Medi-Cal Member Services

Medi-Cal Member Services

As a Medi-Cal member, you can access member services like anyone with a private insurance plan. Since members receive a commercial or public plan, you get assistance through your plan. However, many plans have similar member services, and you can get some help through Covered California.

Navigating health care and its benefits can be tricky. Here are answers to some of the most common questions, such as how to access Medi-Cal resources to help you get the most out of your coverage.

9 Medi-Cal FAQs

When you have questions about Medi-Cal member services, coverage and how the system works, they can really start to pile up. Whether you’re wondering about benefits, how to apply or what to do when something goes wrong, we’ve compiled a list to give you some clarity:

1. How Do I Apply for Medi-Cal?

Applying for Medi-Cal is simple and can be done in three ways:

• You can apply online with the help of Health for California.
• You can apply in person at your local county Medi-Cal office.
• You can apply by mail or phone.

2. How Do I Change or Cancel My Medi-Cal Plan?

Depending on your county, you may have multiple Medi-Cal plan options. If you want to try another plan available in your county, you can change Medi-Cal plans at any time. To switch your Medi-Cal plan, you can contact Medi-Cal Managed Care Health Care Options at 1-800-430-4263.

You may also complete a Medi-Cal Choice Form online. Choose your county from the drop-down menu, then look for the form link under “Choice enrollment forms.” Learn more about the plans available in your county through the Medi-Cal Managed Care Health Plan Directory.

If you need to cancel your Medi-Cal coverage, call your local county office. Once you are released from Medi-Cal, get a quote online to view rates and enroll in a Covered California plan. Remember that there are different income limits for Medicaid and Medi-Cal versus Covered California, which is the state exchange.

3. Where Can I Access Medi-Cal Member Services?

Member services can be found online through your plan and the Covered California website. Each service manages different aspects of your coverage, and your health insurance company handles:

• Premium payments: Your health insurance company will accept premium payments online or by phone.
• ID cards: Your insurance company will issue your membership ID card and provide a replacement card if you lose it.
• Benefits and eligibility: Each insurance plan has unique eligibility requirements and benefits. A representative from your insurance company can explain these details to you.
• Claims: When you need to verify this information, the insurance company can tell you how you paid your service claims.
• Covered medical providers: Your plan’s company can help you find a fully covered health care provider.

Covered California will take care of:

• Enrollment: Through Covered California, you can find out if you qualify for a special enrollment period and see when you can enroll in a Medi-Cal plan.
• Application information: Covered California handles changes to application information such as income verification, proof of residency and citizenship.
• Eligibility: When you request a quote from Covered California, they will determine whether you or a family member are eligible for Medi-Cal.
• Coverage cancellation: You can request to cancel your Medi-Cal plan through Covered California.
• Changing to a private plan: You can enroll in a private plan through Covered California if you will lose your Medi-Cal coverage soon.

When it’s time to renew your plan, your county social services office will contact you if they need any updates to your information or send you a renewal form. You can contact the Medi-Cal Member Helpline or your county’s Medi-Cal office for further assistance.

4. What Does Medi-Cal Cover?

Medi-Cal covers a wide range of free or low-cost services. These include doctor visits, prescription medications, hospital stays, mental health services, pregnancy and maternity services, and preventive care like screenings and vaccines. Check with your health plan for specific coverage details.

5. Where Can I Find My Card Number and Member Number?

After enrolling in Medi-Cal, you will receive an enrollment package from your insurance company, which includes a membership card and your health insurance account information. Your welcome letter from the insurance company may also mention your membership ID number. If you want to make an online account for member services with your insurance plan, you need these numbers to create an account.

6. Where Can I Find Reports About Medi-Cal Plans?

You can find Medi-Cal and health plan reports online. These give you better insight into the quality of care, each program’s integrity, provider network certification, and periodic financial data and accuracy audit results. It also provides you with information on different plans, sample contracts and a sample health plan member handbook with a general program overview.

7. Where Can I Find My Medi-Cal Renewal Form?

County organizations handle Medi-Cal renewals. In most cases, your local agency will use your existing information to renew your Medi-Cal membership. If they can verify these details, they can take care of the process for you. However, they may need to send you a renewal form if your information doesn’t match your records. You can return this form to your county office to continue receiving coverage.

Medi-Cal also requires annual renewal to ensure you are still eligible for coverage. You will receive a notice with instructions, which will allow you to renew online, in person at your county office or by mail.

8. How Do I Check My Medi-Cal Status?

Contact your local county social services directly for office status and eligibility. The California Department of Health Care Services has a comprehensive directory of each county’s agency. You can also review all notices mailed to you from Medi-Cal or your health plan to stay on top of things.

9. Can I Use Medi-Cal in Other States?

Medi-Cal generally only covers services within California. However, some emergencies may be covered out of state. It’s best to contact your county office for specific details before traveling out of state.

Medi-Cal Terms to Know

Like many government programs, Medi-Cal comes with its own set of terms and acronyms that can leave you scratching your head. Some of these include:

• Benefits identification card (BIC): This refers to your Medi-Cal ID card, which you need to access health care services.
• Managed care plan: The managed care plan is the health plan Medi-Cal assigns you to manage your benefits.
• County Organized Health System (COHS): COHS is a nonprofit agency that works with the state to administer various Medi-Cal benefits through local health care providers.
• Federal poverty level (FPL): FPL is the income threshold used to determine your eligibility for Medi-Cal and other programs.
• Share of cost: This is the amount you may need to pay for health care services if your income is above specific limits.

Get a Quote for Medi-Cal Insurance Today

Do you need affordable insurance as a low-income Californian? You may qualify for coverage at little or no cost through Medi-Cal, California’s Medicaid program. When you request a quote from Health for California, we can determine if anyone in your family is eligible for Medi-Cal. We can also recommend services such as CHIP that help you afford health insurance. Request a free health insurance quote today to get started.