In the state of California, if you are a Medicare beneficiary and have an income or assets below a certain level, or have certain health conditions, you may qualify for Medi-Cal. Those who are sponsored by both programs are called Dual Eligibles or Medi-Medis.
Medi-Cal is California’s Medicaid program. There are 4 different Medi-Cal programs. Eligibility for each is determined by monthly income. Medicare is the primary insurance program for dual eligibles. All other costs not covered by Medicare are managed by Medi-Cal. If you qualify for Medi-Cal with a Share of Cost (SOC), you pay a share of the cost of the medical services received. Medi-Cal will only cover expenses if your doctor or hospital accepts Medi-Cal, otherwise services not covered by Medicare will be your responsibility.
A Medicare Supplement, also called Medigap, is a health insurance policy designed to cover medical expenses which are not covered by traditional Medicare. Medigap policies are sold by individual insurance companies directly to Medicare beneficiaries and vary by state.
The need for a Medicare Supplement depends on the type of Medi-Cal program by which you are covered. If you have Full Coverage Medi-Cal, you do not need to purchase a Medicare Supplement. In fact, it is illegal for a health insurance company to sell a Medicare Supplement to those Medicare beneficiaries who qualify for
Medi-Cal and receive full coverage.
If you qualify for Medi-Cal with a Share of Cost, you may need a Medicare Supplement. In this case a Medicare Supplement may be useful if you need to see a doctor who does not accept Medi-Cal, to cover services which would not be covered by Medicare or to lower the Share of Cost for Medi-Cal.