Medi-Cal Member Services (2024)

As a Medi-Cal member, you have access to member services like anyone who has a private insurance plan. Since Medi-Cal members receive a commercial plan or a public plan, you receive this assistance through your plan. However, many plans have similar member services, and you can get some help through Covered California. These additional resources and information let you get the most out of your Medi-Cal coverage.

How Do I Change or Cancel My Medi-Cal Plan?

Depending on the county where you live, you may have multiple Medi-Cal plan options. If you want to try another plan available in your county, you can change it at any time. To switch your Medi-Cal plan, you can call Medi-Cal Managed Care Health Care Options at 1-800-430-4263. You may also complete a Medi-Cal Choice Form that you can find on theHealth Care Options download page. Choose your county from the drop-down menu, then look for the form link under “Choice enrollment forms.” Learn more about the plans available in your county through theMedi-Cal Managed Care Health Plan Directory.

If you need to cancel your Medi-Cal coverage, call yourlocal county office. Once you are released from Medi-Cal, get a quote online to view rates and enroll in a Covered California plan. Be aware that there are different income limitsfor Medicaid/Medi-Cal versus Covered California (the state exchange.)

Where Can I Access My Medi-Cal Member Services?

You can access your member services online through your plan’s website and the Covered California website. Each service manages different aspects of your coverage. Also, your local county office will take care of specific parts of your Medi-Cal membership. Your health insurance company handles:

  • Premium payments:When you need to make a premium payment, your health insurance company will accept it online or by phone.
  • ID cards:Your insurance company will issue your membership ID card. They can also send you a replacement card if you lose it.
  • Benefits and eligibility:Every insurance plan has unique benefits and eligibility requirements. A representative from your insurance company can explain these details to you.
  • Claims:The insurance company can inform you how you paid your service claims when you need to verify this information.
  • Covered medical providers:Your plan’s company can help you find a covered medical provider or change your primary care physician.

Meanwhile, Covered California takes care of:

  • Enrollment:You can determine if you qualify for a special enrollment period, learn when you can enroll or enroll in a Medi-Cal plan through Covered California.
  • Application information:Covered California handles changes to application information such as income verification, proof of residency and citizenship.
  • Eligibility:When you request a quote from Covered California, they will determine if you or a family member has Medi-Cal eligibility.
  • Coverage cancellation:If you want to cancel your Medi-Cal plan, you can request this cancellation through Covered California.
  • Changing to a private plan:You can enroll in a private plan through Covered California if you will lose your Medi-Cal coverage soon.

When you need to renew your Medi-Cal plan, your county social services office will assist. They will get in contact with you if they need any information or send you a renewal form. For further assistance, you can contactyour county’s Medi-Cal officeorthe Medi-Cal Member Helpline(1-800-541-5555).

How Do I Access Member Services?

Medi-Cal members can receive member services through the Internet or by phone. Most insurance plans have online member assistance, and many companies also allow you to call them to receive direct help. Covered California also has online member services that you can access through an account. You can make a Covered California account even if you already submitted an application through another method.

Where Can I Find My Card Number and Member Number?

After you enroll in Medi-Cal, you will get an enrollment package in the mail from your insurance company. This package will include a membership card and information about your health insurance account. Your welcome letter from the insurance company may also mention your membership ID number. If you want to make an online account for member services with your insurance plan, you need these numbers to create an account.

Does Medi-Cal Member Services Have a Phone Number?

For general questions about Medi-Cal, members and medical providers can call the official helpline at 1-800-541-5555. Depending on the situation, you may also call Covered California at 1-800-300-1506 or your county’s Medi-Cal office.

How Do I Pay My Premium Online?

Your health insurance company will receive all premium payments. After you enroll in a plan, you should receive a bill that includes online payment instructions. Most companies require you to make an online account and provide information about your payment card or bank account. You may also have the option to set up recurring payments that automatically withdraw money from the account or card you specify. Covered California has information about each plan’s payment options ontheir member information website.

Where Can I Find My Medi-Cal Renewal Form?

County organizations handle Medi-Cal renewals. In most cases, your local agency will use your existing information to renew your Medi-Cal membership. If they can verify these details, they can take care of the process for you. However, they may need to send you a renewal form if your information doesn’t match your records. You can return this form to your county office to continue receiving coverage.

How Do I Check My Medicaid Status?

Contact your local county social services office to learn about your Medi-Cal status and eligibility. The California Department of Health Care Serviceshas a full directoryof each county’s agency.

