Cal Medi Connect program

D SNP – Dual Eligible Special Needs Plans

Medi Medi – Medicare & Medi-Cal Plan (MMP – Dual Eligible)

Can you choose your own  Medicare Advantage Plan & Medi-Cal HMO or one will be chosen for  you?

  • Option A Medicare & Medi-Cal in ONE plan (Los Angeles Options)
  • Option B Keep Medicare (Get an Advantage Plan or Medi Gap?) and get a Medi-Cal Plan (Los Angeles) Cal Duals.org Cedars Sinai
logo my care my choice

My Care, My Choice helps people who have both Medicare and Medi-Cal explore health care coverage choices based on their location, their needs, and what they want from their coverage.

Unlike other websites, MyCareMyChoice.org isn’t run by a health plan or broker, and it doesn’t sell any products.  But it’s funded by SCAN.

Our goal is simple: helping Californians with Medicare + Medi-Cal learn about their coverage options so they can make the best choice based on their unique needs.

The Advisor Tools page is designed to help the advocates, family members, caregivers, and service providers who help people with Medicare and Medi-Cal make health care decisions.

 

Video

health plans participating in cal medi Connect

Medicare Dual Coverage
# 02179
 
 

Medicare Dual Coverage Pamphlet

Our Webpage on Medicare & Dual Coverage 

Coordination of benefits -
two or more insurance plans
VIDEO 

Employer obligation to report # of employees to Medicare

Explanation from Cal Broker Magazine Sept 2019

Subrogation
Medicare's Right to collect from other Coverage

You're Medicare Advantage plan has  the right and responsibility to collect - subrogate  for covered Medicare services for which Medicare is not the primary payer.

According to CMS regulations at 42 CFR sections 422.108 and 423.462,    Anthem MediBlue Access (PPO), as a Medicare Advantage organization, will exercise the same rights of recovery  that the Secretary exercises under CMS regulations in subparts B through D of part 411 of 42 CFR and the rules established in this section supersede any state laws.  Anthem MediBlue Access (PPO) Evidence of Coverage

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Video

Video understanding medicare advantage mapd

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.

That's why the premium is very low or ZERO!

Consumer Links

Some Cal Medi Medicare MMP Default Plans:

CalDuals is a website to support California’s Dual Eligible Population. Here you will find information about Medicare and Medi-Cal integration through the Coordinated Care Initiative, or CCI. The CCI was launched by the state of California to provide better coordinated care to people with both Medicare and Medi-Cal – dual eligibles.  

Health Net Blue Cross

Cedars Sinai Tool & Information – How to OPT OUT! Also applies EVEN if you don’t use their facilities!

dhcs.ca.gov Technical Page on Cal Medi-Connect Demonstration

Health Care Options 844.580.7272 – State Enrollment Broker – Enroll & Dis-enroll

HICAP – CA Health Care Advocates – 1-800-434-0222

See our Medi Cal Page

Medi-Cal Providers

Provider List by County

Los Angeles Times 2.1.2015 Problems with shifting care for costly patients

DHCS.Gov Medi-Cal Managed Care

ca health advocates.org (Medi-Cal)

LIS – Low Income Subsidy (Medicare Part D Rx – Help with Drug Costs)

Doctor’s can’t bill Medi Medi patients for Co Pays, Deductibles, etc.

InsureMeKevin.com on Blue Cross SNP & Dual Eligibility with Medi-Cal

Fraud, Waste & Abuse

Justice in Aging duals demo advocacy.org/

Technical Links

SB 1008 and SB 1036

CMS Reporting Requirements and other technical stuff

Dual Eligible Performance Studies – Inovalon

Needs assessment checklist

Problems with Medi-Medi – unwitting Guinea Pigs real clear policy.com

InsuBuy International Medical Coverage –
Instant Quotes & Enrollment

Travel Policies

Coverage for Travel - $50k Emergency under Medicare Medi Gap or MAPD Advantage may not be enough!

2 comments on “Cal Medi Connect – Medi-Cal & Medicare – Medi Medi Dual Eligible D SNP

  1. Sandra A says:
    Do you have to have a certain illness or chronic illness to be eligible for medi medi or can anybody get it? 

    I have coverage from Medi-cal cal optima caloptima.org/ but some of my friends that are also on SSI get medi medi

    why is that so?

    and is it better or different from just cal optima Medi-cal?

    • I’m not qualified to answer your question. I’m not an authorized employee of Medi Cal, nor do I get compensated to help Medi Cal beneficiaries or any expenses of this website. 

      Here’s what I did find for you:

      caloptima org/en/AboutUs.aspx

      Better. Together.
      Our mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner..

      CalOptima is a county organized health system that administers health insurance programs for low-income children, adults, seniors and people with disabilities in Orange County.

      As Orange County’s largest health insurer, we provide coverage through four major programs.

      Medi-Cal (California’s Medicaid Program) for low-income children, adults, seniors and people with disabilities

      OneCare (HMO SNP) (a Medicare Advantage Special Needs Plan) for low-income seniors and people with disabilities who qualify for both Medicare and Medi-Cal (Medi Medi)

      PACE (Program of All-Inclusive Care for the Elderly) for older adults, providing comprehensive health services through the CalOptima PACE center

      OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) for people who qualify for both Medicare and Medi-Cal, combining Medicare and Medi-Cal benefits, adding supplemental benefits for vision, transportation and dental services, and providing comprehensive care coordination

      “Better. Together.” is our motto, but it’s also our philosophy. We believe that by working together, we can make things better – for our members and community.

      If you have questions or would like information about CalOptima, please contact us at:

      1-714-246-8600

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