and doctor on the Medi-Cal Managed Care Health Care Options website.
What is a health network?
A health network is a group of doctors, hospitals and other healthcare providers with contracts with your insurance company to provide services for less. These providers are called network providers or in-network providers. Most private and Medicare Advantage plans use healthcare provider networks to control costs. These networks consist of doctors and other healthcare providers willing to accept lower payments from the insurer than they would charge uninsured patients. For this reason, it’s important to understand your plan’s healthcare provider network before getting healthcare. If you visit out-of-network providers, your costs will generally be higher. The exception is in an emergency.
What is a share-of-cost (SOC)?
Individuals with higher income may have to pay a monthly share of the cost, or co-pay, for certain medical services. It works much like an insurance deductible. The amount of the monthly co-pay depends on how much the individual’s net counted income exceeds the maintenance need standard. Several deductions can be used to help meet the monthly co-pay.
What if I receive a health care services bill?
Medical bills can be a big source of stress. Billing errors can occur, and some bills must be bigger to pay. Whether it’s a bill for preventative care, out-of-network services or COVID-19-related care, always check the invoice for possible mistakes and call the provider if necessary. Only pay a medical bill once your insurance company has processed it. Compare the amounts on your account to your explanation of benefits (EOB) to ensure the procedures and total payment amounts match. Also, look for inflated charges and extra items. If you find any errors, contact the billing department right away. They may be willing to settle the matter or offer a payment plan.
What is a managed care plan?
A managed care plan is healthcare insurance that keeps costs low by contracting with groups of doctors, hospitals and clinics to provide services at reduced rates. These healthcare providers are called a provider network. Plans based on managed care have three main options: HMO, PPO and POS. HMO plans require enrollees to designate a primary care physician and get referrals to see medical specialists. HMOs also typically have the lowest monthly premiums. PPO and POS plan give more flexibility but have higher monthly premiums. These plans reduce inflated healthcare costs through various mechanisms, including preventive health measures, programs to review the medical necessity of procedures and the use of generic drugs.
How do I get emergency or urgent care?
If you have a medical emergency, call 911. You can go to an urgent care center if your symptoms are less severe, such as a cough, cold, sore throat or stomachache. These centers are open evenings and weekends and can help with various illnesses and injuries, such as upper respiratory infections, abdominal pain, earaches, lacerations and more. Many offer online check-in so you can provide initial information ahead of time to help reduce your wait time. These clinics can also refer you to an emergency room if they think it’s necessary. To avoid additional costs, show your CalOptima Medi-Cal benefits card when you get after-hours care.
Read related articles: An Ultimate Guide to Medicare.