MEDI-CAL
We Will Get You Qualified for Medi-cal, Even if Your Application Has Been Denied!
asdsaad Medi-Cal is California’s Medic aid program that provides medi-cal services to low-income people at little or no cost. It is administered by the Centers for Medi care and Medic aid Services (CMS) and the California Department of Health Care Services (DHCS). There are more than 90 eligibility categories, and each one has its own rules and requisites.
asdsaadEffective May 1, 2016, California’s undocumented low-income children will now have access to full coverage through Medi-Cal.
asdsaadMost adults who are undocumented do not qualify for Medi-Cal. However, they may qualify for some of the coverage during pregnancy or emergencies.
Medi-Cal provides a range of health benefits, including;
- Pays your Medicare Part B premium
- Covers your Medicare copayments
- Provides benefits not covered by Medicare such as:
- Hearing aids
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- Incontinence supplies
- Dental services
- Vision care
- Medical transportation
- In Home Supportive Services care at home
- Nursing home care
EXPANDED MEDI-CAL
asdsaadExpanded Medi-Cal is also known as Modified Gross Adjusted Income (MAGI). Eligibility includes the non-disabled, non-elderly, childless adult population up to 138% of the Federal Poverty Level (FPL). There is no asset/property test for MAGI households.
asdsaadIf you are working disabled adult or in need of care facility but your income or assets does not qualify you for traditional Medi-Cal, we might be able to get you qualified if you meet certain criteria.
TRADITIONAL NON-EXPANDED MEDI-CAL
asdsaadThe Non-Expanded Medi-Cal population includes the aged, blind, and disabled, long-term care, medically needy, and individuals deemed eligible for Medi-Cal as a result of other programs such as CalWORKs, Adoption Assistance Program, or foster care. Non-Expanded Medi-Cal eligibility will remain subject to the asset/property test.
In addition to paying for nursing home care, Medi-Cal offers five programs / HCBS Waivers relevant to the elderly that helps them to remain living in their homes or in assisted living residences.
- In-Home Supportive Services (IHSS) – Provides for a wide variety of support and care services to individuals in their homes and even permits family members to be hired as personal care providers.
- Medi-Cal Assisted Living Waiver (ALW) – Though not statewide, this waiver helps pay for some of the cost of assisted living.
- Community-Based Adult Services (CBAS) Program – Available statewide, this program provides for adult daycare and adult day health care.
- Multipurpose Senior Services Program Waiver (MSSP) – Provides California seniors with assistance for home modifications, personal emergency response services, and other in-home supports.
- Home and Community-Based Alternatives (HCBA) Waiver – Provides similar services to MSSP but targets more persons who are temporarily living in nursing homes and wish to return home.
MEDICARE
asdsaadMedicare is the federal health insurance program for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. Other categories also qualify for medicare. Such as;
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
- Social Security enrolls you in Original Medicare (Part A and Part B). Other parts of Medicare are run by private insurance companies that follow rules set by Medicare. Medicare usually pays only 80% of the medical cost and the rest of 20% should be covered by supplementary insurance.
The different parts of Medicare help cover specific services:
- Original Medicare includes Part A and Part B.
- You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
- You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
- To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance, you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap) or have coverage from a former employer or union, or Medicaid.
asdsaadIf you (or your spouse) are still working, Medicare works a little differently. Here are some things to know if you’re still working when you turn 65.
asdsaadEnrolling on Medicare if you pass 65 and still working, depends on how you get your health insurance now and the number of employees that are in the company where you (or your spouse) work.
asdsaadThe program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company. Social Security enrolls you in Original Medicare (Part A and Part B).
asdsaadGenerally, if you have job-based health insurance through your (or your spouse’s) current job, you don’t have to sign up for Medicare while you (or your spouse) are still working.
You can wait to sign up until you (or your spouse) stop working or you lose your health insurance (whichever comes first).
- If you’re self-employed or have health insurance that’s not available to everyone at the company: Ask your insurance provider if your coverage is employer group health plan coverage (as defined by the IRS.) If it’s not, sign up for Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty.
- If the employer has less than 20 employees: You might need to sign up for Medicare when you turn 65 so you don’t have gaps in your job-based health insurance. Check with the employer.
- If you have COBRA coverage: Sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up. If you’re eligible for Medicare, you don’t qualify for COBRA coverage without having to pay a premium.
- Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. You usually don’t pay a monthly premium for Part A if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.” - Medicare Part B (Medical Insurance)
Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services. Most people will pay the standard Part B premium amount. The standard Part B premium amount in 2020 is $144.60. If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday includes the month you turn age 65, and ends three months after that birthday. If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it unless you qualify for a “Special Enrollment Period” (SEP). If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll - Medicare Part D (prescription drug coverage)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines). To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage (this includes Medicare drug plans and Medicare Advantage Plans with drug coverage). You can get Medicare drug coverage once you sign up for either Part A or Part B. You can join a Medicare drug plan or Medicare Advantage Plan with drug coverage anytime while you have job-based health insurance and up to 2 months after you lose that insurance. - Part D late enrollment penalty join a Medicare drug plan or Medicare Advantage Plan with drug coverage within 3 months of when your Medicare coverage starts to avoid a monthly Part D late enrollment penalty. You’ll pay an extra 1% for each month you could have signed up for Part D, but didn’t, and didn’t have creditable drug coverage. We’ll add this penalty to your monthly Part D premium.
We Are Helping You Save Hundreds of Dollars on Medicare
Premiums and Supplementary Insurance
We provide assistance and advocacy services relating to:
- Medicare Part A and B Eligibility, Benefits and Claims
- Medicare Coverage Rules
- Medicare Part D Plan Choices
- Programs That Help Low-Income Beneficiaries with Medical Expenses —Medi-Cal, Medicare Savings Programs
- Part D Prescription Costs – The Low Income Subsidy Program, “Extra Help”
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Resources
Check out all of the resources we’ve included to help you prepare and manage your application procedure.
