Options for Dual-Eligible Participants

Effective January 1, 2023, the California Department of Health Care Services’ CalAIM initiative replaced the Cal MediConnect program. CalAIM’s ultimate goal is for a single insurer to be able to coordinate both your Medicare and Medi-Cal benefits. There are multiple benefit plan combinations available:

1. Opt-out: Maintain your Original Medicare and standard Medi-Cal coverages. You will be required to assign your standard Medi-Cal coverage to an insurer contracted with your county to administer Medi-Cal benefits. This coverage option provides no coordination of your Medicare and Medi-Cal benefits.
   
2. Medicare Advantage Plan, plus standard Medi-Cal coverage: You may sign up for a Medicare Advantage HMO or PPO plan that does not include your Medi-Cal benefits. If you prefer this option, you must still assign your standard Medi-Cal coverage to an insurer contracted with your county to administer your Medi-Cal benefits. You do not have to assign your Medi-Cal benefits to the same insurer as the one that operates your Medicare Advantage plan. To see which D-SNP HMO plans Cedars-Sinai contracts with, please click here.
   
3. Medicare Medi-Cal Managed Care Plans (MMPs), also known as Dual Special Needs Plan (D-SNP HMO): A D-SNP HMO is an HMO product that combines your Medicare and Medi-Cal benefits into a single benefit plan. To see which D-SNP HMO plans Cedars-Sinai contracts with please click here.

To find out if your physician accepts traditional Medicare, call 1-800-CEDARS-1 (1-800-233-2771), available 7 days a week, 6 am - 9 pm PT.

Cedars-Sinai is contracted with Brandman Centers for Senior Care and InnovAge for hospital services. To qualify for these services and other PACE programs, you must:

• Be 55 years or older.
• Meet the requirement for skilled nursing home care as determined by an assessment by the PACE organization’s interdisciplinary team.
• Be certified by the California Department of Health Care Services.
• Live in a service area (county and ZIP code) served by a PACE program.
• Be able to live in the community without jeopardizing your health or safety.