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}  or show Medical Expenses..

•  dental or vision insurance get quotes Quotit.
  • Special Plan for Share of Cost – Maximum Care Plans
    • Maximum Care Plans Summary of Benefits
    • Plus  Plan
    • Enrollment Form
  • 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
• Part B Medicare
• Part D Rx,
  • Do you have this in your Medicare Advantage Program?
• Medical Expenses, including Adult Diapers – our webpage
• Covered CA if you are under 65?  Get quotes
  • Email us [email protected]  every situation is different, we will need to research if this will work for you.

“Tell me your monthly Share of Cost amount or how much your Social Worker at Medi Cal said you need to spend on premiums and I’ll tell you exactly how much insurance you need.”

Add a section:

✅ This strategy is permitted under California Medi-Cal rules
✅ Premium payments are allowable medical deductions
✅ No income manipulation required
✅ No assets moved

Also add:

• California Health & Human Services reference

• Medi-Cal Aged & Disabled FPL program

• Citation links (you like citations placed after relevant paragraphs — I’ll match your style)

• 

Need to spend more $$$ to get to  Zero Share of Cost?

We have additional Dental, Vision & Medi Gap plans 

Plans available with Dental for Everyone
Get instant quotes & Enroll 

Child - Subpages 

• “How to Eliminate Medi-Cal Share of Cost with the 250% Working Disabled Program”
• Appeals Medi Cal
• Calculate Instantly Medi Cal Share of Cost and Zero it out!
• FAQ’s Share of Cost
• How to upload documents to BenefitsCal.com
• How to use medical expenses to lower share of cost
  • How to Fix Medi-Cal Share of Cost Retroactively
• IHSS In Home Supportive Services
• Medi Gap to lower share of cost Medi Cal IHSS
• Timing & Redetermination Medi Cal Share of Cost

Site Map

Testimonials 

Plugin Codes

More explanation of how share of cost works and ways to eliminate it – bring it to ZERO!

More explanation, details & Faq’s

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]
    • ONLINE Intake Form
  • 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)

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
  • .  bet tzedek.org/get-help/ 

• Resources & Links

  • How share of cost works and suggestions to eliminate it. HI Cap Contra Costa County
  • CANHR Aged & Disabled
    • Medically Needy
  • Medi Helper Medi Cal Consulting
  •  
  • If you are in share of cost, you get fee for service, not mandatory HMO
  • CA Health Care Advocates Webinars

Share of Cost

Reform

Visit our prior and HISTORICAL versions of this webpage on Archive.org 

#PACE

Artificial Intelligence Summary
(with our review)

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]

1. Age: You must be 55 years of age or older. [1, 2]
2. Location: You must live in a geographic area served by a PACE program. [1, 3, 5]
3. 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]
4. Safety: You must be able to live safely in your home or community, even with the support of PACE services. [1, 9]

1. Contact your local PACE provider: Find a PACE organization that serves your area and contact them to discuss your eligibility. [9]
   1. We can help you.  Email us  [email protected]
2. 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]
3. Enrollment: If you meet all the requirements, you can enroll in PACE. [9]

• 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.

• 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