Medicare and Medi-Cal Dual-Eligible Patients

You qualify for Cal MediConnect if you:

• Qualify for Medi-Cal and Medicare (Parts A and B and are eligible for Part D)
• Live in Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Alameda and Santa Clara counties.

You will not qualify for Cal MediConnect include if you:

• Are under 21 years old
• Receive a development disabled waiver from a regional center
• Do not meet Medi-Cal share of cost (if a beneficiary has Medi-Cal share of cost, they must meet it each month by being in a Medi-Cal funded nursing facility or by receiving In-Home support services in order to qualify for passive enrollment)
• Have end-stage renal disease (except if living in San Mateo and Orange counties)
• Have other health coverage such as retirement, veterans or private insurance
• Receive services from one of the following waiver programs: nursing facility/acute hospital, HIV/AIDS, assisted living, or in-home operations (If a beneficiary wants to join MediConnect and is part of one of these programs, the beneficiary must disenroll from these programs. Beneficiaries who are part of these waiver programs will NOT be passively enrolled.)
• Are enrolled in PACE (you must disenroll first)
• Live in some rural ZIP codes of Los Angeles, Riverside and San Bernardino counties (rural Los Angeles County ZIP code is 90704)

If you receive health care coverage through Medicare, but are not eligible for Medi-Cal, you will not be affected. Anyone enrolled in Medi-Cal, however, will need to enroll in a Medi-Cal managed health benefit plan. Doing so will not affect your care, as long as your primary Medicare remains unattached to an HMO.

No. However, if you are eligible but do not wish to enroll, you must opt out of the program or you will be automatically enrolled. This could mean changes to your plan and physician. If you are eligible for Cal MediConnect but do not wish to enroll, please be sure to opt out.

If you do enroll in Cal MediConnect and decide later you no longer want to be part of the program, you can opt out. To do so, call Health Care Options at (844) 580-7272 or TTY: 800-430-7077 or contact your plan provider and tell them you would like to leave the program.

You will still need to be enrolled in a managed health plan for your Medi-Cal benefits. Leaving Cal MediConnect will only affect how you get your Medicare benefits.

Enrollment is free, but you will still be responsible for the same Medicare and Medi-Cal premiums, copays and deductibles you are accustomed to.

Your choice of physician and hospital providers will generally be limited to those in a Cal MediConnect plan. If you chose to enroll, you will need to be sure that your preferred doctor(s) and hospital are part of that plan.

Yes, you will need prior authorization for all services and specialty care. Referrals and authorizations will need to be coordinated through your primary care provider.

Yes, your coverage will not change.

You will receive three different notices about the Cal MediConnect program within 90, 60, and 30 days of your enrollment date:

• 90 days ahead: This first notice will alert you to the coming change.
• 60 days ahead: This second notice will include a packet with information about plan benefits and information on how to select a plan. This will include a plan that is the best match for you based on how many of your current providers are included in a plan’s provider network.
• 30 days ahead: This third notice will provide you with information about the specific plan you requested. Remember, if you are dual eligible and do not take action on your 60-day notice,, you may be automatically enrolled in Cal MediConnect and a health care plan will be selected for you.

If you wish to keep your coverage for care at Keck Medicine of USC and with our providers, please do the following:

• To opt out of the program and keep regular Medicare, call Health Care Options at (844) 580-7272 or TTY: (800) 430-7077 Monday – Friday, 8 a.m. – 5 p.m. If you choose to opt out of (not to sign up for) Cal MediConnect, you will keep the same Medicare benefits that you already have and you will be able to keep coverage at Keck Medicine of USC. You also will maintain coverage for a larger network of doctors and hospitals.
• To opt out you must select Option B in Step 2 of the Health Plan Choice Form that is part of your enrollment packet. Fill in the circle to the left of the Medi-Cal plan you want. You must also mail in your enrollment form. If this section is not filled out correctly, you will be passively enrolled.