Medi-Cal is a federal and state funded health insurance program for low-income, elderly and disabled persons who qualify for help. Medi-Cal provides no-cost, comprehensive health, dental and vision benefits for people who qualify. Medi-Cal beneficiaries do not pay premiums and they do not have any copayments for services.
Medi-Cal is California’s Medicaid program. It provides health care coverage for more than six million low-income children and families as well as elderly, blind, or disabled individuals. The Medi-Cal Program is administered by the California Department of Health Services. People can apply for Medi-Cal through their county social services department.
Medi-Cal beneficiaries use the same system of care that most Californians use for their health care needs. Medi-Cal is a managed care program that offers a choice of primary care physicians, a good selection of specialty care physicians and a medical Group where care is coordinated. We have partnered with local Medi-Cal providers to give you more choices for doctors, clinics, and hospitals in your neighborhood.
Covered California is a free service that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place where you can get financial help when you buy health insurance from well-known companies. That means when you apply, you may qualify for a discount on a health plan through Covered California, or get health insurance through the state’s Medi-Cal program. Either way, you’ll have great health coverage.
CoveredCA.com is sponsored by Covered California and the Department of Health Care Services, which work together to help Californians get the coverage and care that are right for them.
The Covered California Health Exchange is the government agency offering subsidized Obamacare plans for this state. The California Health Exchange was created to assist citizens and legal residents with applying for marketplace coverage in order to comply with the Affordable Care Act (“ACA”). When the law was passed in 2010, each of the 50 states had to decide to either create a state-run health insurance exchange or offer enrollment through a federally-operated exchange. This state chose to create their own exchange and called it “Covered California”.
The Medicare program, is a federal program that helps senior citizens and certain other individuals pay for health care, is divided into parts; Part A, Part B, Part C, and Part D. Part C is called Medicare Advantage and is an alternative to Parts A and B. When Medicare was created in 1965 (original Medicare), it provided only two parts; Part A and Part B. Generally speaking, Part A is free to eligible recipients and helps pay for in-hospital care. Part B is optional and helps pay for regular medical care (e.g., doctor’s bills, X-rays, lab tests). Individuals who choose to enroll in Part B must pay a premium, a deductible, and co-payments. In 1997, Medicare Part C (Medicare Advantage) became available to persons who are eligible for Part A and enrolled in Part B. Under Part C, private health insurance companies can contract with the federal government to offer Medicare benefits through their own policies. In 2003, under the Medicare Prescription Drug, Improvement, and Modernization Act, Medicare Advantage became the new name for Medicare + Choice plans, and certain rules were changed to give Part C enrollees better benefits and lower costs. The law also created Part D, prescription drug coverage. In most Medicare Advantage Health Plans, patients generally must get their care and services from the Health Plan’s network of providers. Members of Medicare Advantage plans will be asked to choose a primary care doctor or Medical Group. Members that get health care outside of the plan’s network may have to pay for these services. In some cases, neither the Medicare HMO nor the Original Medicare Plan will pay for these services. Medicare HMO plans contracted with our Medical Groups operate much like the Medi-Cal or Healthy Families programs.
Medicare Advantage Special Needs Plans
The Medicare Modernization Act (MMA) created a Medicare Advantage option called “specialized MA plans for special need individuals” (“special needs plans” or “SNPs”). Medicare Advantage Special Needs Plans may limit their membership to people in certain long-term care facilities (like a nursing home), people eligible for both Medicare and Medi-Cal, or with certain chronic or disabling conditions. Special Needs Plans are available in limited areas. The Special Needs Plan is designed to provide Medicare health care and services to people who can benefit the most from special expertise of the plan’s providers, and focused care management. Special Needs Plans also must provide Medicare prescription drug coverage. Special Need Plans, generally provide extra benefits and lower co-payments than in the Original Medicare Plan. For example, a Special Needs Plan for people with diabetes might have additional providers with experience caring for conditions related to diabetes, have focused special education or counseling, and/or nutrition and exercise programs designed to help control the condition. A Special Needs Plan for people with both Medicare and Medi-Cal might help members access community resources and coordinate many of their Medicare and Medicaid services.
CalOptima is a County Organized Health System authorized by federal law to administer Medi-Cal benefits for Orange County residents. It is governed by a board of directors and manages the health care for approximately 290,000 Medi-Cal beneficiaries in Orange County. Since opening its doors in October of 1995, CalOptima has greatly improved access to health care for thousands of the county’s poor, disabled, and aged residents. Operating within a $790 million annual budget, CalOptima contracts with 11 health networks to provide health care to approximately 290,000 Medi-Cal beneficiaries. It also participates in California’s Healthy Families program and has the largest enrollment of any Healthy Families program provider in Orange County.