Dental Coverage designed to lower Income for Share of Cost Medi Cal
Our clients express how the plans work, better than we do!
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Need to spend more $$$ to get to Zero Share of Cost?
All our Health plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy #Calculation
There is No charge for our complementary services, we are paid by the Insurance Company.
- We are authorized Brokers for Dental, Vision & Covered CA get instant quotes direct and in Covered CA with subsidy calculation for:
Watch our 10 minute VIDEO
that explains everything about getting a quote
-
- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
Dental Plans with Quotit – Get proposals
Ways to lower your Medi-Cal #Share of Cost
If you don’t have Full Scope Medi Cal
Get a Vision, Dental or Medi Gap Policy
You can Avoid a Share of Cost dpss flyer in the (ABD-MN) Aged, Blind and Disabled our webpage – Medically #Needy Program (CANHR Fact Sheet 8.14.2023) (My highlighted version) program and then qualify for no-cost Medi Cal A & D FPL.
Just purchase Health Insurance California Code of Regulations 22 ccr 50555.2 : CA Insurance Code §106
- dental or vision insurance get quotes Quotit.
- Special Plan for Share of Cost – Maximum Care Plans
- I just heard at a CA Advocates HI CAP webinar that you can get several dental and vision policies. This kind of makes sense as there isn’t a COB Co Ordination of Benefits Clause on Individual Plans, so you could possibly collect more than the actual claim
- Medi-Gap
- Note that if you have Kaiser or another Medicare Advantage Program, you can’t get Medi Gap
- We are NOT telling you to cancel your MAPD program, but you might want to consider it.
- MAPD vs Lower Share of Cost?
- SEP’s Special Enrollment Periods to drop MAPD if Medi Medi any quarter Medicare.gov
- MAPD options for Dual Eligibles Medi Cal and Medicare
- GET QUOTES & ENROLL Medi Gap Quotit *
- Contact us [email protected] if you want quotes from UnitedHealthcare
- Note that if you have Kaiser or another Medicare Advantage Program, you can’t get Medi Gap
- Part B Medicare
- Part D Rx,
- Do you have this in your Medicare Advantage Program?
Dental For #Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
- Dental for Everyone includes quotes from
- Careington Discount Plan
- Bright Benefits
- Renaissance Dental
- Delta Dental
- AmFirst
- One of our colleagues on how Dental for Everyone Works.
- Some of our webpages on dental
- VSP Vision
Contact Us - Ask Questions - Get More Information
[email protected]
By submitting the information below , you are agreeing to be contacted by Steve Shorr a Licensed Sales Agent by email, texting or Zoom to discuss Medicare or other Insurance Plans as relevant to your inquiry. This is a solicitation for Insurance
Medi-Cal with a Share of Cost (SOC)
Medically Needy
Lower your Share of Cost with Medi Gap or Dental Coverage
General Information on Share of Cost
Center for Health Care Rights
- There are 2 ways to reduce or eliminate the Medi-Cal Share of Cost:
- 2. Buy health insurance each month to get rid of the monthly Medi-Cal Share of Cost.
- ► The money you spend on health insurance premiums each month will reduce your income so that you meet the Medi-Cal monthly income limits of $1,801 for a single person or $2,433 for a married couple.
- ► Example: If you are over the income limit by $50, you can buy a dental policy that costs $50 a month.
- ► Any health insurance premiums can be used to eliminate the Medi-Cal Share of Cost. For example:
- ► Dental or vision insurance;
- ► Medicare Part D drug plan;
- ► Medigap Insurance (private insurance policies that pay Medicare copayments and deductibles).
- ► Medi-Cal office can tell you how much you need to spend on health insurance to get rid of the Medi-Cal Share of Cost.
- Send proof of the extra health insurance to Medi-Cal
- ► Provide Medi-Cal office with written proof that you are buying health insurance on a monthly basis to eliminate the Medi-Cal Share of Cost. Medi-Cal office will update your Medi-Cal record to show that you have full Medi-Cal with no Share of Cost.
See My Medi Cal information
- 2. Buy health insurance each month to get rid of the monthly Medi-Cal Share of Cost.
