How does Medi-Cal work as secondary insurance?
Asked by: Estefania Reinger | Last update: June 15, 2025Score: 4.3/5 (28 votes)
Can you have Medi-Cal as a secondary insurance?
Medi-Cal is the payer of last resort, which means in most cases Medi-Cal will be secondary to the OHC, covering allowable costs not paid by the primary insurance (typically wrap payments or co-pays) up to the Medi-Cal rate.
How does secondary Medi-Cal coverage work?
It depends on which insurance is considered “primary” and which is “secondary.” The insurance that pays first (primary payer) pays up to the limits of its coverage. The insurance that pays second (secondary payer) only pays if there are costs the primary insurance didn't cover.
Do I have to pay back Medi-Cal?
What is Estate Recovery? The Medi-Cal Estate Recovery program must seek repayment from the estates of certain Medi-Cal members after they die. Repayment only applies to benefits received by these members on or after their 55th birthday and who own assets at the time of death.
Can you have Medi-Cal and employer health insurance at the same time?
Yes, it's possible! Explore your options for keeping Medi-Cal when you're employed — or transitioning to an affordable health plan — and how Covered California can help.
Billing Secondary Insurances
Can you have 2 Medi-Cal insurances at the same time?
Can I have 2 health insurance plans at the same time? Yes. A process called coordination of benefits determines which insurance plan will pay first. Your primary plan will pay for the health claim first, paying the costs up to the plan's coverage limits, and then your second plan will kick in.
What disqualifies you from Medi-Cal?
To qualify, you must: Meet the medical requirements of Social Security's definition of disability. Be working and earning income (this can be part-time work). Have countable income less than 250% of the federal poverty level (in 2024, this equates to $3,158/mo.
What is the 3 month rule for Medi-Cal?
You may be able to receive a reimbursement if:
You received a Medi-Cal covered service on a date that you were eligible for Medi-Cal. The three periods of eligibility that are included are the following: RETRO: The 3-month period prior to the month you applied for the Medi-Cal program.
How much money can you have in the bank on Medi-Cal?
eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.
What happens if you don't report changes to Medi-Cal within 10 days?
If you do not report changes to your personal information right away, and then receive Medi-Cal benefits that you do not qualify for, you may have to repay DHCS.
How much does secondary insurance cost?
The cost of supplemental insurance can vary depending on the plan you choose. Fortunately, Aflac offers affordable coverage. Many Aflac policies range anywhere from $8 to $25 or more per month. You can contact Aflac directly for more information on specific supplemental insurance plans that pique your interest.
What are the two types of Medi-Cal?
Medi-Cal is health coverage for low-income children and adults. There are two kinds of Medi-Cal, the expanded Modified Adjusted Gross Income (MAGI) coverage and classic coverage. Some Medi-Cal programs have a Share of Cost, but most do not.
Can you have two health insurances with Medicaid?
The simple answer to the question of “can you have both Medicaid and private insurance?” is a resounding “YES”! Medicaid is given to low-income U.S citizens in need and will not be disputed due to already enrolled in a private health insurance program.
How does secondary Medi-Cal coverage work?
How does secondary insurance work? Secondary insurance plans work along with your primary medical plan to help cover gaps in cost, services, or both. Supplemental health plans like vision, dental, and cancer insurance can provide coverage for care and services not typically covered under your medical plan.
Is there a copay with Medi-Cal?
Applying for Medi-Cal
There are no monthly premiums or co-pays! Please visit our How to Join page for more information on applying for Medi-Cal and joining L.A. Care Health Plan. View our flyer on how you can get enrollment assistance at an L.A. Care and Blue Shield Promise Community Resource Center.
What is the new law for Medi-Cal 2024?
Beginning January 1, 2024, a new law in California will allow adults ages 26 through 49 to qualify for full-scope Medi-Cal, regardless of immigration status. All other Medi-Cal eligibility rules, including income limits, will still apply.
How often does Medicaid check your bank account?
Medicaid agencies can check your account balances for bank accounts at any financial institution you've used in the past five years. They will check when you submit an application and on an annual basis, but checks can occur at any time.
How much income is too much for Medi-Cal?
Most single individuals will qualify for Medi-Cal if there income is under $1,676 per month. Most couples will qualify if their income is under $2,267 per month. If you have disabilities, your income can be slightly higher. You can qualify for Medi-Cal even if you have assets.
Can you have Medi-Cal and another insurance?
Even if you have other health coverage such as health insurance from your work, you may still qualify for Medi-Cal. If you qualify, Medi-Cal will cover allowable costs not paid by your primary insurance. Under federal law, Medi-Cal beneficiaries' private health insurance must be billed first before billing Medi-Cal.
What does Medi-Cal not cover?
Restricted scope Medi-Cal covers limited services. It does not cover medicine or primary care. If you have pregnancy-related limited scope Medi-Cal, you will have the full scope of Medi-Cal benefits, if the service is medically necessary.
What are the limitations of Medi-Cal?
For 2024, the income limits are generally expressed as a percentage of the FPL and vary by the individual's category. For example, an individual may qualify for Medi-Cal if their yearly income is at or below $20,783. A couple may qualify for Medi-Cal if their annual income is at or below $28,208.
Can I have money in the bank and still get Medi-Cal?
➢ Do assets affect my eligibility? Starting on January 1, 2024, assets, such as bank accounts, cash, a second vehicle, and homes, will no longer be counted when determining Medi-Cal eligibility. Income and income from assets, such as income from property, will continue to be counted.
What is the highest income to qualify for Medicaid 2024?
Parents of Dependent Children: Income limits for 2024 are reported as a percentage of the federal poverty level (FPL). The 2024 FPL for a family of three is $25,820. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2024 FPL for an individual is $15,060.
Why does no one accept Medi-Cal?
The most frequent reasons physicians limit Medi-Cal patients in their practices are payment rates and administrative hassles.