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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

What are Dual Eligibility, Medicare Medi-Cal Requirements?

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Question: I’m 61 and receive Medicare as I’m permanently disabled. Currently I am paying $200 out of my $1000 social security income towards my Kaiser Senior Advantage, plus high co-pays. My income is very low (social security only) but I do have assets that I am spending down to augment my income. Can I qualify for Medicaid as well based on income only?

Answer: Medicare beneficiaries in California who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medi-Cal. Medi-Cal also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.

Income limit: The Medi-Cal income limit is calculated as 100% of the federal poverty level (FPL), which changes every year. The current limit is $11,880/yr per individual and $16,020/yr for a couple.

Assets: Individuals may own assets worth no more than $2,000; married couples may own $3,000 worth. But not all assets are included in the count. Exempt assets include:

  • A primary home
  • One vehicle
  • Household items
  • Personal belongings including clothing, heirlooms, and wedding and engagement rings.
  • Burial plots and any money in a designated burial plan fund
  • Life insurance policies and the balance of pension funds, IRAs, and certain annuities

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