Fact Sheet for those eligible for Medi Cal & Medicare
Pros & Cons of D SNP Plans
Medi Medi
Medicare & Medi Cal
- Medi-Medi Plans include:
- A Medi-Medi Plan is a type of Medicare Advantage plan. It is for people who have both Medicare and Medi-Cal, and combines Medicare and Medi-Cal benefits into one plan.
- All Medicare Part A, B, and D benefits. Also, Medi-Cal benefits.
- One care team to coordinate care.
- One health plan to coordinate delivery of services, including medical supplies, transportation, and long-term services and supports.
- One set of benefits and a network of providers, including doctors, hospitals, clinics, labs, pharmacies, and medical equipment suppliers.
- You may have extra benefits like dental, hearing, or vision coverage, in addition to what Medi-Cal covers. DHCS.CA.Gov
- DHCS Explanation Flyer
- Dual Eligible Special Needs Plans in California
- Medi Medi Plans DHCS.Gov * CMS.Gov *
- Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medi Cal Medicaid (title XIX DHCA.CA.Gov ).
Our Webpages for Medicare Advantage Plan
#My Medi-Cal
How to get the Health Care
You Need
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A I Summary
This is INFORMATIONAL ONLY, not intended as Marketing Material!
Email us [email protected] for actual brochure, benefits, premiums, deductibles, etc.
A D-SNP (Dual Eligible Special Needs Plan) in California adds extra benefits to Medicare & Medi-Cal by integrating them, offering things like dental, vision, hearing, transportation, over-the-counter (OTC) allowances, healthy food cards, and better care coordination, often with $0 costs, which you don’t get from just Original Medicare/Medi-Cal alone. [1, 2, 3, 4, 5, 6]
Here’s what a D-SNP provides beyond standard Medicare & Medi-Cal:
- Dental, Vision, Hearing: Comprehensive coverage for services and materials (like glasses or hearing aids) often not covered by Original Medicare.
- Over-the-Counter (OTC) & Food: Monthly allowances (often on a flex card) for OTC health items, personal care, and healthy groceries.
- Transportation: Rides to doctor’s appointments and other health-related locations.
- Meals: Post-hospitalization or ongoing meal delivery benefits for some plans.
- Care Coordination: Integrated care teams and better communication between your Medicare and Medi-Cal benefits, especially with “Medi-Medi” plans in California.
- Lower Costs: Often includes $0 premiums, copays, and deductibles for medical services, keeping your out-of-pocket costs down.
- Specialized Support: May include in-home support, personal emergency response systems, or extra therapy services. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]
In essence, D-SNPs combine your Medicare and Medicaid benefits into one plan, adding valuable supplemental benefits and simplifying care coordination for people eligible for both programs. [5, 6]
AI responses may include mistakes.
#Understanding Medicare Advantage Plans (PDF) #12026
- 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 - Please email us [email protected] for the form - That way we can better analyze your situation to give you the answers to your needs and questions.
- 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!
- Visit our general webpage on Medicare Advantage for much more detail and information.
Contact Us - Ask Questions - Get More Information
[email protected]
By submitting the information below , you are agreeing to be contacted by Steve Shorr a Licensed Sales Agent by email, texting or Zoom to discuss Medicare or other Insurance Plans as relevant to your inquiry. This is a solicitation for Insurance
More Links & Resources
- Medi-Medi Plan 2026 Expansion dhcs.ca.Gov flyer
- Integrated Care dhcs.ca.gov
- Dual Special Needs Plans Contract and Policy Guide dhcs.ca.gov
- Coordinated Care Initiative and Cal MediConnect dhcs.ca.gov
- Fixing the FIDE-SNP – Redefining “Fully Integrated” ati advisory.com
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
AI Summary
Medicare co ordination with Medi Cal
Medicare and Medi-Cal coordinate by having Medicare act as the primary payer for most services, with Medi-Cal serving as secondary insurance to cover costs Medicare doesn’t, like premiums, deductibles, copays, and services Medicare doesn’t cover (like long-term care), often through integrated Medicare Advantage plans called Dual Eligible Special Needs Plans (D-SNPs) for streamlined benefits in California. [1, 2, 3, 4]
Key Coordination Points:
- Primary vs. Secondary: Medicare pays first for covered services (like hospital & doctor visits); Medi-Cal pays the remaining balance, including your Medicare premiums and cost-sharing (copays/deductibles) if you’re eligible for full Medi-Cal.
- Coverage Gaps: Medi-Cal fills gaps by covering services Medicare doesn’t, such as dental, vision, and essential long-term care, but typically only if you use providers who accept Medi-Cal.
- Integrated Plans: Many dual-eligibles enroll in Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan that combines both benefits into one plan, simplifying care.
- Crossover Claims: For those in Original Medicare, claims “crossover” from Medicare to Medi-Cal for secondary payment without you needing to file.
- Matching Plan Policy (California): In California, your Medi-Cal plan follows your Medicare Advantage plan choice to create coordinated care. [1, 2, 3, 4, 5, 6, 7, 8]
How it Works:
- You see a provider: Medicare pays its share first.
- Remaining costs: Medi-Cal pays the rest (deductibles, copays) for Medicare-covered care, or covers non-Medicare services if using a Medi-Cal provider.
- Premium Help: Medi-Cal can pay your Medicare Part B premiums and help with Part A costs.
- D-SNPs Simplify: Choosing a D-SNP consolidates everything into one plan and network, often with extra benefits like dental and vision. [1, 3, 4, 5, 6, 9]
In essence, Medicare provides the core coverage, and Medi-Cal acts as a powerful supplement, significantly reducing or eliminating out-of-pocket costs and expanding available benefits for those who qualify for both. [1, 3, 4]
AI responses may include mistakes.
#Medicare10050 and You 2025
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Everything you want to know
- Steve's Video Seminar Introduction to Medicare & You
- Clear View to Medicare Patient Advocate.org - 36 pages
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Medicare #DualCoverage
Publication - 02179
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VIDEO how two plans coordinate and pay your claim.
- Medicare.Gov on how Medicare works with other insurance.
- Employer obligation to report # of employees to Medicare
- Explanation from Cal Broker Magazine Sept 2019
- Sample Small Employer Group Health Plan
- Medicare & Other Insurance CA Health Care Advocates Fact Sheet pdf
#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
- Medi-Cal (for People with Medicare) – 04-19-23 Hi Cap CA Health Care Advocates