Medi-Cal Aged & Disabled Federal Poverty Level
(A&D FPL) Program
Aged, Blind & Disabled Medi-Cal Program
The Aged and/or Disabled Federal Poverty Level Program (Income Chart) (A&D FPL) serves individuals aged 65 and older, and persons with disabilities. The program makes
FLASH!!!
- Check out this Fact Sheet from Justice in Aging on Medi Cal changes for 2022
- Asset Limit Changes for Non-MAGI Medi-Cal
Full-Scope Medi–Cal Health Benefits
- See the My Medi Cal brochure for details & Benefits
- To qualify for this program, individuals Must meet all of the following three criteria:
- Be aged (65+) or disabled (meet Social Security’s definition of disability, even if your disability is blindness).
- income & assets limits much more liberalized!
- Worksheets for Determining Eligibility Under the Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal Program
Resources & Links
- CANHR.org – Fact Sheet
- CA Health Care Advocates
- Kaiser Foundation
- Does Integrating Medicare and Medicaid Improve Care for Dual Eligibles?
- DHCS.CA.Gov
- Disability Benefits 101
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Medicare And Disabilities
#Understanding Medicare Advantage Plans (PDF) #12026
- MAPD Plans look like a great deal, as the "premium" is paid by fee from the Federal Government, on average $2k/year.Kff * MAPD Plans must cover all A & B services Medicare.Gov * generally they also cover Part D Rx.
- That's why the premium is very low or ZERO!
- Set a Zoom 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 Berwick Needs Assessment Form - We can better prepare for the meeting
- Medicare Advantage (Medicare Part C): An Overview Hi Cap
- HMO - Narrow Networks?
- HI Cap CA Health Care Advocates Fact Sheet
- 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
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MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums!
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How is that possible?
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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.
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Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
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Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
- If You Have Problems with Your Medicare Advantage Plan
- forbes.com/how-insurers-can-navigate-the-costs-of-medicare-advantage-benefits
- politico.com/medicare-advantage-plans-congress
- Uncle Sam wants you to help stop insurers' bogus Medicare Advantage sales tactics
- ca health advocates/using-ai-to-deny-care
- Dodging the Medicare Enrollment Deadline Can Be Costly
- Medicare Advantage Increasingly Popular With Seniors — But Not Hospitals and Doctors
- Medicare Advantage is bad for patients and bad for investors
- When Medicare Advantage Plans Terminate Coverage
- Medi-Cal D-SNP Feasibility Study
FAQ’s
Question
My tax person informed me that claiming my 81 year old father-in-law as a dependent on my taxes would not affect his eligibility for A&D – Aged & Disabled FPL Full Scope – Federal Poverty Level Medical-cal. Is this true?
Similar situation in regards to claiming my mother. She receives SSI/SSDI and receives medical Medi-Cal . Would claiming her as a dependent affect her eligibility for medi-cal
Answer
See Chapter 3 – Western Poverty Law Center on Health Insurance for Low Income. See also Social Security’s website on SSI
Does your Mom get SSI or SSDI, it makes a difference. SSI is dealt with here. See also Social Security’s website on SSI for income & resource information.
SSI
Eligibility
BenefitsResourcesIncomeLiving Arrangements
SSDI gives one Medicare after two years.
We don’t get paid to help people with Medi-Cal, SSI or SSDI. When you read the manual, be sure to read it 3x and when you think you understand it, read it again. We’ve only skimmed the material
Question
I am 70 years of age and have been on medi cal due to low income. I recently applied for my ex husbands social security and my income increased to $1,379.10. Can I still qualify for medi cal?
***Sorry, it looks like you are now over the income limit. See excerpt below. Losing Medi-Cal would give you a Special Enrollment Period into a Medicare Advantage Plan where there are generally no premiums and very little co-pays that we can help you with. You might also qualify for low income subsidies for your prescriptions.
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Question
What if one qualified for Medi-Cal because of a disability, but wants to opt out and get subsidies in Covered CA or just pay full price during Open Enrollment?
Excerpt of email…
[Covered CA] was advised that since member has disability even if he doesn’t want to be on Medi-cal, he will still be referred to them. … Medi-cal caters for people with disability. The member should ask Medi-cal for possibility of releasing him, unfortunately, it’s not under our control .
