What does having Medicare and Medi-Cal together mean?
Having both programs at once is called dual eligibility, and many people know it as Medi-Medi. Medicare is the federal health program for older adults and for some people with disabilities. Medi-Cal is California's Medicaid program, designed for people with limited income, including seniors and people with disabilities. When you have both, Medicare pays first for covered services and Medi-Cal pays last, after Medicare and any other insurance you may have. Qualifying for Medi-Cal is based mainly on income, and for some types of Medi-Cal certain assets are also reviewed. We do not publish exact figures because the limits change every year: your county office verifies the current amounts and confirms whether you qualify. If you live in Los Angeles, we can help you prepare for that verification step by step, at no cost and in your language.
What does Medi-Cal pay when you already have Medicare?
Medi-Cal can ease several Medicare costs. According to Medicare.gov, the state can pay your monthly Part B premium and, through Medicare Savings Programs, help with Part A and Part B deductibles, coinsurance, and copayments. People with dual eligibility are also automatically enrolled in Extra Help, which lowers the cost of prescription drugs. In addition, Medi-Cal may pay for drugs and services that Medicare does not cover. Medicare Savings Programs are applied for through the state and depend on your income and resources; the limits go up each year and some income does not count, so it is worth applying even if you think you will not qualify. In short, with the right combination of benefits, many Medi-Medi members end up paying little or nothing out of pocket. Our team reviews your full situation and tells you exactly which benefits to request.
D-SNP and Medi-Medi plans in Los Angeles
A D-SNP, or Dual Eligible Special Needs Plan, is a type of Medicare Advantage plan designed only for people who have both Medicare and Medicaid. These plans include Part D drug coverage, help coordinate the benefits of both programs, and may cost less. To join you need Part A and Part B and you must live in the plan's service area, and you can only stay enrolled while you keep meeting the eligibility rules. California also has an integrated version called a Medi-Medi Plan: one organization coordinates all Medicare and Medi-Cal services, and your Medi-Cal plan automatically aligns with your Medicare plan. These integrated plans are available in Los Angeles County. Not every D-SNP works the same way, which is why at Goulson Insurance we compare the options in your zip code before recommending one.
How to enroll, and the special rules for duals
People with Medi-Cal or Extra Help get more flexible enrollment rules than everyone else. According to Medicare.gov, you can make changes to your coverage once a calendar month: switch drug plans, return to Original Medicare with a stand-alone drug plan, or join an integrated D-SNP. The change takes effect on the first day of the next month. That means you do not have to wait for the year-end enrollment period if your current plan is not working for you. At Goulson Insurance Services we help you verify your eligibility, compare plans, and enroll at no cost: call Lara Goulson in Century City at (818) 472-5484 or our Valley Village office at (818) 731-5417. Important notice: we are not affiliated with Medicare or any government agency; we do not offer every plan available in your area; Medicare.gov or 1-800-MEDICARE list all options.
Both programs, one conversation
Holding Medicare and Medi-Cal together changes which plans make sense and what you pay. It is worth an hour with someone who works with both, in the language you prefer.
Have both, or think you might qualify? Call (818) 472-5484. Se habla espanol.
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