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

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.

Email Us [email protected]

email us Steve@SteveShorr.com

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.

dual eligible decision guide

Optional Deeper Details Below
The practical explanation is above. The section below includes supporting documents, background material, citations, examples, and technical details for readers who want more.

Our Webpages for Medicare Advantage Plan

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