Medicaid Costs and Coverage in California


Medi-Cal coverage in California is available for low-income households that need assistance covering the cost of health care services. How much does Medi-Cal cost California participants? Medi-Cal cost estimates are dependent on the household income of the enrollees. Medi-Cal covers many health care services for little to no cost to the beneficiary. However, petitioners should be aware of reoccurring monthly expenses and copays of services rendered. Some doctor visits may be complementary as part of the program, while other services may require the enrollee to pay a portion of the cost. It is important for participants to be aware of what services are covered by Medi-Cal and which are not before accumulating a hefty medical bill.

For comprehensive information about Medicaid cost and coverage in California, download our guide.

How much is Medi-Cal coverage for California participants?

The cost of Medi-Cal varies depending on the financial situation of the beneficiary. For many with Medi-Cal coverage, there is no cost associated with services. Not only are services covered by Medi-Cal, but copays and premiums may be absorbed by the state as well. Some enrollees will have reasonable costs associated with coverage, such as a low monthly premium. Households with income between 160 and 266 percent of the federal poverty level (FPL) will have a monthly premium. While Medi-Cal premiums for each child start at $13 per month, a family cap prevents households from paying over a certain amount. Participants must pay the Medi-Cal costs for monthly premiums or risk losing coverage. If enrollees are unable to pay, they should contact their local county office to speak with a representative about options, like requesting an appeal.

Premiums for Medi-Cal coverage can be paid online, by mail or in person at Western Union Convenience Pay locations. The state offers premium discounts such as a percentage off after setting up automatic payments. Likewise, certain California residents can deter Medi-Cal cost estimates with a Medi-Cal waiver. Participants may also be responsible for a portion of the cost from services rendered. Medi-Cal participants who have higher incomes will have copays and other share of costs expenses.

Find out more about Medi-Cal premium discounts in our comprehensive guide here.

Determining What Services Are Covered by Medi-Cal in California

While Medi-Cal cost estimates can fluctuate by type of service rendered, the state ensures that a core health services are part of the coverage plan. Medi-Cal covers a standard set of 10 comprehensive services deemed as essential health benefits. Services covered by Medi-Cal include outpatient services, hospitalization, emergency services, maternity and newborn care, prescription drugs, services for mental health and substance use disorder, laboratory services, pediatric services, rehabilitative services and preventative management.

Some dental services are covered by Medi-Cal for adults and children enrolled in California Medicaid, which is known as Denti-Cal. These services include dental exams and x-rays, fluoride treatments, teeth cleaning, prefabricated crowns, roots canals for the front teeth, fillings, full dentures and other dental services that are medically necessary.

Vision services are covered by Medi-Cal for individuals who are eligible for full-scope Medi-Cal. If you are not certain if you are eligible for Medi-Cal vision services, contact your county human services agency. Medi-Cal coverage for vision services include a free routine eye exam every 24 months. This includes a full eye health check and any tests needed for an eyeglass prescription. In some instances, Medi-Cal insurance may also cover contact lenses if you are unable to wear eyeglasses due to an injury, condition or disease.

Medi-Cal covers low-vision testing if you have a certain type of visual impairment that affects your ability to perform day-to-day activities and cannot be corrected by means of standard eyeglasses, medication, contact lenses or surgery. An example of such as conditions is age-related macular degeneration. If you are a Medi-Cal beneficiary and you have experienced the loss of one or both eyes due to injury or disease, you may be eligible for artificial eye services and materials.

Participants with Medi-Cal coverage who qualify for share of cost (SOC), or copayments, will be responsible for paying their portion of health care expenses. How much Medi-Cal you will have to cover will depend on your monthly income. Find out more about Medicaid SOC in California by downloading our detailed guide here.

What does Medi-Cal not cover for California enrollees?

The state sends information mentioning which services are covered by Medi-Cal according to the program that the participant is enrolled in once that are considered eligible for Medicaid in California. Medi-Cal does not cover non-essential health services such as cosmetic surgery, ambulance services, vasectomy and hearing aids. Additionally, Medi-Cal does not cover services not specific the participant’s plan. For instance, the Presumptive Eligibility for Pregnant Women plan from Medi-Cal does not cover labor, delivery or hospitalization costs since the program specifically covers temporary prenatal services while determining eligibility of expecting mothers. Furthermore, some services are specific to the participant’s age or extenuating factors. Medi-Cal does not cover eyeglasses except for Medi-Cal beneficiaries who are younger than 21 years of age and those who are residents of a nursing home.

In California, Medi-Cal does not cover family planning services because Family Planning, Access, Care and Treatment (Family PACT) cover these. PACT provides family planning services to eligible low-income men and women. Its aim is to promote reproductive health and prevent unwanted pregnancies.

Download our comprehensive guide to find out more about which services are covered by Medicaid in California.

What Are the Available Health Services in California?

Low-cost, and even free health benefits are available to a large number of California residents, with some being offered to low-income applicants and others being offered to elderly or disabled individuals. However, before you can access these health services, you need to submit the appropriate application and prove that you meet the necessary qualifications. To learn all about the different health benefits you can receive in California and the application procedures that you must undergo to obtain these benefits, download our free comprehensive guide.

Who Is Eligible to Obtain California Health Benefits?

California’s health programs have various eligibility requirements that applicants must meet in order to successfully enroll. Income, age and other factors are all taken into consideration in the eligibility verification process. Find out which health benefits you qualify for here.