Share of Cost - CHCF 2010

Medi-Cal with a Share of Cost (SOC
Medically Needy
Lower your Share of Cost with Medi Gap or Dental Coverage

Ways to lower your Medi-Cal #Share of Cost

If you don’t have Full Scope Medi Cal 

Get a VisionDental or  Medi Gap Policy

You can Avoid a Share of Cost  in the (ABD-MN) Aged, Blind and DisabledMedically #Needy Program (CANHR Fact Sheet 8.14.2023) (My highlighted version) program  and then qualify for no-cost A & D FPL.

Just purchase California Code of Regulations :

 

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.
    • Send us your NOTICE OF ACTION, etc. from Medi Cal
      • notice of action

Footnotes * Wikipedia * InvestopediaMerriam – WebsterThings 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 *

Resources & Links

 

Introduction to #MediGap

2024 Choose Medi Gap Policy

Our video explaining the Governments brochure on choosing a Medi Gap Policy.  Click the little square on the right, to enlarge the video.

Get Quote for Medi Gap

Guaranteed Right to get Medi Gap if your #Medi-Cal benefits change...

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

 

Worksheet for Medi Cal with no share of cost

FPL worksheet avoid share of cost

  • Source – ABD FPL Worksheet Single Adult – Not Living in Board & Care  Disability Rights
  • Is the amount in Step 13 equal to or less than $1,677 in 2023?  $20,121 in 2024  That amount is 138% of the FPL.
    • If yes, then you qualify for Medi-Cal with no share of cost.
  • 2024 Covered CA Chart for 138% FPL
  • 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 $1,732 in countable monthly income for an individual ($2,351 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

 

Resources & Links

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).

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.

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

Question  Hi, My father was approved for IHSS In Home Supportive Services  under Medi-Cal with share of cost. His SOC is $1723 which extremely high. His income from SS and pension is about $2,500. He currently has senior advantage with Kaiser. NO additional insurance. How could he spend $646 in insurance premium to eliminate his share of cost?

Answer  – Please send us [email protected] all the paperwork from Medi Cal so that we can review it.  We will not post any confidential or identifying information.  Would you consider dropping Kaiser to get a Medi Gap plan?

 

ONLINE Enrollment in Medi-Cal
How to VIDEO

benefits Cal

 

#BenefitsCal is a one-stop-shop to apply for...

Clarification from Hi Cap 

 

Hello Mr. Shorr,

Mrs. Burns shared your latest email with me, and I will respond.

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  

 

Share of Cost

Reform

Problems with Share of Cost and spending $500 on a $2,500 Social Security Check

  • I have already written to Steve lopez [Los Angeles Times]. I am looking to make a difference here and I have explained this to the social worker who called me just now from Medi-Cal. I asked her to pass the information up to her supervisor and to her supervisor supervisor and to the mayor of this city and to the representatives of this District until we get some satisfaction. Steve has already shown me that 70 organizations have already written to the governor on this matter.
  • Further the social worker informed me that it is not retroactive meaning that I am responsible for the $1812 in April that were not paid to the IHSS caregiver involved at the time.
    • She now tells me that she is suing me and taking me to court to get the money. She also asked me to lie and approve all of her hours the rest of April even though she did not work those hours. She quit and abandoned me on April 23rd at 12:30 p.m.. I texted her as she going to return? The answer was unfortunately no.
  • I did some calculations today and what we have done in terms of the expenses I now will have for the insurances to lower my income so that I don’t have an $1,800/month share of cost is going to eat up my fixed income per month.
    • $2,500 Social Security Income
    • – 430  Medi Gap Premium
    • –    93   Dental
  • This is a huge tragedy that is going to prohibit me from having a caregiver until the earliest in July and maybe not even then. I can’t begin to tell you how much I have been suffering and now I have to pay my caregiver to come here privately to give me a shower and take care of some other things that I’m just unable to do now. The last shower I had taken before today was last Sunday. And I literally have worn the same clothes and had no shower until today, friday, and now he will return on Tuesday evening because I have another medical appointment on Wednesday.
  • My strength and stamina are being depleted more and more each day. I believe that what is necessary is that if you can and are willing, please call and describe to my Social Worker at Bet Tzedek  what I’m experiencing and see if we can’t get some reporter to come here and interview me and make this story and travesty go Nationwide and also let me demand that this insanity of not taking into account a senior’s income level in the calculation of the share of cost.
  • I literally am unable to pay what I already owe and I’m being dug into a deeper and deeper hole each month. The nation must be awakened to the fact that Medicaid and Medi-Cal are stifling out the lives of seniors like me and perhaps even killing them if stamina gives out and their life ends. I’ve already had three strokes. I have avoided a fourth since 2015 because of the excellent medical care I have received from Dr Leonard scuderi cardiologist and many others.
  • How much stress can I take before the 4th stroke does occur and I become more debilitated than I am or in fact die? Has my time now caught up with me and my end of life is in sight?
  • Feel free to send this email to G-d and everyone see if  there isn’t a way to stir up notoriety about this mess of my life now.
  • I’m happy to represent any and every senior across this country who is facing the same insanity.