Maybe shouldn’t argue with Medi-Cal to say not disabled – could hurt Medicare and Social Security Disability Claim
#My Medi-Cal
How to get the Health Care
You Need
24 pages
Smart Phones - try turning sideways to view pdf better
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- More explanation
- Enroll with Benefits Cal
- What is Medi Cal - VIDEO
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Medi-Cal Managed Care HMO – Health Care Options
- Benefits Cal is a one-stop-shop to apply for...
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Here you can review and choose the HMO that you want to deliver your Medi-Cal health Care.
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BIC Benefits Identification Card
Have Medi Cal pay Medicare Part B $174 Premium #Costs # 10126
Medi Cal * Part B Outpatient Premium Forgiveness
- How the ‘Medicare Cliff’ is raising costs and worsening health for many older low-income adults
- Medicare.Gov MSP Medicare Savings Programs
- DUALLY ELIGIBLE BENEFICIARIES UNDER MEDICARE AND MEDICAID (Medi Cal) MLN Knowledge Booklet
- cms.gov/QMB Qualified Medicare Beneficiary Programs
- CA Health Care Advocates on MSP
- Minimum Federal Eligibility Requirements for Medicare Savings Programs in 2024
- Save money on your Medicare costs
- CA Department of Aging 1-800-434-0222 -
- Medicare Counseling HICAP State Health Insurance Assistance Programs SHIP
- FACT Sheet Low Income Assistance: Medicare Savings Programs CA Health Care Advocates HI CAP
- Medicare Savings Programs in California
- health care rights.org Serving Los Angeles County
- dpss.lacounty.gov/savings
- Disability Benefits 101
- National Council on Aging MSP
- MSP Medicare Savings Plan CA Health Care Advocates
- khn.org/billions-of-dollars-in-benefits-go-unused
- Our webpage on Part D Rx Extra Help - LIS Low Income Subsidy
- Explanation of countable Income Insure Me Kevin.com
- FAQ
- Will the Aged & Disabled program pay for Medicare Part B Outpatient & Doctor Visits premium of $174?
- See brochure above.
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- See brochure above.
- Medicare I need help with choosing what my options are.
- Take a look at our webpage on Original Medicare A & B plus Part D Rx and Medi Gap vs Medicare Advantage
- Set up a Zoom Meeting and we can discuss. www.SteveShorr.com/Meeting
- Will the Aged & Disabled program pay for Medicare Part B Outpatient & Doctor Visits premium of $174?
Brother - Sister - Sibling Side Pages Subpages
View our website with your Desktop or Tablet for the most information
True #Freedom Home Health Plans
True Freedom Plan Details - Brochure 1/2023
- Enrollment Form
- email [email protected] for fillable pdf
- ONLINE Enrollment - put in our agent information
- Rate Chart
- One page brochure
- VIDEO Explanation on True Freedom Plan
- The Long Road Ahead Video
- The application disclaimers
- FAQ's
- True Freedom website, but be sure to enroll with us!
"Prepaid Home Health Care?"
Watch 3 minute simple plain English Video
- Email us for more information [email protected]
- Our webpage on Long Term & Home Health Care
- Our webpage on True Freedom
CA Dept of Aging – Home & Long Term Care Booklet
Please note, there are updates all the time, double check everything.
#Taking Care of Tomorrow Booklet
NAIC Shoppers Guide to Long Term Care
Links – Resources
- Big change in Medi-Cal rules opens the door to more seniors
- CA Health Advocates – Medi-Cal for People who have Medicare
- CANHR.org * Aged & Disabled
- Disability Benefits 101
- Orange County Social Services Agency
- Chart – MAGI and NON-MAGI Qualification for Medi-Cal
- See also our site on Medi-Medi – both Medi-Cal and Medicare
- Insure Me Kevin.com – Friendly Competitor
- How to Report Income Change
- MC 239 Denial of Benefits
- Medi-Cal Eligibilty Procedures Manual Article 22 Disability 179 pages
- Medically Needy Program
- Program for All Inclusive Care For The Elderly
- Welfare & Instituions Code General Provisions [14000 – 14042]
https://www.dhcs.ca.gov/provgovpart/Pages/Medicare-Advantage-Information-for-Dual-Eligible-Beneficiaries.aspx
On our Part B Premium Forgiveness Page, do you know what level you qualify at??
