Your Medi-Cal Is Ending—What Should You Do?
When your income, household size or other circumstances change, you may no longer qualify for Medi-Cal. You may then qualify for a private health plan and financial help through Covered California.
Do not simply accept the first plan shown or wait until your Medi-Cal card stops working. Review the effective date, premium, doctors, hospitals, prescriptions and out-of-pocket costs before confirming a plan.
Step 1: Report the Change to Medi-Cal
Your county must first determine whether you remain eligible for Medi-Cal. Report changes involving income, employment, household members, address or other health coverage promptly. Review our Report Changes to Medi-Cal guide for the appropriate steps and contact information.
You may be asked for current pay stubs, an employment letter, proof of household changes or other documents. Keep copies of everything you submit and save your confirmation number or screenshot.
- Read every county notice carefully.
- Verify the date your Medi-Cal will end.
- Confirm that your address, email and telephone number are current.
- Do not assume that submitting a document means the county has already processed it.
A Covered California Plan May Be Selected for You
Some people who lose Medi-Cal and become eligible for Covered California financial help may have a health plan automatically selected. Covered California generally uses the lowest-cost Silver plan available for the household or may add the person to an existing household plan.
Automatic selection does not mean that it is necessarily your best plan. You may keep it, change to another available plan or decline it. Before confirming anything, compare the plan’s physician network, hospitals, prescriptions, deductible, copayments and maximum out-of-pocket limit.
A plan with no monthly premium still needs to be confirmed. When a monthly premium is required, the enrollment generally must be confirmed and the required premium paid.
You Generally Have 90 Days After Losing Medi-Cal
Losing Medi-Cal provides a special-enrollment opportunity through Covered California. The special-enrollment period is generally available for 90 days after the last day of Medi-Cal coverage.
Do not wait until the final week. Waiting can create problems obtaining documents, correcting household information, reviewing doctors or arranging the first premium payment. Coverage will not necessarily begin retroactively just because Medi-Cal previously covered you.
Review our Special and Open Enrollment guide for enrollment dates, qualifying events and effective-date information.
The Cheapest Premium May Not Be the Best Plan
A plan selected automatically may have the lowest Silver premium, but it may not include your doctor, medical group, hospital or prescriptions. Before enrolling, review:
- Your primary-care physician and specialists.
- Your preferred hospital and medical group.
- Your prescriptions and the plan’s drug formulary.
- Referral requirements and whether the plan is an HMO, EPO or PPO.
- Deductibles, copayments, coinsurance and the maximum out-of-pocket limit.
- Whether an Enhanced Silver plan is available based on your income.
Use our Find Your Doctor Before You Enroll guide and our Covered California and Medi-Cal Income Chart before making a final selection.
Appoint Steve Shorr as Your Covered California Agent
You may appoint Steve Shorr as your Covered California Certified Insurance Agent. There is no additional charge to you for this assistance. Once properly appointed, Steve can help review your application, estimated income, financial assistance, available plans, provider networks and enrollment.
Covered California calls this process delegating your case. It can usually be completed through a secure text authorization, through your Covered California account or with assistance from the Covered California Service Center. You remain in control and may remove or change your delegated agent.
Never send your Covered California username or password. Contact Steve first, and he will explain the appropriate authorization procedure.
Information to Have Ready
Having the following information available will make the transition easier:
- The Medi-Cal notice showing why coverage is ending and the termination date.
- The names, birth dates and relationships of household members.
- Your expected household income for the entire calendar year.
- Recent pay stubs or other proof of current income.
- Your preferred physicians, hospitals and medical groups.
- A list of prescriptions, dosages and preferred pharmacies.
- Your Covered California case number, when available.
Do not send account passwords by email. Sensitive documents can be provided through an approved secure-document method after you contact Steve.
What If Medi-Cal Ended by Mistake?
If you believe the county used incorrect income, household or immigration information, contact the county immediately and review the appeal instructions contained in your notice. Enrolling through Covered California does not necessarily correct an incorrect Medi-Cal decision.
If Medi-Cal has correctly ended but your Covered California account does not show the transition, contact Covered California or ask your appointed agent to help investigate. Keep copies of your Medi-Cal termination notice and any Covered California eligibility notice.
Medi-Cal Contact and Help Information | Official Medi-Cal and Covered California FAQs
Official Documents and Technical Details
The practical explanation appears above. These official documents provide additional program details for consumers, agents, eligibility workers and readers who want the underlying technical information.
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