Lower or Eliminate Your Medi-Cal Share of Cost

• If Medi-Cal says you have a monthly Share of Cost, do not begin by purchasing insurance at random. First determine the exact monthly amount the county says must be reduced. Then check whether your existing health-insurance premiums and allowable medical expenses have already been counted.
• California Medi-Cal rules provide for the deduction of health-insurance premiums in applicable Medically Needy income calculations.
  • See California Code of Regulations, Title 22, §50555.2
    .
  • See the  DHCS Non-MAGI Medi-Cal Guide
    .
  • Your county eligibility worker makes the final determination for your individual case.

Which Best Describes Your Situation?

• I already know my monthly Share of Cost.
  Compare the amount you need with the available dental, vision and Medicare-related premium options.
  
  See options based on your Share of Cost.
  
• I do not know the correct amount.
  Use the  Medi-Cal Share of Cost Calculator
  
  as a preliminary estimate. Compare the result with your county Notice of Action or the amount supplied by your county worker.
• I believe the county calculation may be wrong.
  Check whether Medicare Part B, Part D, Medicare Supplement, dental, vision or other health-insurance premiums were omitted. You may also have  medical expenses that may help lower your Share of Cost
  .

Three Possible Ways to Avoid or Reduce Share of Cost

1. Correct the Existing Calculation

Before buying anything, verify the income, Medicare premiums, other health premiums and deductions used by the county. Sometimes Share of Cost can be reduced because an existing premium or expense was not counted.

2. Check the 250% Working Disabled Program

A person who meets the disability, work, income and other program requirements may qualify through the  250% Working Disabled Program

instead of remaining in Share of Cost Medi-Cal. Even part-time employment or self-employment may be relevant. Eligibility is determined by the county.

3. Add an Allowable Insurance Premium

If a monthly amount still remains, an appropriate dental, vision, Medicare Supplement or other health-insurance premium may help reduce it. The insurance should also provide benefits that you understand and can use. It is not merely a payment made to Medi-Cal.

• $1–$84 per month:
  A basic  dental or vision plan
  
  may be sufficient.
• $85–$425 per month:  AmFirst Maximum Care
  
  offers several premium choices within this range.
• $426–$600 per month:
  A combination of  AmFirst Maximum Care
  
  and another qualifying  dental or vision premium
  
  may be necessary.
• $601 or more:
  The situation should be reviewed individually before applying. Existing Medicare premiums,
  
  Medi-Gap premiums
  
  and other allowable expenses may need to be combined.

The current AmFirst application lists dental-plan premiums from $85 through $425 per month. Optional vision coverage may add another premium. Coverage is subject to application acceptance and approval.

Send Steve the Information Needed for a Useful Answer

For a free preliminary review,  email Steve

with the following information:

• The monthly Share of Cost shown by your county.
• Your county and ZIP code.
• Whether you have Medicare Parts A and B.
• Any premiums you already pay for Medicare Part B, Part D, Medicare Advantage, Medi-Gap, dental or vision.
• Whether the problem concerns future months or previous months.
• Your Notice of Action, if available and if you are comfortable sending it.
• Email Steve Your Share of Cost Information
  

Steve Shorr has specialized in California health insurance since 1975. There is no separate charge for assistance with an insurance application. Compensation is paid by the insurance company when applicable. Steve is an insurance agent, not a county eligibility worker, attorney or tax adviser.

• Contact, Zoom, Disclosures and License Information
  
• 17 Reasons to Use Steve Shorr Insurance
  
• Biography of Steve Shorr
  

After Enrollment: Send Proof to the County

After approved enrollment, the county may request a proof-of-coverage letter, premium invoice, effective date and evidence that the premium was paid. Keep copies of everything submitted and follow up with your county worker.

See the complete  proof and BenefitsCal document-upload instructions
.

Sample Proof of Dental Insurance for BenefitsCal

• See Proof and BenefitsCal Upload Instructions
  
• View the AmFirst Application and Current Premium Choices
  

Trying to Correct Past Months?

A carrier may sometimes approve an earlier effective date under its own requirements. However, purchasing coverage today does not automatically eliminate a past Share of Cost. Back premiums, prior claims, effective-date rules and county acceptance must all be reviewed.

See  how to review past-month and retroactive Share of Cost options
.

Share of Cost Testimonials

• “Medi-Cal reviewed my Mom’s case and eliminated her Share of Cost effective February 1. My family is very grateful that this issue was resolved in a very timely manner.” — Don V.
• “Eliminating her Share of Cost will allow her to stay living at our home longer, so it’s very wonderful.” — Mary
• “You are a wealth of knowledge, and I am so grateful to connect with you.” — Carie C.

• See additional  Share of Cost comments and testimonials
  .
• See  general client testimonials
  .
• See this  Reddit discussion about Share of Cost
  .

This page provides general educational and insurance information. Medi-Cal eligibility and Share of Cost decisions are made by the county based on the individual facts and current program rules.