Lower Share of Cost with Medical Expenses???
AI Summary
To lower your Medi-Cal Share of Cost (SOC), you can use payments for medically necessary services, supplies, and equipment, even if they aren’t covered by Medi-Cal or are from non-participating providers, including doctor visits, prescriptions, dental care, hospital stays, prosthetics, transportation, and sometimes IHSS/in-home care, by submitting detailed receipts and physician orders to your county worker. [1, 2, 3, 4, 5]
What Counts as Medical Expense to lower share of cost (Examples)
- Services: Doctor/dentist visits, hospitalizations, mental health, rehab (PT/OT), acupuncture, chiropractic, specialist care, lab tests.
- Medications: Prescription drugs, certain prescribed over-the-counter meds (like insulin, vitamins), but not nutritional supplements.
- Supplies & Equipment: Wheelchairs, oxygen, hearing aids, dentures, eyeglasses, incontinence supplies, special phones for disabilities, medical equipment. See our webpage on DME Durable Medical Equipment
- Insurance Costs: Your Medicare premiums, health insurance premiums, co-pays, and deductibles (if not covered by Medi-Cal).
- Care-Related Costs:
- Transportation: Reasonable costs for travel to medical appointments.
- Lodging: Needed to get medical treatment.
- In-Home Care: IHSS or prescribed home care services beyond standard hours.
- Service Animals: Costs for specially trained animals for the disabled.
- Unpaid Bills: Past, unpaid medical bills can count for future months, and you can get retroactive coverage if your SOC was met in prior months. [1, 2, 3, 5, 6, 7, 8]
- View list on Cal Fresh.org website
How to Get Expenses Applied
- Pay the Provider: Pay for the medically necessary service or item.
- Get Proof: Keep detailed receipts and, if possible, a doctor’s order or prescription.
- Contact Your County: Submit these documents to your county Medi-Cal worker Benefits.Cal so they can be applied to your Share of Cost. [3, 5, 7]
AI responses may include mistakes.
Worksheet for Medi Cal with no share of cost
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- Aged & Disabled, Medically Needy, and Working Disabled Medi-Cal Programs January 2024 CANHR
- CHCF explanation SOC Share of Cost Rev December 2017
- Is the amount in Step 13 equal to or less than $1,801 effective 4/1/2025 Canhr * That amount is 138% of the FPL.
- If yes, then you qualify for Medi-Cal with no share of cost.
- Covered CA Chart for 138% & 250% FPL
- Two years ago, California state officials agreed to change the $600-a-month allocation for other needs to match 138% of the federal poverty level. (That figure, which changes annually, is the same one California generally sets as the income limit for Medi-Cal.) This year, that would amount to over $1,700 a month.The new level was supposed to go into effect in January 2025, but the plan was jettisoned amid a state budget deficit. Groups that advocate for the elderly and disabled are now asking the state to make it happen in 2026. Read More >>> LA Times 11.27.2024
- Aged & Disabled Federal Poverty Level Medi-Cal (A&D FPL).
If you are aged or disabled, and are not eligible for SSI, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. You must:- Be either aged (65+), or disabled (meet Social Security’s definition of disability, even if your disability is blindness)
- Have less than xxx in countable monthly income for an individual ($xxx for a couple).
- canhr.org/aged-disabled-medi-cal-program/
- Our webpage on Aged & Disabled
- If you are single and live on your own, follow these steps to figure out if your countable income makes you eligible for A&D FPL Medi-Cal. If you live with others, you should use DB101’s Benefits and Work Estimator.
- Find your total countable income using Social Security’s rules. DB 101
Who pays Medicare Part B your or Medi Cal?
