Those Eligible for Both Medicare and Medi-Cal

People who qualify for both Medi-Cal and Medicare benefits are known as “dual eligibles” or “Medi-Medis.” In California, this group generally has greater medical needs than the rest of the population, with most people having several chronic health conditions or disabilities requiring several services and supports. More than half have incomes of less than $10,000 per year. In the past, the systems worked together fairly smoothly for dual eligibles: Medicare was considered the primary payer, with Medi-Cal providing secondary coverage to take up some of the slack, covering deductibles, copayments, some premiums, and the cost of some drugs Medicare does not cover.
But with the recent expansion of Medi-Cal, its higher income limits, and other differing eligibility rules, some risk losing Medi-Cal benefits when they reach age 65 and become eligible for Medicare; others face potential gaps in benefits or enrollment periods. To ward off problems, Medi-Cal and Medicare have partnered to launch Cal MediConnect, a program to help coordinate care and keep people in their homes and communities rather than facilities when possible. Initially, Cal MediConnect will be tested in eight counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.

Source: Covered California

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