When do you turn 65?
Did you want to check out Medicare Advantage Plans?
Please complete the intake form, so we have what we need to help you.
Do you have a share of cost?
What Rx Prescriptions do you take?
Are you collecting Social Security?
What qualifies you for Medi Cal?
What Zip Code – County are you in?
Interested in a Medi Gap vs Medicare Advantage Plan?
See our video and official brochure for an introduction to Medicare
I have been paying Medicare Part A Hospital Part B Dr. Visit because I need to buy it. I don’t have 40 credits. https://medicare.healthreformquotes.com/seminar/rules-get-part-hospital-medicare-no-charge/
Now I paid $691.80 each month.
Question: Medi-Cal said that Once I joined to medicare, I could not return to Medi-cal.
Please let’s me know that is true or not.
What plan-criteria did you qualify for Medi-Cal?
Aged & Disabled?
MAGI – Under 65? https://individuals.healthreformquotes.com/subsidies/intro/calculation/age-65-tax-credits/ https://individuals.healthreformquotes.com/subsidies/magi/
See our webpage on Covered CA subsidies for those over 65 who don’t qualify for premium free part A Medicare https://medicare.healthreformquotes.com/seminar/rules-get-part-hospital-medicare-no-charge/
GOTCHA
While you are generally considered eligible for government-sponsored MEC (and are ineligible for the PTC) if you are able to enroll in that coverage, you are considered eligible for government-sponsored coverage under the following programs only if you are enrolled in the program.
4. Coverage under Medicare Part A for which the individual must pay a premium. https://www.irs.gov/pub/irs-pdf/p974.pdf
So, it looks like if you let your Medicare Coverage go, you might then apply for Medi Cal, if you otherwise qualify.
Try going through Western Poverty’s booklet on Insurance for Low Income Californian’s https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=4
Please note, I’m not an attorney nor an authorized Medi Cal representative. Try emailing someone on our contact page to double check.
Question
My grandma earns 1096 through social security and then she ears $586 through her pension for a total of 1682.47
They have calculated her net non exempt income at 1400.55 beginning 12/2017
Minus her $600 maintenance need means she has a share of cost of $801 beginning 12/2017.
The wierd thing is my grandma was approved for medi-cal and IHSS last year with the same income.
I’m thinking somehow the non exempt income might have been calculated differently.
Can you please help me figure out how they determine non exempt income?
I looked at the link above https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm but it didn’t help me.
My grandma cannot pay for any share of cost. Her rent alone is over $800 per month not counting any bills etc.
I really only do MAGI Medi-Cal
And even on that I don’t get paid
After the 20th I could look into this a little more
You might want to call or email Medi-Cal
Or call people at California health advocacy – DB 101 who are the ones we both cited – Here’s who DB 101 suggests you contact
Call or visit your local county social services agency.
Call Disability Rights California at 1-800-776-5746.
Call the Health Consumer Alliance at 1-888-804-3536.
I have a huge tax loss carry forward tax loss. Is that an offset against my countable income?
See our webpage on Negative MAGI
Publication 554 Tax Guide for Seniors
Publication 907 Tax Highlights for Persons With Disabilities
Publication 524 Credit for the Elderly or the Disabled
Western Poverty Law
The A&D FPL program is connected to income.
Do you perhaps know of another program that may help my wife Linda, who is incapactated due to a brain tumor and that does not have us ratcheting up insurance premiums every year to cover the share of cost?
Since you have a tax loss… and negative MAGI Income, you shouldn’t have a share of cost.
You might look into Medicare Advantage since you have Medicare A Hospital & B Doctor Visits
While your entitled to a “Medi Medi” plan, you wouldn’t have to take it. You can qualify for a regular Medicare Advantage Plan. Just has higher co pays.
We suppose to call to renew mom’s financial aid 1 week before March 29.
With all this corona virus thing… we totally forgot.
What do we do
See our webpage on Insurance Coverage for Corona Virus, the link is above in our webpage.
