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Do you live in California and Qualify for Dual Eligibility

Double Trouble

Sometimes, Medicare just isn’t enough to cover medical expenses. It’s a tough situation, but this is the socioeconomic position of many individuals currently in the country. The idea of dual eligibility exists, however, to counteract this in order to make sure people are covered no matter what their background might be. Dual eligibility means that you’re 65 years of age or older as well as meet a certain income minimum for the government to give you funds to qualify for both Medicare and Medicaid. If you’re dual eligible for these plans, it used to be that you could change plans whenever you wanted throughout the year without worry. Now, though, since people have been caught abusing the system, Medicare has decided to undergo some changes to this policy.

Before 2019, people that were eligible for both government-funded systems referred to as dual eligibles, had a continuous enrollment period called the LIS SEP (Low Income Subsidy Special Enrollment Period). This period allowed them to enroll or disenroll from a Medicare plan or the Part D plan at any time throughout the year. Now, dual eligibles must wait to change plans on a quarterly basis, meaning they have 4 opportunities a year to switch plans if they so choose.

These changes made to whichever plans will take place on the first of the month directly after having made a switch. Those involved with the program Cal Mediconnect are still able to enroll or disenroll from it at any point throughout the year, though, so the changes only apply to those who are dual eligibles.

This change in plan enrollment doesn’t affect the already established enrollment periods, like the annual enrollment period which is still set to take place from October 15 to December 7 of every year.

Cal Mediconnect?

Cal Mediconnect a relatively new pilot program, brought into conception in 2014. It aims to unify Medicare and Medi-Cal into a singular plan, like those that are dual eligibles. This program premiered in just 8 counties of California; Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Alameda, and Santa Clara. (This link goes into further detail about when the new rule takes effect, who all is going to be affected by it, and who is exempt from it in the coming years.)

Since this plan works to bring together both Medicare and Medi-Cal under one name, it features many of the benefits that come with each plan. For instance, with Cal Mediconnect you’re entitled to:

  • Medical Care
  • Prescription Medications
  • Mental and Behavioral Health Care
  • Long Term Services and Supports
  • Connection to Social Services

Will Cal Mediconnect be Available in More Counties?

The future of Cal Mediconnect is uncertain as to whether or not it will continue to spread throughout California into all existing counties rather than staying based in the eight southernmost areas. Its success rate since implementation in 2014 speaks very positively on the program as a whole, as the benefits and care that the plan offers are hard to pass up. Alongside those benefits listed above, Cal Mediconnect also entitles beneficiaries to a Care Coordinator that personally looks after your health, doctors, hospital visits, specialists, pharmacies, and many other advantages you’d find in a Medicare or Medicaid plan. You can even continue seeing your current doctor, provided that they operate within the Cal Mediconnect network or are willing to switch over within a calendar year.

If you reside in one of these service areas, contact one of our licensed representatives to see if signing onto this type of plan would be good for you. Keep in mind that you need to be eligible for both Medicare and Medi-Cal. It can’t hurt to talk with an agent to see how much this plan might cost you and what kind of longevity you could see with this program.

Turn and Face the Strange (Ch-Ch-Changes)

If you have any questions about this change in enrollment eligibility or what plans you should be signing on to if you’re nearing the age of eligibility, please reach out to a licensed representative. They’re going to have the best answers when it comes to your questions about specific plans, and they’ll know how to navigate best this new quarterly system based on your current health needs. If great care is just a phone call away, what is there to wait for?