Some people qualify for both Medicare and Medi-Cal and are called “dual eligible”. This is also referred as “Medi-Medi”.
the Expertise to Help
Californians with Medicare and Medi-Cal, people who are dually eligible, face many options when exploring how to get the healthcare they need. This is a unique and diverse group who have low incomes, are high need, and account for a disproportionate share of spending in both programs. Medi-Cal Managed Care offers more choices in how care is delivered for people who qualify for both of these programs. Vivant Health has high-quality programs for dually eligible beneficiaries. They have access to integrated care choices that are valuable to people with high needs. With its close ties to the community and a long history of serving high-need populations, Vivant Health is uniquely positioned to help provide health home-related health services, which include helping patients meet their individual health goals.
When people have two forms of health coverage, such as Medicare and Medi-Cal, there can be inefficiencies in how care is paid for and provided. Integrated care means that an individual can access medical care and non-medical services by working through Vivant Health, which is responsible to provide and/or organize care. Vivant Health uses care coordination to connect the individual to a range of services and supports to meet his/her overall needs. Vivant Health’s experienced social workers also provide assistance to patients who can benefit from programs that provide needed non-medical services. Overall, Vivant Health uses thoughtful care coordination through a range of community service programs to better manage care.
Medicare and Medi-Cal Benefits
for Dual-Eligible Beneficiaries?
Medi-Medi is the short-hand term for having Medicare and Medi-Cal at the same time. Generally speaking, Medicare is based on either age (65 and over) or permanently disabled status. Medi-Cal is the California version of Medicaid, which is generally based on income and assets.
It’s possible for people to be eligible for both at the same time. Hence the term Medi-Medi.
The two plans will generally coordinate benefits or out-of-pocket costs together for people who are eligible.
This is a common question, and the quick answer is NO!
Medicare is a federal program to provide health coverage to individuals under age 65 who are permanently disabled or blind individuals age 65 and over who are eligible.
Medi-Cal is California’s version of Medicaid, which provides coverage and assistance to individuals who qualify based on income and assets, as well as individuals with SSI (permanently disabled or blind).
They are two separate plans. But when used together, they can be coordinated well for those individuals who qualify for both.
That’s where the Medi-Medi, or dual-eligible, program through Vivant Health comes into play.
If you’re eligible for Medi-Cal and Medicare, they will work together to reduce your out-of-pocket costs and better coordinate your healthcare services.
Medicare Advantage plans are approved by Medicare to provide you with coverage for Medicare Part A and Part B. Most plans combine medical and prescription drug coverage. Extra benefits for dental care, hearing aids, and vision may also be offered.
Here is what your coverage will include:
- Inpatient hospital stays
Skilled nursing facility stays
Hospice Care
Primary and specialty care visits
Outpatient mental health visits
Lab and X-ray
Preventative services and wellness screenings
Durable Medical Equipment (DME)
Ambulance coverage
Part B Drugs
Medicare Advantage plans provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to individuals who qualify for both parts of Medicare. These plans are contracted with Medicare and offered by private insurance companies that combine parts A & B and often include Part D (Drug Coverage) as well as additional benefits not covered by Medicare. These additional benefits may include:
Drug coverage
Vision allowance
Dental coverage
Transportation
Fitness benefit
Over the Counter
Predictable out of pocket costs
Vivant Health participates in several Medicare Advantage health plans. In order to access the physicians and health services offered, it is important to select Vivant Health at the same time a Medicare Advantage health plan option is being selected.
Your health is our priority, and we’re with you every step of the way.
Some people may be eligible to make changes to their health plan coverage during the year.
For additional information on Medicare in general, please call 1-800-MEDICARE (TTY users call 1-877-486-2048), 24 hours a day, 7 days a week, or visit medicare.gov