Medicare and Medi-Cal Dual-Eligible Patients
Recent changes to Medicare and Medi-Cal benefits may prevent you from seeing your physicians at Keck Medicine of USC.
If you have Medicare and Medi-Cal benefits (dual eligible), you may be enrolled in a new health plan under a program called Cal MediConnect. This may direct you to another physician who is not with Keck Medicine of USC. To avoid this change, you need to take action.
An enrollment form and information packet in a blue envelope will be mailed to you within 60 days of your birthdate directly from Medi-Cal. To continue receiving care at Keck Medicine of USC, please choose one of the following options when completing your form:
- Opt out of Cal MediConnect
- If you choose to opt out of (not enroll in) Cal MediConnect, you will keep your existing Medicare benefits and you will be able to continue seeing your USC physician. You will, however, still need to select a Medi-Cal managed health plan for your Medi-Cal coverage. This will help cover your Medicare deductibles, coinsurance payments and other support services.
OR
- If you choose to opt out of (not enroll in) Cal MediConnect, you will keep your existing Medicare benefits and you will be able to continue seeing your USC physician. You will, however, still need to select a Medi-Cal managed health plan for your Medi-Cal coverage. This will help cover your Medicare deductibles, coinsurance payments and other support services.
- Enroll in Cal MediConnect
- If you chose to enroll in Cal MediConnect, your Medicare and Medi-Cal services will be managed through one plan. While Keck Medicine of USC is currently contracted with the Care 1st and Caremore plans, this does not guarantee you will be able to keep your current USC physician.
OR
- If you chose to enroll in Cal MediConnect, your Medicare and Medi-Cal services will be managed through one plan. While Keck Medicine of USC is currently contracted with the Care 1st and Caremore plans, this does not guarantee you will be able to keep your current USC physician.
- Do Nothing
- If you take no action, you will be automatically enrolled in the Cal MediConnect program and a health plan will be selected for you. Depending on the health plan and physician you are assigned, you may not be able to keep your current USC physician.
For more information or if you have already enrolled in Cal MediConnect and are having problems seeing your USC physician, please call (800) USC-CARE for assistance and ask to be connected with your physician’s office. You can also visit www.calduals.org.
TAKE ACTION TO KEEP YOUR USC PROVIDERS
Recent changes to Medicare and Medi-Cal benefits may prevent you from seeing Keck Medicine of USC physicians. To keep your USC provider, please do the following:
Opt out of Cal MediConnect and keep regular Medicare With this option, you will be able to keep the same Medicare benefits that you already have and you will be able to keep coverage at Keck Medicine of USC. You also will maintain coverage for a larger network of doctors and hospitals.
• Call Health Care Options at (844) 580-7272 or TTY: (800) 430-7077 Monday – Friday, 8 a.m. – 5 p.m.
• To opt out you must select Option B in Step 2 of the Health Plan Choice Form that is part of your enrollment packet.
• Fill in the circle to the left of the Medi-Cal plan you want.
• You must also mail in your enrollment form. If this section is not filled out correctly, you will be passively enrolled.
Frequently Asked Questions (FAQ)
You qualify for Cal MediConnect if you:
- Qualify for Medi-Cal and Medicare (Parts A and B and are eligible for Part D)
- Live in Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Alameda and Santa Clara counties.
You will not qualify for Cal MediConnect include if you:
- Are under 21 years old
- Receive a development disabled waiver from a regional center
- Do not meet Medi-Cal share of cost (if a beneficiary has Medi-Cal share of cost, they must meet it each month by being in a Medi-Cal funded nursing facility or by receiving In-Home support services in order to qualify for passive enrollment)
- Have end-stage renal disease (except if living in San Mateo and Orange counties)
- Have other health coverage such as retirement, veterans or private insurance
- Receive services from one of the following waiver programs: nursing facility/acute hospital, HIV/AIDS, assisted living, or in-home operations (If a beneficiary wants to join MediConnect and is part of one of these programs, the beneficiary must disenroll from these programs. Beneficiaries who are part of these waiver programs will NOT be passively enrolled.)
- Are enrolled in PACE (you must disenroll first)
- Live in some rural ZIP codes of Los Angeles, Riverside and San Bernardino counties (rural Los Angeles County ZIP code is 90704)
If you receive health care coverage through Medicare, but are not eligible for Medi-Cal, you will not be affected. Anyone enrolled in Medi-Cal, however, will need to enroll in a Medi-Cal managed health benefit plan. Doing so will not affect your care, as long as your primary Medicare remains unattached to an HMO.
No. However, if you are eligible but do not wish to enroll, you must opt out of the program or you will be automatically enrolled. This could mean changes to your plan and physician. If you are eligible for Cal MediConnect but do not wish to enroll, please be sure to opt out.
If you do enroll in Cal MediConnect and decide later you no longer want to be part of the program, you can opt out. To do so, call Health Care Options at (844) 580-7272 or TTY: 800-430-7077 or contact your plan provider and tell them you would like to leave the program.
You will still need to be enrolled in a managed health plan for your Medi-Cal benefits. Leaving Cal MediConnect will only affect how you get your Medicare benefits.
Enrollment is free, but you will still be responsible for the same Medicare and Medi-Cal premiums, copays and deductibles you are accustomed to.
Your choice of physician and hospital providers will generally be limited to those in a Cal MediConnect plan. If you chose to enroll, you will need to be sure that your preferred doctor(s) and hospital are part of that plan.
Yes, you will need prior authorization for all services and specialty care. Referrals and authorizations will need to be coordinated through your primary care provider.
Yes, your coverage will not change.
You will receive three different notices about the Cal MediConnect program within 90, 60, and 30 days of your enrollment date:
- 90 days ahead: This first notice will alert you to the coming change.
- 60 days ahead: This second notice will include a packet with information about plan benefits and information on how to select a plan. This will include a plan that is the best match for you based on how many of your current providers are included in a plan’s provider network.
- 30 days ahead: This third notice will provide you with information about the specific plan you requested. Remember, if you are dual eligible and do not take action on your 60-day notice,, you may be automatically enrolled in Cal MediConnect and a health care plan will be selected for you.
If you wish to keep your coverage for care at Keck Medicine of USC and with our providers, please do the following:
- To opt out of the program and keep regular Medicare, call Health Care Options at (844) 580-7272 or TTY: (800) 430-7077 Monday – Friday, 8 a.m. – 5 p.m. If you choose to opt out of (not to sign up for) Cal MediConnect, you will keep the same Medicare benefits that you already have and you will be able to keep coverage at Keck Medicine of USC. You also will maintain coverage for a larger network of doctors and hospitals.
- To opt out you must select Option B in Step 2 of the Health Plan Choice Form that is part of your enrollment packet. Fill in the circle to the left of the Medi-Cal plan you want. You must also mail in your enrollment form. If this section is not filled out correctly, you will be passively enrolled.
