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Dental Coverage designed to lower Income for Share of Cost Medi Cal

share of cost how much do you need to lower your income

Visit our main webpage on lowering Share of Cost to ZERO!

Maximum Care Plan Dental Coverage to eliminated Medi Cal Share of Cost

Amfirst higher premium

Our clients express how the plans work, better than we do!

Hi Steve,

Good Morning!

Medi-Cal reviewed my Mom’s case and eliminated her share of cost effective as of February 1.

My family is very grateful that this issue was resolved in a very timely manner.

Thank you very much again for your assistance in facilitating this effort.

I will definitely keep your contact information for any future insurance needs.

Sincerely,

Don  V

 

******************

Thank you so much.

Eliminating her share of cost will allow her to stay living at our home longer so it’s very wonderful.

Mary

Hi Steve,

THANK YOU SO MUCH for getting back with me.  You are a wealth of knowledge and I am so grateful to connect with you

….

Thank you!

Carie C

 

 

See more testimonials on Share of Cost in comments below

 

See general testimonials

 

 

More than one dental policy??? Who pays first?

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

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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 For #Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

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[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 

share of costHow to reduce share of cost

  • 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.
    • benefits CalSee My Medi Cal information
    • medi cal vs covered ca fpl

Share of Cost in California Explained (Medi-Cal Rules)

If you live in California and have Medi-Cal with a share of cost, you’re not alone — and you’re probably frustrated. Share of cost is one of the most misunderstood parts of Medi-Cal, and it affects thousands of Californians every month.

This page explains how share of cost works in California, what expenses count, and when alternatives like Covered California health plans may cost less overall.

What Is Share of Cost in California Medi-Cal?

In California, share of cost is the amount you must pay (or incur in medical bills) each month before Medi-Cal begins paying for covered services.

It functions similarly to a deductible — but with important differences:

  • It resets every month

  • It is based on income, not plan design

  • It applies only to certain Medi-Cal programs

Once your share of cost is met in a given month, Medi-Cal pays for the rest of that month’s approved services.

Why California Uses Share of Cost

California applies share of cost when your income is:

  • Above standard Medi-Cal limits

  • But still low enough to qualify after allowable deductions

This often applies to:

  • Seniors (65+)

  • Individuals with disabilities

  • People receiving Social Security

  • Individuals with variable or non-MAGI income

California uses specific income rules that differ from MAGI Medi-Cal, which is why many people are surprised when they receive a share of cost notice.

How Share of Cost Is Calculated in California

California considers:

  • Gross monthly income

  • Household size

  • Certain allowable deductions

  • Living arrangements

The final number becomes your monthly share of cost, and it resets every calendar month.

⚠️ A small reporting error can result in a much higher share of cost than necessary.

What Medical Expenses Count Toward Share of Cost in California?

Many expenses can be applied toward your share of cost, including:

  • Doctor visits

  • Hospital services

  • Prescription medications

  • Dental care

  • Vision services

  • Medical equipment

  • Some unpaid medical bills from prior months

Rules can vary by county and situation, so verification matters.

Share of Cost vs Covered California Plans

Many Californians with a high share of cost are surprised to learn they may qualify for Covered California subsidies instead.

Covered California plans may offer:

  • Monthly premium tax credits

  • Predictable copays

  • No monthly reset

  • Broader provider access in many areas

For some households, a subsidized Covered California plan can cost less per year than meeting share of cost multiple times.

Can Share of Cost Be Reduced or Avoided in California?

In many cases, yes.

Depending on your situation, options may include:

  • Correct income categorization (MAGI vs non-MAGI)

  • Proper deduction reporting

  • Household or filing status changes

  • Transitioning to a Covered California plan

This is where working with a licensed California health insurance agent can prevent costly mistakes.

Get Help With Share of Cost in California

If you’re dealing with share of cost in California, you deserve clear answers.

I help Californians:

  • Understand Medi-Cal share of cost rules

  • Compare Medi-Cal vs Covered California options

  • Estimate subsidies accurately

  • Avoid unnecessary medical expenses

👉 Click here to get an instant subsidy and plan comparison
👉 Or contact me directly for personal help

Lower Share of Cost with Medical Expenses???

share of cost

 

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
  1. Pay the Provider: Pay for the medically necessary service or item.
  2. Get Proof: Keep detailed receipts and, if possible, a doctor’s order or prescription.
  3. 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.
[2]calfresh.guide/medical-expense-deductions/

How to Lower Your Medi-Cal Share of Cost (Los Angeles County)

If you have Medi-Cal with a share of cost, you may be paying more than required.
Certain out-of-pocket medical expenses — including dental insurance premiums —
can lower your share of cost dollar-for-dollar.

What Lowers Share of Cost?

  • Dental insurance premiums
  • Vision insurance premiums
  • Medicare Part B and Part D premiums
  • Medicare supplement (Medigap) premiums
  • Other private health insurance premiums

How the Math Works

Every $1 of allowable medical expense lowers share of cost by $1.

What to Upload

Upload a premium bill, policy summary, insurance letter, or bank statement
showing the premium amount.

What to Write

Out-of-pocket dental insurance premium. Please apply as an allowable medical
expense to reduce Medi-Cal share of cost.

Follow Up

Call LA County DPSS at 1-866-613-3777 after 3–5 business days.