Resources & Links

24 comments on “Share of Cost – Medically Needy – Eliminate with Health Insurance Premiums

    • Your question is beyond our pay grade. Which is Zero. We don’t make a nickel unless you were to get a Medi Gap plan where we make say a 10% commission, paid by the Insurance Company, so there is no additional charge to you.

      Thus, here’s our research, not legal advise.

      The simple answer is MAGI Income, what’s on the Tax Return…

      What if one has a million dollar income from investments? That’s unearned, right?

      Income Limits.

      To be eligible for the A&D FPL or the Blind FPL Medi-Cal programs, an applicant’s countable income 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

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

      Countable Income for SSI Program

      Income definition

      Income is anything you receive during a calendar month and can use to meet your needs for food or shelter. It may be in cash or in kind.

      In-kind income is not cash; it is food or shelter, or something you can use to get food or shelter.

      Countable Income definition

      Countable income is the amount left over after:

      Eliminating from consideration all items that are not income; and
      Applying all appropriate exclusions to the items that are income.
      Countable income is determined on a calendar month basis. It is the amount actually subtracted from the maximum Federal benefit to determine your eligibility and to compute your monthly payment amount.

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

      (a) Gross unearned income includes:

      (6) Veterans payments which include:

      (A) Pensions based on need.
      (B) Compensation payments.
      (C) Educational assistance.

      Section 50507 – Gross Unearned Income

      California Code of Regulations Article 10 Income Section 50501 – 50571

  1. My elderly mother has dementia and we applied to In home supportive services with a Medi Cal share of cost of $993 dollars

    to qualify for full medi cal she would need to purchase $111 in extra insurance a month and

    she currently has AARP united healthcare Medicare Advantage insurance.

    Due to pre existing conditions and medical underwriting we are having trouble trying to switch to traditional Medicare with a Medicap supplement and

    we are wondering what other insurance options could qualify her for full medi cal with no share of cost.

    • 2. Prescription Drugs

      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. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage prescription drug plan to get these benefits. (Note: if you are in Cal MediConnect, you will get your prescription drugs through your Cal MediConnect managed care plan.) Medi-Cal, however, will pay for certain categories of drugs not covered by Part D, including:

      • Drugs used for smoking cessation
      • Certain cough and cold drugs
      • Certain over-the-counter drugs
      • Vitamins and minerals

      With Medicare Part D drug coverage, you must make copayments of no more than $1.30 for generic drugs and $8.95 brand name drugs in 2020. The 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. https://cahealthadvocates.org/low-income-help/medi-cal-for-people-with-medicare/#Prescription

  2. I need to understand income levels on Covered CA chart for the Silver 94 plan.

    I have seen some info that specifies Inc level can be as low as approx $11,500 or 100% of poverty level if not eligible for

    ‘full-scale scope of benefits Medi-Cal‘.??

    Reply

    The reason that the Covered CA Income – FPL chart below used to show Share of Cost or Cost Sharing Reduction (CA Health Care Foundation 2010 Report) above 100% is

    If the member’s income is less than >138% to less than <150% they qualify for Enhanced Silver 94.

    The earlier chart shows less than > 100% as in some states, NOT California, Medi-cal is for those under <100%. excerpt of 8.4.2015 email California has adopted Medi-Cal expansion, so in CA if you make less than 138% of FPL you get Medi-Cal, not Cost Sharing Reduction – Enhanced Silver.

    because Medi-Cal requires participants to pay Share of Cost if they make more than 100% of the FPL. If they make below 100%, at that point Medi-Cal will absorb complete cost for coverage. If you have any other questions, please let us know. Email Rec’d from Covered CA 11.28.2014 12:15 PM

  3. I applied for Medi-Cal on November 1, 2017 but the application is pending a “shared” cost approval.

    Reply
    Steve Shorr says:

    Try contacting your local county see link above or use menu to find the contact page.

