Medi-Cal Benefits & Coverage Plans

California’s Medicaid program, Medi-Cal, helps Californians in specific groups get free or low-cost health care. Medi-Cal plans offer the same benefits as private plans, but they have a much lower price. Low-income Californians who don’t qualify for Medi-Cal may have eligibility for financial assistance through Covered California. These options make it easier for people in California to afford health care.

Your Benefits Under Medi-Cal

Medi-Cal members get free or low-cost coverage through a public or commercial insurance plan. Each Medi-Cal plan’s specific benefits may vary, but they must provide the Affordable Care Act’s 10 “essential health benefits” that include:

• Preventive care, chronic disease management and wellness services
• Prescription drugs
• Behavioral health services
• Outpatient services
• Maternity and newborn care
• Children’s services, including vision and oral care
• Laboratory services
• Emergency services
• Hospital stays
• Physical and occupational therapy and related devices

People who have Medi-Cal may have full-scope or partial-scope coverage. Full-scope coverage includes all services covered under Medi-Cal, and partial-scope coverage involves some of these services.

Plan Options and Prices

A new Medi-Cal member may choose from the insurance plans offered through their county. Before selecting an option, they receive coverage under Medi-Cal Fee-for-Service. However, they must choose a plan within 30 days, or the State of California will choose for them. Select counties have one plan available that automatically becomes the member’s plan.

The price of a Medi-Cal plan depends on a variety of factors, including income. You may have no cost to pay for your Medi-Cal coverage, or you might have a small premium. Health for California’s quote tool can help you understand the price you may need to pay for your plan.

Low-Income Options for Medicaid

Adults who earn zero to 138 percent of the federal poverty line qualify for assistance under Medi-Cal. Medi-Cal also covers Low-income children, families and pregnant women. After you apply for Medi-Cal, you will receive a letter of determination that explains your eligibility and cost share. Under federal law, you cannot get premium assistance for a Covered California plan if you qualify for Medi-Cal. However, Medi-Cal covers all or most costs for many members.

Getting Medi-Cal Through Covered California

When you apply for Medi-Cal through Health for California and Covered California, you will receive information on you and your family members’ eligibility. Some Californians can receive Medi-Cal regardless of their income. Your letter of determination will let you know if you can apply for additional financial assistance. If you qualify for Medi-Cal, your county social services office will help you manage your benefits.

Coverage Through the Affordable Care Act and Covered California

If you don’t qualify for Medi-Cal, you may still have financial assistance options. Applicants who earn between 138 and 400 percent of the federal poverty line can get a tax subsidy. Through the Affordable Care Act and Covered California, you can receive health care coverage at a lower price than usual. If you earn more than 400 percent of the federal poverty level, you receive no financial assistance. However, Covered California shows all available plans, making your search easier.

Get a Medi-Cal Quote Today

You can only know if you qualify for financial assistance through a quote and application. Get a free quote for Medi-Cal today through Health for California.