Medicare Savings Programs & LIS Low Income Subsidy aka Extra Help
Have Medi Cal pay Medicare Part B $185 Premium #Costs # 10126
Medi Cal * Part B Outpatient Premium Forgiveness
Updated 11/16/2025
Note that this is 2025 numbers
-
- See also the 2026 Covered CA FPL Federal Poverty Level Chart
-
- DUALLY ELIGIBLE BENEFICIARIES UNDER MEDICARE AND MEDICAID (Medi Cal) MLN Knowledge Booklet
- CA Health Care Advocates on MSP
- Medicare.Gov MSP Medicare Savings Programs
- Save money on your Medicare costs Fact Sheet MSP Income Limits
- FACT Sheet Low Income Assistance: Medicare Savings Programs CA Health Care Advocates HI CAP
- Disability Benefits 101
- National Council on Aging MSP
- MSP Medicare Savings Plan CA Health Care Advocates
- khn.org/billions-of-dollars-in-benefits-go-unused
- Our webpage on Part D Rx Extra Help - LIS Low Income Subsidy
- Explanation of countable Income Insure Me Kevin.com
- dhcs.ca.gov/Medicare-Savings-Programs-in-California
- Prescription Drug Discount Program for Medicare Recipients Pharmacy.ca.gov *
100 vs 138% ???
Incontinence
What Out of Pocket Expense Counts towards Share of Cost
IRS Publication 502 pdf * html
Medical & Dental #Expenses
-
- Aetna Listing of HSA allowable expense
- Topic no. 502, Medical and dental expenses IRS.Gov
- expenses exceed 7.5% of your adjusted gross income for the year may be deductiblexxx
- Medical Necessity? Our webpage
- The Tax Definition of "Medical Care:" Repository Law.com
- Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.
- Turbo Tax
- Schedule A 1040 Itemized Deductions
More information on Medi Gap Plans & Quotes
Sample Medi Gap Quotes for 98 year old
We are looking to maximize premium for share of cost
Guaranteed Right to get Medi Gap if your #Medi-Cal benefits change...
- You can deduct the cost of that policy or product and that may help them get under the strict income limit in the Aged & Disabled Federal Poverty Level FPL and Blind FPL programs. See above, you must have original Medicare, A & B not Medicare Advantage. Learn More Medicare.gov
- You may be able to drop Medicare Advantage - but that is up to YOU! We are not telling you to do it!
- If your purchase private health insurance with coverage that duplicates Medi-Cal coverage, the private health coverage would be billed first and then Medi–Cal would pay for the services it covers after the private health carrier pays or denies a claim. Our webpage on Dual Coverage * Western Center Law & Poverty Guide for Low Income Americans * CA Code of Regulations 22 § 50555.2 * Health Care Rights.org *
Guaranteed Issue Rules to Get Medi Gap
- Here’s a video explanation of our research on how one might get Medi Gap even if they are not healthy. If you have a Medicare Advantage plan, see also Situation # 17
- Visit our Medi Gap Guaranteed Issue Page
- Problems getting Medi Gap if you have full benefits Medi Cal?
Right to Opt out of Medicare Advantage
Introduction to #MediGap
Publication 02110
- 2025 Official Medicare Guide to choosing a Medi Gap Policy # 02110
- MORE Information and Links
- Matrix - Spreadsheet of what Medicare Pays, Medi Gap pays and what little you pay
More explanation, details & Faq’s
How much do I have to spend to eliminate share of Cost?
-
- Yeah, it’s very confusing. Please scroll down and read everything. Send us your paperwork and we can review, [email protected]
- Log into Benefits Cal.org and see if you can find the information there.
- Check with your Medi Cal Social Worker
- See the worksheets below
- Send us your NOTICE OF ACTION, all documents, etc. from Medi Cal
- Understanding the Shared Monthly Cost for Medi-Cal CANHR
- The most common way to reduce or avoid a shared monthly cost is to purchase supplemental health insurance policies to lower countable income, such as supplemental dental, vision, or a Medicare Part D prescription drug plan.
- See above for more. It’s important to note that not everyone can purchase these plans. The monthly cost of these health insurance plans lower your countable income, which may help you qualify for Medi-Cal with no shared monthly cost.