Presented by Steve Shorr, Licensed Insurance Agent

How to Lower Your Medi-Cal Share of Cost (Los Angeles County)

Intro (short + reassuring)

If you have Medi-Cal with a share of cost, you may be paying more than required.
Many people don’t realize that dental insurance premiums and other health premiums can lower share of cost dollar-for-dollar.

This page explains exactly how it works, what documents to upload, and what to say to Los Angeles County so it gets applied correctly.

What Is Share of Cost?

Share of cost is the monthly amount you must pay for medical expenses before Medi-Cal starts paying.

The good news:
Certain out-of-pocket medical expenses reduce it.

Expenses That Can Lower Share of Cost

If you pay these yourself, they usually count:

  • Dental insurance premiums

  • Vision insurance premiums

  • Medicare Part B premiums

  • Medicare Part D premiums

  • Medicare supplement (Medigap) premiums

  • Other private health insurance premiums

Employer-paid premiums do not count.

How Much Will My Share of Cost Drop?

It’s simple math:

Every $1 of allowable medical expense lowers your share of cost by $1.

Example:
Dental premium: $52 per month
Share of cost: $850

➡ New share of cost = $798

Multiple premiums can be combined.

What Documents Do I Need?

Upload one of the following:

  • Insurance premium bill

  • Policy summary showing monthly cost

  • Letter from the insurance company

  • Bank statement showing the premium payment

Documents must show:

  • Name of the Medi-Cal member

  • Insurance company name

  • Monthly premium amount

  • Recent date

Where to Upload (Los Angeles County)

Upload documents at BenefitsCal.

Choose:

  • Upload Documents

  • Document Type: Medical Expense

What to Write in the Comment Box

Copy and paste this exactly:

“Out-of-pocket dental insurance premium. Please apply as an allowable medical expense to reduce Medi-Cal share of cost.”

Important: Follow Up

After 3–5 business days, call LA County DPSS:

📞 1-866-613-3777

Say:

“I uploaded proof of dental insurance premiums and am requesting it be applied to reduce share of cost.”

If You Get Pushback

Dental insurance premiums are allowed.

  • 42 CFR § 435.726 (Federal regulation)

  • California Welfare & Institutions Code § 14005.12

Dental and vision premiums are allowable medical expenses under Share-of-Cost Medi-Cal.

Need Help?

If you’re unsure what counts or want help reviewing your situation, contact a licensed health insurance professional.

Presented by Steve Shorr, Licensed Insurance Agent

Ask us a Question? FAQ's?

Share of Cost #Worksheets

Worksheet for Medi Cal with no share of cost

FPL worksheet avoid share of cost

Share of cost example

share of cost example

  • CHCF explanation SOC Share of Cost Rev December 2017
    • Includes cost calculation worksheets  The most Plain English explanation I’ve found!
    • CANHR understanding share of cost for Medi Cal 
    • IHSS explanation 
  • 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).
  • 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
  •  

#chart

Instant Quotes & Subsidy Calculation         Email Us [email protected] 

2026 Covered CA Income Chart FPL Federal Poverty Level

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

Get Help Medicare Costs

 

Medicare Savings Programs 

Note that this is 2025 numbers

qmb benefits

Incontinence 

What Out of Pocket Expense Counts towards Share of Cost

Does Medicare Cover Incontinence?

See our webpage on DME  Durable Medical Equipment

 

IRS Publication 502 pdf * html

Medical & Dental #Expenses

publication 502 medical & dental expense

Get Instant Quotes & Proposals for Medi Gap - Supplemental Plans

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 

Get Quotes 

maximize medi gap premium

Get Instant Quotes & Proposals for Medi Gap - Supplemental Plans

Get Quote for Medi Gap

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

Guaranteed right to get Medi Gap

 

Right to Opt out of Medicare Advantage

right to opt out of MAPD when on medi calright to go back to original medicare

 

Get Instant Quotes & Proposals for Medi Gap - Supplemental Plans

Introduction to #MediGap

 

Publication 02110

Choosing Medi Gap Plan

 

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.
      • notice of action

Footnotes * Wikipedia * Investopedia *  Merriam – Webster *  Things to know about Share of Cost * HICAP *

Sample income calculation

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

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

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

 

IHSS In-Home Supportive Services

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. ?
    .
  • 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.
          .
  • Question How does Medi-Cal share of cost work with Medicare Part D Rx Prescription coverage?
    .
  • ..
  • See situation # 16 above, it looks to me like you can get Medi Gap guaranteed issue.
  • Question Does veteran aid & attendance or death benefits as unearned income count towards share of cost?.
    .

benefits Cal

See My Medi Cal information 

IRS Publication 502 pdf * html

Medical & Dental #Expenses

publication 502 medical & dental expense

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

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  

 

Resources & Links

Resources & Links

Share of Cost

Reform

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

Nope the 2025 Updates didn’t get funded

 

#PACE

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
  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]
How to apply and what to expect
  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]
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.

 

6 comments on “Share of Cost – Eliminate with Dental, Vision Medi Gap Insurance Premiums”

  4. Thank you for your help – I’ve spent years trying to figure this out and I’m glad you were able to help me.

    Reply

  5. Hi Steve,

    Thank you for the nice presentation, [Loom explanation of an email] very helpful to see everything onscreen.

    Best regards,
    Leslie

    Reply

  6. 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

    Reply

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