Cost and Coverage of Medicaid in California

If you are wondering, “What services are covered by Medicaid in California?” note that insured services and equipment will vary from state to state. The types of Medicaid insurance services provided by Medi-Cal (the name of California’s Medicaid program) will be different from those provided in other parts of the country. Furthermore, the question of, “How much does Medicaid cost?” varies similarly across the nation and within each state. For instance, while Medicaid coverage in CA will come with a monthly premium for some beneficiaries, others will not have to pay anything for medical services. In July of 2016, just under 12 million Californians were covered by Medi-Cal. This figure is the largest of all states in the United States. If you live in California, and do not make enough money to afford health care coverage sold on the private market, you may qualify for Medi-Cal.

For more information on Medicaid costs in California, and for details on what services Medicaid covers and what services it does not, review the sections provided below:

  • What is covered under Medicaid in California?
  • What does Medicaid not cover in California?
  • Medicaid costs in California

What is covered under Medicaid in California?

Most types of Medicaid insurance cover the same services and equipment. However, because Medicaid varies slightly from state to state, applicants must ask, “What services are covered by Medicaid in my state of residence?” in order to find out if the state medical assistance program suits their needs. California Medicaid coverage, specifically, covers a wide variety of services and equipment for eligible beneficiaries.

These include:

  • Prescription drugs.
  • Lab services.
  • Mental health services.
  • Substance abuse disorder services.
  • Behavioral health treatment.
  • Hospitalization.
  • Outpatient services (ambulatory).
  • Chronic disease management.
  • Preventive and wellness services.
  • Emergency services.
  • Newborn care.
  • Maternity care.
  • Occupational therapy and physical therapy.

Children’s medical services including vision and dental care are also covered by California Medicaid. Additionally, in 2014, Medicaid-covered dental services were restored in CA for beneficiaries 21 years of age and older. These services include exams, X-rays, dentures (full), root canals for front teeth, fillings, teeth cleanings, treatments with fluoride, crowns that are prefabricated and other dental procedures that are deemed medically necessary for the patient.

What does Medicaid not cover in California?

While Medicaid coverage in California insures beneficiaries for a number of helpful services, certain procedures and pieces of equipment are not covered by Medi-Cal. Regarding, “What does Medicaid not cover in CA?” the services and equipment that are not covered include experimental items, chiropractic treatment, surgeries to improve one’s aesthetics, private-duty nursing and medical services provided by a member’s family or friends.

The CA Medicaid program establishes covered services based on medical necessity. Therefore, any service that is not deemed medically necessary will not be covered in California.

Medicaid Costs in California

For those wondering, “How much is Medicaid in California?” note that most Medicaid beneficiaries pay nothing for Medi-Cal due to the fact that they earn low incomes. In any case, obtaining CA Medicaid cost estimates is necessary for those who do not fall into this group of applicants. Between 2014 and 2015, petitioners for Medicaid were required to pay monthly premiums if their family’s income was between 160 and 266 percent of the Federal Poverty Level. Premiums were also a requirement for children between the ages of 1 and 19 who were part of the Optional Targeted Low-Income Children’s Program. Another name for this program was the Medi-Cal for Families Program.

In any case, Medicaid cost estimates are low for anyone required to pay a premium within the state of California, because their family income exceeds the program’s designated thresholds. Concerning the question, “How much does Medicaid cost each month?” premiums are just $13 each for eligible children, and a maximum of $39 per month for each eligible family.

Even if your Medicaid cost estimates are relatively low, you may not be able to afford to pay the Medicaid coverage premiums that have been assigned to your family, based on your combined income. If that is the case, contact your local county office in order to speak with a representative. He or she will help you determine if you are eligible for other types of Medicaid insurance in California, or possibly another similar government program. Additionally, even if you are not eligible for other government assistance, the eligibility worker will be able to determine if you qualify for a discount on your Medicaid premiums.

The different ways in which you may receive a discount on Medicaid premiums are as follows:

  • Pay by Electronic Fund Transfer rather than by any other method, and you will get a monthly premium discount of 25 percent.
  • Pay three months of Medicaid coverage premiums in advance, and you will receive the fourth month of coverage free of charge.
  • Set up automatic bill pay for your Medicaid premiums, and you will receive a 25 percent discount on monthly payments. You can set up automatic payments by calling 1-877-267-3729 or by going online.

In addition to answering, “How much does Medicaid cost for me?” and “What discounts am I eligible for?” potential beneficiaries must also learn about the different ways that they can pay their Medicaid premium bills. Currently, California Medicaid coverage can be paid for in five different ways. Applicants can pay by phone or online, by providing their debit or credit card number. Medi-Cal accepts payments with VISA and MasterCard debit/credit cards. Additionally, applicants can submit payment in cash in person at any local Western Union Convenience Pay location. Also, applicants can follow the instructions on their monthly statements to complete an Electronic Fund Transfer. Finally, by-mail checks or money orders can be sent to the following address:

Medi-Cal for Families
Payment Section
P.O. Box 138011
Sacramento, CA 95813-8011

Submitting Medicaid coverage payments on time is essential. Beneficiaries who do not pay their premiums for two months will be issued a notice of benefit discontinuation.