Medi-Cal with a Share of Cost (SOC)
Lower your Share of Cost with Medi Gap or Dental Coverage
Get a, Life, Dental or Medi Gap Policy
- Medi-Gap or other private health insurance product, including
- Part D Rx,
- Do you have this in your Medicare Advantage Program?
Final Expense – ask about the plans that are guaranteed issue, just don’t pay full benefits for say 3 years & Life Insurance?,
- dental or vision insurance get quotes.
- How share of cost works and suggestions to eliminate it. HI Cap Contra Costa County
- CANHR Aged & Disabled
- Medi Helper Medi Cal Consulting
You can deduct the cost of that policy or product and that may help them get under the strict income limit in the A&D FPL and Blind FPL programs. See above, you must have original Medicare, not Medicare Advantage.
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 *
- 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?
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).
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.
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
SOC Share of Cost is calculated or determined by using your monthly income, with this formula:
Medi-Cal subtracts $600 (for an individual) or $934 (for a couple) from your monthly income, and any other health-insurance premiums you may be paying.
For example, if you have an individual
monthly income of $1,300,
Medi-Cal subtracts – $600
for a SOC of = $700.
This means you must pay at least $700 in covered medical expenses and/or health care premiums in a given month before Medi-Cal covers any of your health care costs for that month. For people with a high SOC, Medi-Cal is mostly a form of catastrophic coverage, meaning Medi-Cal will most likely only help them for emergencies or high-cost medical conditions. Check out CHCF for 3 other examples!
Note: If you have Medi-Cal with a SOC, Medi-Cal will not pay your Medicare Part B Doctor visits monthly premium. This means your Part B premium will be deducted from your Social Security check each month. One exception applies if you are in a Medicare Savings Program (MSP) that pays for your Part B premium (QMB, SLMB or QI). If you are in one of these MSPs, you will not be affected.
If you meet your SOC with medical costs in any given month, Medi-Cal will retroactively pay your Part B premiums for the month(s) in which the SOC is met. Medi-Cal will send the payment to the Social Security Administration (SSA), which will refund you the amount of the premium. Any Part B premium refund Western Poverty Law * CA Health Care Advocates * Read the full article from CHCF * AB 715 Fact Sheet *
Share of Cost still applies, but only in certain situations. Mainly in the case of disabled adults or those over 65. per 12.10.2014 email from sheinberg law group.com
Share of Cost & Skilled Nursing
Links & Resources
- California Code of Regulations
- CHFC explanation of Share of Cost
- Legal Aid of San Mateo is your Share of Cost Calculated Correctly
References & Links
- CHCF explanation SOC Share of Cost Rev December 2017
- CANHR Aged & Disabled Program
- CA Health Care Advocates
- Health Consumer Alliance Fact Sheet
- Disability Rights CA Share of Cost – Nursing Home Resident
- Bridget MacKay Law
- Medi-Cal What it means to you Phamplet
- 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
- 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 *
- Get more detail on the Individual & Family Carriers available in CA
- 2023 Official Medicare Guide to choosing a Medi Gap Policy # 02110
- Anthem Blue Cross Information & Enrollment
- United Health Care
- Blue Shield – Medi-Gap Information & Enrollment
- Your Rights to Enroll without Health Questions
Medi Gap pays the medical expenses that Original Medicare Part A (Hospital) and Part B (Doctor) doesn't. Check out the chart on this page to see what Medicare Pays, what you pay and what a Medi Gap plan pays.
- If you have a Medigap policy and get care, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then, your Medi-gap policy will pay its share. You’re responsible for any costs that are left. Medicare.Gov *
Original Medicare, Medicare Advantage nor Medi Gap pay for long term care either in a nursing home or at home care. Get more information on Long Term Care here. Even if you think you can't afford any extra premiums, there's a lot of valuable information to help with planning.
Be sure to put in our AGENT # 2094784
Delta Dental – Covered CA Plans
- California Brochures
- Delta Dental PPO Premium Plan covers implants at 50%, after a 12-month waiting period.
- Delta Dental Individual & FamilyTM Delta Dental PPOTM Family Dental Plan 669 KB
- Delta Dental PPOTM Children’s Dental PPO for Small Businesses 790 KB
- Delta Dental PPOTM Family Dental PPO for Small Businesses 794 KB
- Delta Dental Individual & FamilyTM DeltaCare® USA Family Dental HMO 872 KB
- DeltaCare® USA Children’s Dental HMO for Small Businesses 837 KB
- Members Resource WebPage
- Broker ONLY
- Medi Cal Explained CHCF
- More explanation
- California Advancing and Innovating Medi-Cal (CalAIM) is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory.
- Medi Cal Contact Information
- Our Webpages on
- Medi Cal Benefits
- Denti Cal
- Medi-Cal – MAGI Income Eligibility Criteria
- Aged and Disabled Federal Poverty Level Program
- Contact Info – Complex Questions – Reference Materials Medi-Cal
- Dual Coverage? Medi Cal, Employer Group, Individual, Cal Medi Connect & Medicare
- Full Scope Medi-Cal – Benefits & Coverages
- Transitions from Medi-Cal to get Covered CA
BIC Benefits Identification Card
- One of our colleagues on how Dental for Everyone Works.
- Some of our webpages on dental
- VSP Vision
#Medicare10050 and You 2024
Everything you want to know
- Steve's Video Seminar Introduction to Medicare & You
- Audio from Medicare.Gov
- Clear View to Medicare Patient Advocate.org - 36 pages
- Your Medicare #Benefits # 10116
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Inpatient ONLY - How Medicare Pays for your Surgery Part A vs Part B Very Well Health.com
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- TITLE XVIII—HEALTH INSURANCE FOR THE AGED - Medicare AND DISABLE
That's why the premium is very low or ZERO!
- Set a phone or Skype Meeting
- We can now do SOC Scope of Appointment, before the Meeting via a 3 minute recorded meeting 2 days before. AHIP Training Module 4 Page 14 *
- #Intake Form - We can better prepare for the meeting
- HMO - Narrow Networks?
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums! How is that possible? The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It's best to apply when you turn 65 for the supplement plans or advantage plans, as that's the main "Open Enrollment" period, guaranteed issue for any plan.
Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?