Footnotes * Wikipedia * Investopedia * Merriam – Webster * Things to know about Share of Cost * HICAP *
Share of Cost: “A person’s or family’s net income in excess of their maintenance need that must be paid or obligated toward the cost of health care services before the person or family may be certified and receive Medi-Cal.” 22 CCR § 50090 * Western Poverty Law *
Explanation of Share of Cost #SOC
- If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program, but you meet the criteria of the low asset-level requirements, you may still qualify and be eligible for Medi-Cal with a share of cost (SOC).
- Uh Oh 2026 it looks like there is an asset test! Learn More Insure Me Kevin.com * Daily News * CANHR Fact Sheet * CANHR FAQ’s *
- SOC functions like a deductible, it’s not a percentage, like a Co-Pay. You must pay this amount in any month you incur medical costs. After your SOC is paid, Medi-Cal will pay the remaining amount of your medical bills for that month.
- Note: A SOC is not a monthly premium. It is more like a deductible. It is the amount of medical expenses you are responsible to pay for before you can get full Medi-Cal coverage for the remainder of the month. If you have no medical expenses, you pay nothing.
- More detail on how & where to pay your share of cost when you have IHSS In-Home Supportive Services Scroll down and see our references & links too.
- VIDEOs
Income Limits
To be eligible for the A&D FPL or the Blind FPL Medi-Cal programs, an applicant’s Countable Income for SSI Program cannot exceed a level set by the state that is based on the Federal Poverty Level. The countable monthly income limit for an individual adult or child is based upon the Federal Poverty Level (100% FPL), plus $230.37 Welf. & Inst. Code § 14005.40(c)(1) See Western Poverty Law Page 91 for what seems like the best and understandable explanation
Cal Matters – Problems with Income Limits – Inflations – Numbers haven’t changed in 30 years.
References & Links
-
- CHCF explanation SOC Share of Cost Rev December 2017
- Includes cost calculation worksheets
- CANHR Aged & Disabled Program
- CA Health Care Advocates
- Health Consumer Alliance Fact Sheet
- Disability Rights CA Share of Cost – Nursing Home Resident
- Medi-Cal What it means to you Phamplet outdated?
- Covered CA Agent Certification Circa 11.2013 Page 5 et seq)
- Health Rights Hotline. Our number is 1-888-354-4474.
- 1-800-952-5253 to get a fair hearing
- Medi-Cal Contact Info
- Working Disabled Program – Premium may be less than Share of Cost
- Nolo – Spend Down
- Health Consumer Alliance Helping Californians get the health care they need
- McKay Law Medicaid Qualification
- CA Department of Aging Find Services
- This overview of the Medi-Cal program addresses issues relevant to older adults and persons with disabilities. At the end of this chapter is a listing of other sources of information about Medi-Cal, including information about consumer informational fliers and Medi-Cal mental health services. Bet Tsezak
- Eligibility Procedure Manual dhsc.gov
- IHSS Share of Cost
- AB 1900 to Relieve California’s Seniors, the Disabled, and Low-Income Families from the Hardship of Medi-Cal ‘Share of Cost’ Expenses
- Ways to Lower or Stop your Medi-Cal Share of Cost
- Medi-Cal Notice of Action (NOA) – Frequently Asked Questions
- Medi Cal Forms
FAQ’s
Getting additional Insurance to #lower SOC Share of Cost
IHSS In Home Supportive Services
Please send us [email protected] all the paperwork from Medi Cal so that we can review it and see above for various plans once Medi Cal tells you how much you need to spend
FAQ’s
- IHSS webpage
.
. - Question With SOC Share of Cost at 770.00 do I need to present the card at routine office visits, or present it only if medical expense is greater than 770.00. ?
.- Answer Yes, that way you get the Medi-Cal Negotiated Rate.
- Answer Yes, that way you get the Medi-Cal Negotiated Rate.
- Question If I have Share of Cost, can I get a Covered CA plan with Subsidies? APTC
.- Yes, since SOC is NOT minimum essential coverage so they can qualify for financial assistance through Covered California.
