Medi-Cal is a need-based insurance program for California residents who participate in Medicare. It is funded by monies allotted to the Medicaid program and is designed to aid Californians who are disabled or have low incomes. Persons receiving Medi-Cal may also have a Medigap policy.
Medi-Cal provides coverage for many medical procedures that are not covered by Medicare. However, most patients continue to maintain their Medicare coverage. In such cases, they are covered by Medicare and Medi-Cal. This double eligibility will generally list Medicare as the primary insurance. Because Medi-Cal will act as the supplemental insurance, a Medigap policy is typically not needed.
As a rule, Beneficiaries who have Medi-Cal do not need a Medigap policy. It is actually illegal for an insurance agent to sell a Medigap policy to a person who is eligible for Medi-Cal. Californians who qualify for Medi-Cal for brief time spans can elect to place his Medigap policy on hold for as long as two years. He may be charged lower premiums to maintain the policy, but it the beneficiary decides to give up his Medigap plan, he is allowed to return to his old Medigap policy after Medi-Cal is discontinued.
Are There Any Advantages To Keeping Both Medi-Cal And Medigap?
Keeping a Medigap policy in place while on Medi-Cal will basically duplicate the patient’s coverage. The beneficiary will not enjoy greater savings or reductions in out-of-pocket expenses. There is no advantage to keeping both policies.
Medical services must be deemed medically necessary in order to be covered by Medi-Cal. Covered procedures can include prescribed drugs, home health services, laboratory tests, X-rays, hearing aids, visits to the doctor, certain dental services, and some durable medical equipment. Certain services will need prior authorization.