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What is Covered California?
If you do not have health insurance through a job, Medi-Cal, Medicare, or other health insurance that meets the Affordable Care Act requirement, you can find coverage through a health insurance marketplace. Covered California is the health insurance marketplace for residents of California. It allows residents to compare and shop for health insurance coverage plans. Depending on income, you may qualify for a lower insurance premium or Medi-Cal. Note: To qualify for a lower insurance premium, you must enroll during the Open Enrollment period which begins October 15th, 2019. However, there are certain events that can allow you to enroll outside of the Open Enrollment period. For more information on Special Enrollment, click here. If eligible, individuals and families can enroll in Medi-Cal year-round.
What is Medi-Cal?
Medi-Cal is the Medicaid health care program in California. Medi-Cal offers free or low-cost health insurance coverage for eligible, low-income, California residents. The coverage provided through Medi-Cal pays for many medical services.
Many Medi-Cal recipients have no monthly premium, no co-payment, and no out of pocket costs for medical services. Some recipients will have an affordable monthly premium. Individuals may apply for Medi-Cal at any time during the year through the Ventura County Human Services Agency. There is no deadline to enroll in Medi-Cal. In some cases, applicants may be able to receive coverage right away.
What is Medi-Cal Managed Care?
Most Medi-Cal recipients will enroll in and receive care through managed care plans. Managed care plans will determine the primary care providers, facilities, and specialists from which you are entitled to receive care. Medi-Cal managed care options will vary depending on the county in which a Medi-Cal recipient lives.
In Ventura County, the Medi-Cal Managed Care Plan is through Gold Coast Health Plan. Once enrolled, you will select a primary care provider through your Medi-Cal Managed Care Plan network. A primary care provider is the doctor you will see for physical exams. These doctors also help authorize services and connect you to specialists you may need.
What is Medicare?
Medicare is a federal program that provides health care coverage for:
-people who are 65 or older.
-certain people under 65 with disabilities.
-people with End-Stage-Renal Disease (ESRD). ESRD is a condition in which individuals have permanent kidney failure that requires dialysis or a transplant.
Medicare is composed of four parts, A, B, C, and D.
Medicare Part A is hospital insurance. It covers hospital stays, receiving care in nursing facilities, hospice care, and certain types of home health care.
Medicare Part B is medical insurance. It covers doctor’s visits, outpatient care, preventative services, and medical supplies.
Another way to break it down is that there are two types of Medicare: Original Medicare and Medicare Advantage.
Original Medicare is made up of Medicare Parts A (hospital insurance) and B (medical insurance). The coverage through Original Medicare is provided through the federal program itself. Recipients may choose their doctor, specialists, and hospitals, as long as they accept Medicare.
Medicare Part C is Medicare Advantage. It offers a combination of the coverage received through Parts A and B. If you have a Medicare Advantage plan, you have both hospital and medical insurance. This coverage is not directly provided by Medicare. It is provided through private insurance companies that are approved by Medicare. Like an HMO or PPO, you more than likely must choose providers, specialists, and facilities that are in the insurance company’s network.
Medicare Part D is prescription drug coverage. If you have Original Medicare, you will need to enroll in a separate Part D plan. The coverage is provided through private insurance that is approved by Medicare. If you have a Medicare Advantage plan, it’s likely the company you choose will also have an accompanying Part D plan. It is also likely that you can only enroll in that plan if you want prescription drug coverage.
What is Denti-Cal?
Medi-Cal provides free or low-cost dental care for most Medi-Cal recipients. Medi-Cal Dental, or Denti-Cal offers dental services at no cost, depending on household income and family size. For more information and to find a Medi-cal dental provider, visit Smile California.
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