- Minimum essential coverage includes:
- Full-scope Medi-Cal programs, including the Targeted Low-Income Children’s Program (former Healthy Families program),43 Medi-Cal Access Program (MCAP – former AIM program), and Refugee Medical Assistance programs administered by Medi-Cal;44
- Medi-Cal Share of Cost programs and programs with limited scope of services such as Minor Consent), individuals enrolled in these programs can simultaneously enroll in a Covered California plan with advanced premium tax credits so long as they meet Covered California’s eligibility criteria.
- Medi-Cal only covers what Covered California does not, such as In-Home Supportive Services, adult dental, or long-term care, so individuals should check provider networks before picking a Covered California plan for most regular health services. Western Poverty Law *
- Plans with Covered CA subsidies? Get quote…
- Get Covered CA quotes.
.
- Minimum essential coverage includes:
- Yes, since SOC is NOT minimum essential coverage so they can qualify for financial assistance through Covered California.
- Question How does Medi-Cal share of cost work with Medicare Part D Rx Prescription coverage?
.- Answer If you are receiving both Medicare and Medi-Cal benefits, the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal.
- Low-Income Subsidy (LIS) program, also known as the “Extra Help” program, will pay for part or all Medicare Part D drug-benefit plan premiums, depending on the plan in which you are enrolled. Learn more about the Extra Help program and the Medicare Part D drug benefit.
.
- Low-Income Subsidy (LIS) program, also known as the “Extra Help” program, will pay for part or all Medicare Part D drug-benefit plan premiums, depending on the plan in which you are enrolled. Learn more about the Extra Help program and the Medicare Part D drug benefit.
- Answer If you are receiving both Medicare and Medi-Cal benefits, the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal.
- ..
- See situation # 16 above, it looks to me like you can get Medi Gap guaranteed issue.
- Here’s a video explanation of our research and answer to your question.
- You can also get dental & vision coverage.
- I will grant that it’s very confusing on the time periods that you can enroll or exit a Medicare Advantage Plan.
.
- Question Does veteran aid & attendance or death benefits as unearned income count towards share of cost?.
.- t seems like the best and understandable explanation
IRS Publication 502 pdf * html
Medical & Dental #Expenses
-
- Aetna Listing of HSA allowable expense
- Topic no. 502, Medical and dental expenses IRS.Gov
- expenses exceed 7.5% of your adjusted gross income for the year may be deductiblexxx
- Medical Necessity? Our webpage
- The Tax Definition of "Medical Care:" Repository Law.com
- Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.
- Turbo Tax
- Schedule A 1040 Itemized Deductions
Clarification from Hi Cap
Hello Mr. Shorr,
Mrs. Burns shared your latest email with me, and I will respond.
- First, California Health Advocates (CHA) focuses primarily on Medicare issues. We leave the topic of Medi-Cal calculations and regulations for share of cost determination to the appropriate county Medi-Cal office.
- Second, when Medicare beneficiaries request help from the local HICAP, we encounter the fact that many beneficiaries are very much connected to their Medicare Advantage Plan, and often that works against them if they have a large Medi-Cal Share of Cost (SOC) . Sometimes the only option is to return to Original Medicare during the Open Enrollment (October 15 to December 7), or other Special Enrollment Periods, and try to get a Medi gap with a premium that will help them with reducing their countable income. But then as you know, their situation would have to meet one of California’s Guarantee Issue regulations, otherwise they’d be subject to underwriting.
- Third, if a beneficiary feels that their SOC was not calculated correctly, the HICAP can refer the beneficiary to their
- Area Agency on Aging partner – Legal Services – for assistance. [Bet Tzedek – Los Angeles]
- This is the proper referral as established under the Older Americans Act.
I hope this helps with your concerns, and have to emphasize that CHA does NOT do policy or advocacy work on Medi-Cal related issues.
All the best,
Tatiana
Tatiana Fassieux
Education & Training Specialist
California Health Advocates (CHA)
FAQ’s
- IHSS In Home Supportive Services
- Fill out the application for Medi Cal and see.
- .
- r information on Dental for Medi Cal
- See our IHSS FAQ Section
- aged and disabled program?
- Western Poverty Guide Page 78
- This page might be easier to read on CA Health Care Advocates.
- Here’s contact information for Medi Cal. Do you have an online portal with them? What county are you in?
