Is Medi-Cal a PPO or HMO?

Asked by: Caleb Wilkinson  |  Last update: February 11, 2022
Score: 5/5 (53 votes)

Medi-Cal is health insurance for people with low incomes. Some counties have Medi-Cal Managed Care, in which the State contracts with HMO plans to provide health care services to Medi-Cal members.

Is Medi-Cal considered HMO?

Almost all Medi-Cal plans are “managed care plans” which means they function similar to an HMO. Medi-Cal Plans can be found in the Medi-Cal Managed Care Health Plan Directory. A managed care plan means you'll have a primary care physician, and they're the one person you'll see if you need medical care.

What kind of insurance is Medi-Cal?

Medi-Cal, California's Medicaid program, is a public insurance health care program which provides health care services for low-income individuals and families who meet defined eligibility requirements.

What is Medi-Cal PPO?

A PPO is a preferred provider organization. A PPO is good plan for people who want to see providers without prior approval from their health plan or medical group and who do not want to choose a primary care doctor. You get most of your health care from a network of doctors and other providers. ... The PPO pays the rest.

What are the two types of Medi-Cal?

This guidebook explains the two kinds of Medi-Cal: Regular Medi-Cal and Medi-Cal Health Plans.

What is an HMO, PPO, HDHP or EPO

25 related questions found

Is Medi-Cal managed care the same as Medi-Cal?

All counties now have Medi-Cal managed care plans sometimes also called Medi-Cal health care plans. These types of Medi-Cal managed care plans are a type of Managed Care Organization. ... There are two basic types of Medi-Cal managed care plans: COHS (County-Organized Health Systems) model plans and non-COHS model plans.

Is Medi-Cal same as Medicaid?

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources.

What is an HMO vs PPO?

To start, HMO stands for Health Maintenance Organization, and the coverage restricts patients to a particular group of physicians called a network. PPO is short for Preferred Provider Organization and allows patients to choose any physician they wish, either inside or outside of their network.

Is Medi-Cal state or federal?

Medi-Cal—California's Medicaid program—is a state-federal program that offers free or low-cost health coverage to Californians with low family incomes. Prior to the Affordable Care Act (ACA), Medi-Cal served low-income families and children, the elderly, and people with disabilities.

What is Medi Medi insurance?

Medicaid is a joint federal and state program that helps pay medical costs if you have limited income and resources and meet other requirements. Some people qualify for both Medicare and Medicaid and are called “dual eligibles.” This is also referred to as “Medi-Medi.”

Is Medi-Cal a marketplace insurance?

Enrollment. Covered California is the new marketplace for affordable, low cost and no cost health insurance, including Medi-Cal. It's a “no wrong door” approach that will help Californians learn their eligibility for subsidized health benefits, compare insurance plan options, and enroll to receive coverage.

Which HMO is best in California?

According the most recent annual rankings from National Committee for Quality Assurance (NCQA), the top three rated HMOs serving members in Northern California are:
  • Kaiser Foundation Health Plan of Northern California.
  • UnitedHealthcare of California.
  • Western Health Advantage.

Is CalOptima the same as Medi-Cal?

Medi-Cal — also known as Medicaid — is a public health insurance program for low-income people offered by the state. ... CalOptima provides health care coverage for Orange County residents who are eligible for full Medi-Cal.

What does Medi-Cal stand for?

The California Medical Assistance Program (Medi-Cal or MediCal) is California's Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.

Do I have Medi-Cal insurance?

How Do I Check My Medicaid Status? Contact your local county social services office to learn about your Medi-Cal status and eligibility. The California Department of Health Care Services has a full directory of each county's agency.

Can I have both HMO and PPO?

Yes, you can have two health insurance plans. Having two health insurance plans is perfectly legal, and many people have multiple health insurance policies under certain circumstances.

Which pays better HMO or PPO?

In general, HMO premiums are lower than other plans (like PPOs) that give you more flexibility. Additionally, you may pay less for deductibles, copays, and prescriptions with HMOs. PPO premiums are higher than HMOs. You also typically pay more for out-of-pocket costs like deductibles and copays.

What is full scope Medi-Cal?

Medi-Cal provides free or low-cost health care for some people who live in California. Full scope Medi-Cal covers more than just care when you have an emergency. It provides medical, dental, mental health, and vision (eye) care. It also covers alcohol and drug use treatment, drugs your doctor orders, and more.

How much is Medi-Cal per month?

How much are the premiums? The premiums for Medi-Cal for Families are $13 for each child and no more than $39 per family per month. What can I do if I disagree with paying a monthly premium? Monthly premiums must be paid for the child(ren) to remain eligible for this Medi-Cal program.

Does Medi-Cal check your bank account?

Yes. Asset tests are a part of Medicaid eligibility requirements. Medi-Cal is the State of California's Medicaid program. Bank accounts are one of the easier tests for the government to make.

What is HMO managed care?

Health Maintenance Organization (HMO) manages care by requiring you to see network providers, usually for a much lower monthly premium. HMOs also often require you to see a PCP before going elsewhere, and do not cover you to see providers outside the network. Preventive care is covered at 100%.

What is Medi-Cal GMC?

The Geographic Managed Care (GMC) model was established to provide medical care for Medi-Cal recipients in specified aid code categories for a capitated fee. This model is available in Sacramento and San Diego counties.

How do Medi-Cal managed care plans work?

Under managed care, the state contracts with health plans to deliver Medi-Cal benefits to enrollees in exchange for a monthly premium, or “capitation” payment for each enrollee. The plans are accountable for and at financial risk for providing the services in the contract.


Sunday's Los Angeles Times/Orange County Edition profiled CalOPTIMA, the county's "cutting-edge, HMO-type health system for the poor and disabled." It was started three years ago as part of the "state mandate to shift the urban poor to managed care" and has since replaced the Medi-Cal system in the county.

What is a Medi-Cal BIC card?

You have now received or will shortly receive a plastic Benefits Identification Card (BIC). This BIC is used to verify your eligibility for Medi-Cal benefits, allowing your Medi-Cal providers to bill for your medical and/or dental care.