What Proof Does Medi-Cal Need to Lower Share of Cost?

If you bought insurance to reduce or eliminate a Medi-Cal Share of Cost, the next step is usually proving it to the county. The county may need documents showing that the coverage is active, what the monthly premium is, and when the coverage started. That proof may help reduce your Share of Cost going forward, and in some cases may help with a retroactive adjustment.

This page explains what proof you may need, why immediate proof can matter, and how to upload documents through BenefitsCal.

---

What documents should you upload? Medi-Cal county workers may ask for different items depending on the case, but useful proof often includes:

• Proof of coverage letter showing the insurance is active.  The AmFirst Plan provides proof within 24 hours!
• Insurance ID card or confirmation page.
• Premium invoice showing the monthly cost.
• Payment receipt or confirmation number.
• Bank or credit card proof if the county asks for proof that the premium was actually paid.
• Effective date showing when the policy started.

Why immediate proof is important: Some plans, such as certain AMFERS dental plans, may provide proof of coverage quickly after enrollment. That can be very helpful when a county worker asks for documentation before adjusting Share of Cost.

This can matter especially when you are dealing with:

• End-of-month timing
• A retroactive Share of Cost correction
• IHSS caregiver or timesheet concerns
• Prescription costs
• Medical bills that were already paid
• A county worker requesting proof before making the change

Need proof quickly? After enrollment, email Steve  [email protected]  if you need help locating the proof documents that may be needed for your county worker.

---

How to Upload Documents to BenefitsCal

BenefitsCal may allow you to upload proof documents online, see instructions below,  instead of mailing or delivering them in person. After logging in, look for the document upload or case document section. Upload clear copies of your proof of insurance, premium bill, and payment confirmation if available.

Practical tip: Before uploading, rename the files clearly, such as:

• AMFERS-Proof-of-Coverage.pdf
• Dental-Premium-Invoice.pdf
• Premium-Payment-Receipt.pdf
• Insurance-ID-Card.pdf

Clear file names may make it easier for the county worker to understand what you submitted.

After uploading: Save or print the confirmation if BenefitsCal gives you one. You may also want to follow up with your county worker and explain that the insurance premium is being submitted to reduce Medi-Cal Share of Cost.

---

 

Common Questions

FAQ’s 

• Can insurance premiums reduce Medi-Cal Share of Cost?
  Yes, certain health-related insurance premiums may be used as deductions when calculating Share of Cost. This is why dental, vision, Medicare supplement, or other qualifying premiums may sometimes help reduce or eliminate Share of Cost.
• Can Share of Cost be fixed retroactively?
  Sometimes. If the insurance was already in effect and the county did not count the premium correctly, you may be able to ask for a correction. See: How to Fix Medi-Cal Share of Cost Retroactively.
• What if I already paid medical bills?
  Keep copies of bills, receipts, and proof of payment. Some expenses may help meet or reduce Share of Cost. See: How to Use Medical Expenses to Lower Share of Cost.
• Can a caregiver upload documents?
  A caregiver or family member may be able to help, but the county may require authorization or account access. This is especially important for IHSS-related situations, where timing and proof may affect the person receiving care.
• How long does it take?
  That depends on the county and the case. Uploading clear proof quickly may help, but it is still important to follow up with the county worker.

---

Related Share of Cost Pages

• How to Eliminate or Lower Medi-Cal Share of Cost with Dental Insurance
• Medi-Cal Share of Cost Calculator 
• How to Use Medical Expenses to Lower Share of Cost
• How to Fix Medi-Cal Share of Cost Retroactively
• Dental Coverage and Coordination of Benefits
• Using Medigap to Lower Medi-Cal Share of Cost
• Medi-Cal 250% Working Disabled Program
• Questions?
  • Email Steve Shorr at [email protected].

To lower your Medi-Cal Share of Cost (SOC) using health insurance premiums, you must prove to your county eligibility worker that you are paying out of pocket for supplemental insurance, dental, vision, or Medicare Part D plans. [1, 2]

Acceptable Proof Includes:

Other Ways to Lower Your SOC:If you have unpaid medical bills, paid-out-of-pocket medical expenses, or receipts for health items that Medi-Cal does not cover, you can submit these to your local office to meet or reduce your monthly SOC. [6, 7]

How to Submit:Contact your assigned eligibility worker at the

to submit your documents and request a recalculation of your countable income or a reduction in your SOC.

[1] https://dpss.lacounty.gov/content/dam/dpss/documents/en/medical/Share%20of%20Cost%20Flyer.pdf

[2] https://cchicap.org/low-income-assistance/eliminating-medi-cal-share-of-cost/

[3] https://canhr.org/understanding-the-share-of-cost-for-medi-cal/

[4] https://www.reddit.com/r/IHSS/comments/1dm0iqd/this_is_how_you_get_rid_of_share_of_cost_soc/

[5] https://www.leguphealth.com/blog/how-to-get-reimbursed-for-health-insurance-costs-from-your-employer

[6] https://healthconsumer.org/wp/wp-content/uploads/2018/04/HCA-Medi-Cal-Share-of-Cost_2.pdf

[7] https://www.dhcs.ca.gov/services/Documents/Pub68_myMedi-Calcomparison.pdf

Do Not Assume That Uploading the Documents Finishes the Job

After submitting the change:

• Save the BenefitsCal confirmation or screenshot;
• Keep copies of everything submitted;
• Contact the county eligibility worker;
• Confirm that the documents were received;
• Explain that the premium is being reported because it may affect Share of Cost;
• Ask the county to complete the eligibility review; and
• Request a written Notice of Action showing the decision and new Share of Cost.

Suggested Message to the County

I am reporting a change in the monthly health-insurance premium I pay. The premium is $_____ per month and became effective on __________. I uploaded proof of coverage, the premium amount and available proof of payment. Please confirm receipt, review the allowable premium deduction, recalculate my Medi-Cal Share of Cost and issue a written Notice of Action showing the result.

Eligibility, deductions and the effective date of a change are determined by the county based on the complete facts and documentation.

What Should You Upload for a New Insurance Premium?

The county may ask for different proof depending on the case. Useful documents commonly include:

• Proof-of-coverage letter showing that the insurance is active;
• Premium invoice showing the amount charged each month;
• Effective date showing when the policy began;
• Insurance identification card or confirmation page;
• Payment receipt, bank record or credit-card confirmation when proof of payment is requested; and
• Cancellation or termination notice when a policy has ended.

Use clear file names so the purpose of each document is easy to understand. Examples:

• Dental-Proof-of-Coverage.pdf
• Monthly-Premium-Invoice.pdf
• Premium-Payment-Receipt.pdf
• Insurance-Effective-Date.pdf

Complete instructions are on our separate proof page:

Proof Needed to Lower Share of Cost