Fact Sheet CMS eligible for Medicare & Medicaid

Fact Sheet CMS eligible for Medicare & Medicaid

Fact Sheet for those eligible for Medi Cal & Medicare

Medi-Medi (Dual Eligible): Medicare + Medi-Cal Explained

 

If you qualify for both Medicare and Medi-Cal, you may hear the term “Medi-Medi” or Dual Eligible.
This combination can significantly reduce your healthcare costs — but choosing the right way to use both programs is where many people get confused.

This page will help you understand your options, avoid common mistakes, and decide whether a Dual Special Needs Plan (D-SNP) or staying with Original Medicare + Medi-Cal makes more sense for your situation.

 

What Does Medi-Medi Cover?

When you have both programs:

  • Medicare pays first (primary insurance)
  • Medi-Cal pays second (covers many remaining costs)

In many cases, this means:

  • ✔ Little or no premiums
  • ✔ Little or no copays
  • ✔ Extra benefits depending on your plan

What are Medicare & Medi Cal  11306 pdf 

Your 3 Main Coverage Choices

1. Original Medicare + Medi-Cal

You keep Medicare Parts A & B and use Medi-Cal as secondary coverage.

2. Medicare Advantage D-SNP (Dual Plan)

A private plan designed specifically for people with both Medicare and Medi-Cal.

  • ✔ May include dental, vision, hearing, transportation, food cards
  • ✔ Coordinated care and case management
  • ✖ Usually requires staying within a network

3. Medicare Advantage (Non-D-SNP)

A regular Medicare Advantage plan without full dual coordination.

  • ✔ Some extra benefits
  • ✖ May not fully integrate with Medi-Cal benefits

Advantages of a Dual (D-SNP) Plan

  • ✔ Extra benefits not included in Original Medicare
  • ✔ Care coordination between Medicare and Medi-Cal
  • ✔ Often very low out-of-pocket costs

Disadvantages to Watch For

  • ✖ Limited doctor networks
  • ✖ Prior authorization requirements
  • ✖ Not all plans coordinate benefits equally well

Simple Decision Path

Use this quick guide:

  • Want maximum doctor flexibility? → Stay with Original Medicare + Medi-Cal
  • Want extra benefits and coordinated care? → Consider a D-SNP
  • Already have doctors you trust? → Check if they accept the plan before switching

Where SSDI Fits In

If you are on SSDI (Social Security Disability Insurance), you may:

  • Qualify for Medicare after 24 months
  • Also qualify for Medi-Cal based on income
  • Become eligible for a Dual (Medi-Medi) plan

Each situation is different, especially when income, Share of Cost, or disability status changes.

Start Here (No Pressure)

If you want to explore your options:

  • ✔ Compare plans and benefits
  • ✔ Check if your doctors are in-network
  • ✔ See what extra benefits you may qualify for

→ View Medicare Advantage Plan Options

→ Schedule a Zoom Meeting or Ask a Question

Note: Not all plans are offered in every area.  We represent multiple organizations and can help you review available options based on your location.

Medicare Advantage Plans that we represent

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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]
 
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