Some people qualify for both Medicare and Medi-Cal and are “dual eligible" beneficiaries. Like all Medicare beneficiaries, dual eligible beneficiaries can choose whether to receive care through Original Medicare, or enroll in a Medicare Advantage (MA) plan, sometimes called “Part C" or “MA Plans." In California there are several types of Medicare Advantage. Local HICAP organizations can provide assistance.
For Medi-Cal benefits, most dual eligible beneficiaries are enrolled in Medi‑Cal managed care plans. Enrollment in a Medi-Cal managed care plan does not impact Medicare benefits or provider access.
Medi-Medi Plans coordinate all benefits and services across both programs, including all Medicare
and Medi-Cal covered services.
Medi-Cal Matching Plan Policy
To address the challenges for beneficiaries of coordinating across different health plans for Medicare and Medi-Cal benefits, DHCS has a Medi-Cal matching plan policy in 17 counties. Under this policy, a beneficiary's Medicare plan choice is the lead, and the Medi-Cal plan follows. This means that for dual eligible beneficiaries that choose to enroll in a MA plan in those counties, their Medi-Cal plan must align with their MA plan choice, if there is a Medi-Cal plan affiliated with their MA plan. The Medi-Cal matching plan policy does not change or impact a beneficiary's MA plan choice. The beneficiary notice is here.
Note: For additional information on the 2023 policy, view the Medi-Cal Matching Plan Policy Scenarios slides. These slides provide visuals on four common scenarios that generally apply to dual eligible beneficiaries.
The 17 counties with the Medi-Cal matching plan policy in 2024 are: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Clara, Stanislaus, and Tulare counties.
For beneficiaries with questions about the Medi-Cal matching plan policy, please contact Medi-Cal Managed Care Health Care Options: Home | Medi-Cal Managed Care Health Care Options
Additional contact information is available at the Medi-Cal Health Care Options website.
