Confused About how it works if you have Medi-Cal, Medicare, Employer Coverage, or Dental Insurance with multiple policies?
Many Californians have more than one type of health coverage. You may have Medicare and Medi-Cal, employer insurance and Medi-Cal, two dental plans, or another combination of insurance. The big question is usually:
- which plan pays first,
- which plan pays second, and
- do you have to choose a Medi-Cal HMO?
This page is a starting point. It helps you find the right topic quickly, instead of trying to read through every possible coordination of benefits rule at once.
Start Here — What Kind of Dual Coverage Do You Have?
Medicare + Medi-Cal:
Learn how Medicare and Medi-Cal work together, who usually pays first, and when Medi-Cal may help with costs Medicare does not pay.
Medi-Cal HMO Selection:
If you received a notice telling you to pick a Medi-Cal managed care plan, start with the Medi-Cal HMO selection page. This is one of the most common sources of confusion.
Employer Insurance + Medi-Cal:
If you or a family member has job-based health insurance and Medi-Cal, the employer plan may pay first, with Medi-Cal possibly acting as secondary coverage.
Dental Coordination of Benefits:
Dental plans may also coordinate benefits. The rules can be different from medical insurance, especially when Medi-Cal Dental is involved.
Basic Coordination of Benefits Rules:
For people who want the technical explanation, coordination of benefits rules help decide which coverage pays first and which pays second.
Important: Medi-Cal is often described as the payer of last resort, but the real-world answer depends on the type of coverage you have, whether you are in managed care or fee-for-service Medi-Cal, whether Medicare is involved, and whether the provider accepts the coverage involved.
- If your main question is whether you must pick a Medi-Cal HMO, or how a Medi-Cal HMO works with your private insurance, start here:
Can you have Private – OHC Other Health Insurance &
Medi Cal at the Same time?
- Yes,
- You can have Medi-Cal even though you have Other Health Coverage (OHC) through individual or group private health (or dental) insurance coverage.
- See the email we rec’d May 17th from Medi Cal to clarify some of these issues.
- Read the rest of the page on which plan pays first, etc. namely, the other plan.
- If you qualify for Medi Cal, you cannot get Covered CA Subsidies.
If you don't #want Medi-Cal
Can you buy private insurance?
- If your income qualifies for Medi-Cal, you can buy Insurance coverage (FREE QUOTES), but there won't be ANY subsidies. You pay the full premium. However, if it's Medi Cal Share of Cost, it's not considered Minimum Essential Coverage, so you could get subsidies.
- Please note that the Private Plan pays first and Medi Cal won't pay if the doctor isn't a Medi Cal provider. Since Medi Cal is virtually HMO that might be difficult to have both plans pay.
- FAQ's
- Which Pays first Medi Cal or other coverage?
- Choose HMO Plan
- FAQ & Clarification of Mandatory HMO Enrollment
- Friendly Agent's Blog on how to have different plans for different members of the family.
Which Insurance Plan pays #first
Medi-Cal or OHC Other Health Coverage?
- Under federal law, your private health insurance must be billed first before billing Medi-Cal. Medi-Cal may be billed for the balance, including your other plans co-payments, co-insurance and deductibles. See below about if you have a Medi Cal HMO. Also, you may have a problem if you went to a provider that isn’t a Medi Cal doctor. You may not quote this page. It’s a summary of what we have footnoted and linked to from official documents & law. Cite only those.
- Denti – Medi Cal and other dental plans See page 19 of Dental Member Handbook
- If you are in a HMO – Managed Care Providers coordination may be difficult and/or you can’t get a Medi Cal HMO, but must have fee for service,
- See the email we rec’d May 17th from Medi Cal to clarify some of these issues
Jump to section on:
- Introductory Brochure to Medi Cal
- Reference Materials
- Mandate to report other coverage
- Cal Medi Connect – Medi Medi
- Which Pays first Medi Cal or other coverage?
- Can you get Private Coverage?
- Basic Law on Coordination of benefits
- FAQ & Clarification of Mandatory HMO Enrollment
- Choose HMO Plan
- Medicare
#My Medi-Cal
How to get the Health Care
You Need
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Medi-Cal Managed Care HMO – Health Care Options
Here you can review and choose the HMO that you want to deliver your Medi-Cal health Care.
- Get a lot more detail & analysis on Medi Cal HMO providers see our webpage on that
Do you have to #tell or Report to Medi Cal that you have other coverage?
If you are a Medi-Cal beneficiary and have individual or group private health (or dental) insurance coverage, you are required by federal and state law to report it. You can report it directly to Department of Health Care Services (DHCS) by visiting their webpage on that.
You can also report it to your county eligibility worker, your health care provider, and/or to the Local Child Support Agency (LCSA), when there is an absent parent who may be responsible for your child(ren)’s medical care, or in establishing paternity of a child born out of wedlock. If you fail to report any private health insurance coverage that you have, you are committing a misdemeanor.
The State of California is mandated to find out if you have other health coverage or if it’s available and to collect payment from liable third parties, like a car accident. Thus, you must assign rights to medical support and help locate liable third parties, even going so far as to helping to establish paternity of children born outside of marriage so that the state may seek payment for medical services provided to the child.
- See our webpage on
What do I do if my other health plan sends a check to me?
Send any payment you get directly from an insurance carrier for services paid by Medi-Cal or medical support payment you get from the absent parent to DHCS at:
Department of Health Care Services
Third Party Liability and Recovery Division
Cost Avoidance Section
P.O. Box 997424, MS 4719
Sacramento, CA 95899-7424
If you have other health insurance coverage, the computer system will be coded to show other health insurance. If this information is incorrect you can contact your county eligibility worker to temporarily override this information.
Better yet you can report your other Insurance Information ONLINE!
If you are having a claims payment problem with a provider, you may call the Beneficiary and HIPAA Privacy Help Desk at (916) 636-1980.
If you have both Medicare and Medi-Cal, aka Medi Medi Medicare (not Medi-Cal) will pay for most prescription drugs for Medi-Cal beneficiaries who are eligible for Medicare Part A (hospital) or Part B (outpatient). Here’s our webpage on Medicare Part D (drug coverage) “Medi-Cal What it Means to you” Section 12
#Autism
See our new webpage on Autism
Visit our webpage on Medicare and other coverage who pays, is it legal?
AI Generated
- Transition, Not Termination: The program didn’t disappear; it transitioned into MMPs for better care coordination.
- Integrated Care: MMPs provide all Medicare (Part A, B, D) and Medi-Cal services together, just like Cal MediConnect aimed to.
- Availability: These plans operate in former Cal MediConnect counties (LA, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Clara) and are expanding statewide.
- No Coverage Gap: Members were automatically moved, so there was no break in coverage. [1, 2, 4, 5, 6, 7, 8, 9]
#Understanding Medi-Cal Long Term Care
Archive Rev 2001
- CANHR California Advocates for Nursing Home Reform
- Our Webpage on Redetermination Requalification
- Our webpage on how to qualify for Medi Cal Nursing Home Benefits
- When will California's Medi-Cal Will Pay for a Nursing Home, Assisted Living, or Home Care Nolo.com
- Long-Term Services and Supports in Medi-Cal Fact Sheet CHCF.org
- canhr.org/overview-of-medi-cal-for-long-term-care
Understanding Long-Term Care Medi-Cal
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