The CA Department of Insurance is asking Insurance Companies to give a 60 day grace period.
The April 15th tax deadline has been set back 3 months.
Tenant evictions are on hold
So, my 2c is just file today!
I’m not authorized to give advice or help people with Medi Cal. Follow the links and updates to our web pages. Wait on hold for hours to ask someone and get the wrong answer.
Did you want Term Life or Health Insurance Quotes? See links above.
I found a citation
It’s in the covered California press release about coronavirus open enrollment
Open up the link scroll down and you’ll see it says there’s a 90 day hold on redetermination
https://www.coveredca.com/newsroom/news-releases/2020/03/20/california-responds-to-covid-19-emergency-by-providing-path-to-coverage-for-millions-of-californians/
I have been approved for full Medi-Cal services under the Aged & Disabled Federal Poverty Level Program ,
Can I safely discontinue a policy for a supplemental insurance that covered the 20% that medicare didn’t cover.
I presume your talking about a Medi Gap plan?
What if you want to go to a doctor that doesn’t accept Medi Cal?
What Medi Cal HMO plan will you be in?
Here’s our page on dual coverage.
It might be possible that Medi Cal would pay your Medi Gap premium? Go to our Medi Gap Medi Cal page and let us know which of 7 categories you qualified under.
What if you don’t pass redetermination next year, will you be able to get your Medi Gap plan back? Here’s Medi Gap’s guaranteed issue rules Yes, it looks like losing Medi Cal is one of them. There are DEADLINES!
See also Medicare Savings Programs.
I’m 78, never worked, not disabled. I have a reverse mortgage with my sister whom I live with and we file taxes together. Our income is too low for Covered CA. What can I do to get Insurance. Buying into Medicare is way too expensive, especially since I’d have to pay late enrollment penalties. What can I do?
You’re right, proceeds from a reverse mortgage don’t count as MAGI Income. https://www.irs.gov/faqs/other/for-senior-taxpayers/for-senior-taxpayers
Please fill out this asset questionnaire and return to us privately at [email protected]
CANHR simpler list
Please review Understanding Medi-Cal’s Asset Test for Seniors and People With Disabilities
Medi Cal General Property Limitations
Please send us a list privately of what the MAGI income is.
Problem:
Most adults with incomes up to 138% of the Federal Poverty Level (FPL) are eligible for free Medi-Cal because of the Affordable Care Act (ACA). But seniors can only qualify for free Medi-Cal if their incomes are below 123% FPL – the income level for the Medi-Cal Aged & Disabled Program. This means that adults who are eligible for free Medi-Cal at 64 can lose free Medi-Cal when they turn 65. The only way for seniors with income above 123% FPL to access Medi-Cal benefits is to pay hundreds of dollars in a monthly Medi-Cal “share of cost,” which many are unable to do. The ACA, while good for most low-income Californians, left out nearly 30,000 low-income seniors. https://www.justiceinaging.org/wp-content/uploads/2019/03/AB-715-Arambula-Factsheet.pdf
Medi Cal State Wide Enrollment – Los Angeles
My 83 year father was forced to stop working due to his ailing health.
As his daughter, I am extremely over whelmed right now trying to get my dad financial assistance, and, care. Nothing is coming to fruition and all of the agencies (non-profit) won’t return my calls or help, it’s very discouraging.
My dad receives a modest sum of $1,48 from Social Security and has expenses of rent $964 & utilities $400. He has nothing left over for food/medication/other items or help and desperately needs it.
He has over $3k in medical bills that are mounting. He goes to 4-6 appointments per month (including for his eye).
He had cataract surgery on both eyes last year and the surgeon messed up the right eye, leaving him blind in the right eye. He had has gallbladder removed right before the Christmas holiday. It’s been one thing after another.
We are out of money and yet, he cannot qualify for any assistance. I do not understand.
I cannot find anyone who is willing to help us. He sits at home all day alone.
Medicare is providing some nurse assistance 1 day per week but that too will end at the end of the month.
I applied for Medi-Cal on November 1, 2017 but the application is pending a “shared” cost approval.
It goes on and on. I do not know where to turn to for help.
He is a Vet but trying to get those benefits could take months; and, too trying to find help has been too difficult.