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.
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
- Medi Cal Explained CHCF
- Historical Guide 2006 CHCF 174 pages
- CalAIM California Advancing and Innovating Medi-Cal — is a far-reaching, multiyear plan to transform California’s Medi-Cal program and to make it integrate more seamlessly with other social services. The goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs.
- Medi Cal Contact Information
- 10 Essential Health Benefits
- Our Webpage on Medi & Denti Cal Benefits
- Western #Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Our Webpage on
Get a Medi Gap Policy
You can Avoid a Share of Cost in the (ABD-MN) Aged, Blind and Disabled – Medically #Needy Program program and then qualify for no-cost A&D FPL. Just purchase Medi-Gap or other private health insurance product, including Part D Rx, dental or vision insurance. * Wikipedia * Investopedia * Merriam – Webster *
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.
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
Visit our Medi Gap Guaranteed Issue Page
- One of our colleagues on how Dental for Everyone Works.
- Sample Quote
- Blue Cross Dental & Vision
- Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental
- Blue Shield Medicare Advantage Dental & Vision
- 2021 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
Be sure to put in our AGENT # 2094784
Delta Dental – Covered CA Plans
- 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
- DeltaCare® USA Family Dental HMO for Small Businesses 848 KB
References & Links
Health Consumer Alliance Fact Sheet
Disability Rights CA Share of Cost – Nursing Home Resident
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
Working Disabled Program – Premium may be less than Share of Cost