- Try calling Denti Cal 1-800-322-6384
- .
- See above about Mandatory HMO Enrollment
- 3. What is the difference in coverage between Medi-Cal and Covered California?
.- Medi-Cal is health coverage, just like the coverage offered through Covered California. Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as “essential health benefits.”
- Essential health benefits . dhcs.ca.gov/Medi-Cal FAQs
- .
- Do they have to pay in sharing the cost for a CAREGIVER $439 or NOT We are in Alameda County.
- See our IHSS FAQ Section
- See our Medi Cal related pages above
Resources & Links
- Worksheets for Determining Eligibility Under the Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal Program Disability Rights CA
- CHCF explanation SOC Share of Cost Rev December 2017
- Includes cost calculation worksheets
- Chapter 2 – DETERMINATION OF MEDI-CAL ELIGIBILITY AND SHARE OF COST
- Medically #Needy Program (CANHR Fact Sheet 8.14.2023) (My highlighted version)
- Western Poverty Law *
- CA Health Care Advocates * Read the full article from CHCF *
- AB 715 Fact Sheet *
- CHCF for 3 other examples!
- CHFC explanation of Share of Cost
- Legal Aid of San Mateo is your Share of Cost Calculated Correctly
- CA Code of Regulations Article 10 Income
Artificial Intelligence Summary
(with our review)
To qualify for the Program of All-Inclusive Care for the Elderly (PACE), you must meet four main criteria:
While Medicare and Medicaid are primary funding sources, you can also be eligible with Medicare or through private payment if you don’t qualify for Medicaid but meet the other requirements. [1, 2, 3, 4, 5, 6, 7, 8]
The four core eligibility requirements
- Age: You must be 55 years of age or older. [1, 2]
- Location: You must live in a geographic area served by a PACE program. [1, 3, 5]
- Nursing Home Level of Care: You must be certified by your state as needing a nursing facility level of care. This means you need a significant amount of help with daily tasks like bathing, dressing, or walking. [1, 9, 10]
- Safety: You must be able to live safely in your home or community, even with the support of PACE services. [1, 9]
How to apply and what to expect
- Contact your local PACE provider: Find a PACE organization that serves your area and contact them to discuss your eligibility. [9]
- We can help you. Email us [email protected]
- Assessment: The PACE interdisciplinary team will assess your physical and functional needs to determine if you qualify for a nursing home level of care. [10, 11]
- Enrollment: If you meet all the requirements, you can enroll in PACE. [9]
Cost [7]
- With Medi Cal : If you have Medi Cal , you typically do not pay a monthly premium for long-term care services through PACE.
- With Medicare: If you have Medicare but do not qualify for Medi Cal you will pay a monthly premium for the long-term care portion of the PACE benefit.
- Private Pay: If you don’t have Medicare or Medi Cal, you may be able to pay privately for PACE services.
AI responses may include mistakes.
[11] youtube.com
- my place health.com/
- myPlace Health specializes in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish.
- Our myPlace PACE (Program of All-Inclusive Care for the Elderly) model provides seamless primary care, integrated health plan coverage, personalized social engagement, and customized services – all at no cost if you are eligible for Medi-Cal or both Medicare and Medi-Cal.
- .dhcs.ca.gov/PACE
- cal pace.org/
- dhcs.ca.gov/ inclusive care for the elderly
- medicaid.gov/ /program-all-inclusive-care-elderly
- medicare.gov/PACE
- cms.gov/pace/factsheet
https://individuals.healthreformquotes.com/life-ltc-disability-retirement/ltc/estate-recovery-2/
I appreciate your guidance on getting to zero share of cost, very informative! 🌟
Thank you for your help – I’ve spent years trying to figure this out and I’m glad you were able to help me.
Hi Steve,
Thank you for the nice presentation, [Loom explanation of an email] very helpful to see everything onscreen.
Best regards,
Leslie
Hi Steve,
Our zoom meeting this morning was very much appreciated.
I really benefited a lot from our discussion
Thank you very much for your assistance.
Sincerely,
Don V