I Have Both Medicare and Medi-Cal
If you have both Medicare and Medi-Cal (called dual eligible), you may have the choice to participate in a new pilot program called Cal MediConnect. This program is being tried out in Los Angeles and seven other counties in California. (Click here to see who is eligible for Cal MediConnect.)
You likely will be receiving information about this program – including an enrollment form – starting in April 2014. These materials will come in a blue envelope in the mail.
Opt Out of Cal MediConnect
- If you choose to opt out of (not to sign up for) Cal MediConnect, you will keep the same fee-for-service Medicare benefits that you already have and you will be able to keep coverage for Cedars-Sinai. You also will maintain coverage for a larger network of doctors and hospitals.
- You will likely need to sign up for a Medi-Cal managed care health plan for your Medi-Cal coverage if you are not already in one. The Medi-Cal managed care plan will be responsible for covering Medi-Cal benefits, long-term support services and coordinating with Medicare for deductibles and coinsurance.
Enroll in Cal MediConnect
- Cedars-Sinai is participating in Cal MediConnect through the L.A. Care Health Plan.
- If you choose to enroll in Cal MediConnect, your Medicare and Medi-Cal services will be bundled together and coordinated through one plan. In addition, there will be a supplemental vision and transportation benefit. Health plans include L.A. Care, CareMore, Health Net, Molina and Care 1st.
- Cal MediConnect participants have access to a smaller number of approved doctors and hospitals. If you choose Cal MediConnect, all of your care would provided at Cedars-Sinai and by a narrow network of doctors affiliated with Cedars-Sinai. If you want to keep your current physician(s), please check to make sure they are participating in Cal MediConnect before joining. Since not all physicians are participating, it could mean that you would lose coverage for your doctor even though you will still have coverage for Cedars-Sinai Medical Center.
- To find out if your physician is included in this plan, call 844-CS-MEDIS (844-276-3347), available 24 hours a day.
Do Nothing (Passive Enrollment)
If you do not do one of the two options above, you may be passively enrolled, in the Cal MediConnect program and a health plan will be chosen for you. This may mean that you lose coverage for Cedars-Sinai.
If you wish to keep your coverage for care at Cedars-Sinai and with Cedars-Sinai health providers, please call 844-CS-MEDIS and we can help answer your questions as they pertain to Cedars-Sinai.
Voluntary enrollment for Cal MediConnect plans through L.A. Care and Health Net began April 1, 2014. Voluntary enrollment for plans through CareMore, Care1st and Molina began July 1, 2014.
If you are eligible for Cal MediConnect and do not actively choose a plan within Cal MediConnect – or opt out of enrolling in Cal MediConnect – you may be passively enrolled starting July 1, 2014. Passive enrollment means you will be automatically enrolled in the Cal MediConnect program and a health plan provider will be selected for you. This may result in you losing coverage to Cedars-Sinai Medical Center and its physicians.
Passive enrollment occurs during your birth month or sooner.
At any time, with 30 days of notice, you can change your mind and select a different option – including opting out of Cal MediConnect. You can make this change even if you have been passively enrolled.
How to Select Coverage
An enrollment form will be sent to you by the California Department of Health Care Services with an information packet and return envelope 60 days prior to your birth date. This information will come in a blue envelope in the mail.
You have three options when it comes to enrolling:
- By mail – Complete the Medicare and Medi-Cal choice form and mail it back to the California Department of Health Care Services in the postage-paid envelope. If you lose the form, you can call Health Care Options to request another one. Each form is specific to the beneficiary.
- By phone – Call Health Care Options, which is a branch of the state’s Medi-Cal Managed Care Division, at 844-580-7272; TTY users, 800-430-7077.
- In person – Find a Health Care Options enrollment assistance location near you. To find a location, call the number above or click the following link and select your county: www.healthcareoptions.dhcs.ca.gov/HCOCSP/Presentation_Sites/
If you would like to switch to a different plan (even if you have been passively enrolled in Cal MediConnect), you will need to follow one of the three options above to change your plan. Changing your selection requires 30 days of notice.
For more information on how to keep coverage for care from Cedars-Sinai, call 844-CS-MEDIS (844-276-3347). Available 24 hours a day.
For more guidance, click the option that best describes your situation.