How do I use Medi-Cal to cover copays and deductibles?

This will come into play only if you use Medi-Cal providers. For example, if you pick a provider that accepts Medi-Cal and your insurance, Medi-Cal will take care of your co-payment and your deductible. An area that it is useful to look for the overlap is ABA because there are so many visits per week. Medi-Cal will pay the co-pays as long as the provider accepts it. Other areas Medi-Cal can be very helpful are with DME and outpatient hospital services.

If there are remaining costs or copayments after the primary insurance pays its share, Medi-Cal can be billed for the amount not covered by the primary insurance, up to the Medi-Cal reimbursable rate, if the provider is contracted with the specific form of Medi-Cal that the child receives. In practice, this will look like presenting your primary insurance card along with your Medi-Cal card to a provider and asking them to bill Medi-Cal after the private insurance pays its portion.

Whatever portion of the deductible was met by the secondary insurance will be counted to the deductible just as if you had paid it yourself. Call or chat with the private insurance and speak to the coordination of benefits division so that everything works smoothly behind the scenes. Be sure the provider has completed the process of any needed preauthorization with both health plans.

You should also note that many providers who contract with a Medi-Cal managed care plan may not accept straight Medi-Cal. Because Medi-Cal supports your primary insurance (including vision and dental insurance) and does not override it, you should first make sure your physician, facility, or service accepts your primary insurance. Then, you can ask if they accept fee-for-service or straight Medi-Cal. If they do, they can bill your primary insurance before billing the amount not covered to Medi-Cal.

Note: If you ever receive an invoice from a provider that is contracted with both your private insurance and Medi-Cal, that is not allowed. This is called "balance billing," and providers are not allowed to balance bill you for a medical encounter in which authorizations are in place for the primary insurance and Medi-Cal.

For more information, see How to Use Medi-Cal as Secondary Insurance.