  4. My current pay stub as of last week says I made 21,314.05 that’s including Holiday Vacation OT & sick pay & my regular earnings are 19,922.42 I have 2 children & I am receiving CAL-fresh I have been receiving Medi-cal & now it’s redetermination time will I still qualify for benefits?

    Reply
    Steve Shorr says:

    February 20, 2017 at 11:01 am

    Probably. It appears that your family income is below 138% of Federal Poverty Level. See chart, complementary quote and subsidy calculation in webpage above

  5. Is medi-cal shared cost based on total monthly income if the person passes away during the month and the income is reduced ?

    • Do You Have to Pay a Share of Cost?

      If you do not get one of the above types of Medi-Cal, you may still be able to get no-cost IHSS if your countable monthly income is less than the SSI monthly benefits rate in California — $943.72 for an individual or $1,582.14 for a couple in 2020. (We’ll explain more about how countable income is calculated below.)

      If your countable monthly income is above the SSI benefits rate, you can still get IHSS if you meet all other eligibility criteria. You may, however, would have to pay a share of cost. CA.db101.org

      Countable Income

      The amount of income that Social Security or the state counts when figuring out if you qualify for benefits and, if so, the level of benefits you should get. Not all of your income counts.

      Example: Supplemental Security Income (SSI) counts most unearned income, but a bit less than half of earned income. So, if you have $500 in unearned income and $500 in earned income, your countable income for SSI would be just $697.50, even though your total income would be $1,000. Other programs, such as disability-based Medi-Cal and Medicare Savings Programs often use calculations similar to SSI’s.

      This is a rather complex question, even though it sounds simple enough. Please double check, whatever we find with Medi-Cal – Contact Info.

      Here’s a sample form to complete to determine share of cost.

  6. How exactly is Linda’s Medi-Cal share of cost calculated?

    Each year, as my disabled wife’s social security income goes up by a few points, we wait for a letter to see if she has a share of cost, and then adjust her insurance premiums accordingly.

    This doesn’t always work, and twice now I’ve had to file an appeal to get the share of cost calculated correctly.

    ’m usually given a pass/fail judgement, with little transparency as to how this is calculated.

    It would be great to know precisely how this is calculated.

    Of course, the choice I think I am making here is

    a) no extra insurance beyond Medicare, but then she must pay a share of cost (with no extra coverage benefit) vs.

    b) pay for additional coverage at a lower cost than the actual share of cost, and which sets her share to nil.

    Am I making a smart decision within this framework?

    • Individuals must show that they do not have other minimum essential coverage in order to qualify for financial assistance through Covered California.

      Minimum essential coverage includes:

      • Medicare Part A and Medicare Advantage plans;
      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
      • TRICARE;
      • Comprehensive health care offered by the Veterans Administration;45
      • Coverage provided to Peace Corps volunteers;
      • Coverage under the Nonappropriated Fund Health Benefit Program from the Department of Defense;
      • Self-funded health coverage offered to students by universities for plan or policy years that began on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these programs may apply to HHS to be recognized as minimum essential coverage);46
      • State high risk pool coverage established on or before November 26, 2014 in any state;47 • Most employer-sponsored health plans, including COBRA and retiree coverage;
      • Plans purchased on the individual market;
      • Grandfathered health plans; and Other plans as designated by HHS.

      Note

      that because certain Medi-Cal programs are not minimum essential coverage, (namely 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. https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=156

  7. My Dad is in skilled nursing but WILL be coming home in a few months.

    Medi-Cal says his share of cost is all of his income, less $50 (he gets to keep $50).

    The problem with this is that he and I share a rented house. He also has a car payment. Neither of these things are taken into account?

    So they don’t take into account that he needs a home to go home to?

    • You’re questions probably goes beyond my pay grade (Zero). See my reply below.

      In the meantime, if you send me privately all the documents, [email protected] I can review and see if I can give you any insight on how to get a lower share of cost, no share of cost, get on Medicare, whatever.

      Plans with Covered CA subsidies? Get quote.

  8. 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. ?

  9. If my father has private pay providers in the home or 160 hours per week and IHSS has granted him 90 hours per month how is the share of cost met?

    • Visit the IHSS webpage

      Twice a month, both you and your provider who works for you will receive an “Explanation of IHSS SOC” letter that will tell you how much money to pay the provider. Remember, the SOC is part of provider’s salary. You, as the IHSS recipient, must pay the SOC, if any, to the provider monthly. The SOC may change from month to month.

      For questions regarding SOC, contact your Social Worker at (888) 822-9622.

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