Get a Quote for Medi-Cal Insurance Today

Do you need affordable insurance as a low-income Californian? You may qualify for coverage at little or no cost through Medi-Cal, California’s Medicaid program. When you request a quote from Covered California, we can determine if anyone in your family has eligibility for Medi-Cal. We can also recommend services such as CHIP that help you afford health insurance. Requesta free health insurance quote todayto get started.

Medi-Cal Member Services (2024)

FAQs

How do I speak to someone at Medi-Cal? ›

Telephone Service Center 1-800-541-5555

The Telephone Service Center (TSC) is available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

How does Medi-Cal verify income? ›

Income can be verified by providing various types of documents such as the acceptable list below. One of the most common proofs is a pay stub. If you submit a pay stub, make sure that it is current and within the last 45 days; otherwise, Covered California may not accept it.

Why did I get denied for Medi-Cal? ›

Reasons for Medicaid / Medi-Cal Denial

Most commonly, an applicant is denied for having income and / or assets over Medicaid's limit(s). See state-by-state eligibility criteria. Another common denial factor is actually an approval, but with a Penalty Period due to violating Medicaid's Look-Back Rule.

What is the fastest way to get Medi-Cal? ›

Online: It takes about 30 minutes to sign up for Medi-Cal online through Covered California. You can also get a quote through our website.

What is the customer service number for Medi-Cal eligibility? ›

(800) 541-5555

What is the regular Medi-Cal phone number? ›

Medi-Cal beneficiaries are required by federal and state law to report private health insurance. To report or change private health insurance, go to http://dhcs.ca.gov/mymedi-calor call 1-800-541-5555 (TTY 1-800-430-7077). Outside of California, call 1-916-636-1980.

What disqualifies you from Medi-Cal in California? ›

The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant's property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets according to the program rules.

Does Medi-Cal check bank accounts? ›

In 2024, renewal forms will no longer ask for asset information. That means you can keep your savings and assets and still keep your Medi-Cal coverage. It is important to open and review any mail received from your county about your Medi-Cal coverage. asset information?

What happens if I don't report an income change to Medi-Cal? ›

If you do not report changes to your personal information right away, and then receive Medi-Cal benefits that you do not qualify for, you may have to repay DHCS.

How do I know if Medi-Cal is approved? ›

You will be notified immediately of your eligibility determination. You can visit your local county human services office. You can use your information to confirm your Medi-Cal eligibility and get a temporary identification card. This will allow you to get services until your enrollment is complete.

What is the downside of Medi-Cal? ›

Even if you manage to find decent quality services that take Medi-Cal, they may be impossible to utilize due to how many doctors or facilities have long or closed wait lists. Most people, in the whole dynamic, are paid poorly. Many of them show it in the quality of their work.

How long does it take for Medi-Cal to get approved? ›

How Long Will it Take for My Application to Be Processed? It may take up to 45 days to process your Medi-Cal application. If you apply for Medi-Cal based on disability, it may take up to 90 days. Your local county office or Covered California will send you an eligibility decision letter.

Can I get emergency Medi-Cal in California? ›

If you are 26 – 49 years old and qualify: Until December 31, 2023 - You will get emergency Medi-Cal.

How can I apply for emergency Medi-Cal in California? ›

1 – Go to the emergency room. If you are experiencing a true medical emergency, where your only choice is to go straight to the nearest hospital, then go. The hospital will provide you with the health care you need. Then, the hospital's billing department will assist you in applying for emergency Medi-Cal benefits.

How much can you make a month to get Medi-Cal? ›

The number you get is the amount of monthly income that is counted for the A&D FPL program. If it is less than $1,732 for individuals or $2,351 for a couple, then you qualify for free, full scope Medi-Cal based on A&D FPL rules.

How do I talk to a live person at Covered California? ›

Get free expert help within 15 minutes

If you already have a Covered California case, please contact your certified enroller if you have one, or call our service center at (800) 300-1506 for assistance. Please fill in your contact information below.

How do I check my Medi-Cal status in California? ›

Check your Medi-Cal Benefit Status
  1. By Smart Phone or Tablet. Visit BenefitsCal to:
  2. By Desktop Computer. To check your benefits with a desktop computer visit BenefitsCal.com.
  3. By Phone. To check the status of your benefits, visit BenefitsCal.com or call 888-472-4463.
  4. Request a replacement Benefit Issuance Card (BIC)

What number is 8004304263? ›

Health Care Options at 1-800-430-4263, Monday through Friday, 8:00 a.m. - 5:00 p.m. What is Medi-Cal Managed Care? Medi-Cal is California's Medicaid program. It provides medical, dental, mental health, alcohol and drug use treatment, and vision care to millions of Californians.

What is the income limit for Medi-Cal 2024? ›

EWC 2024 Income Eligibility Guidelines
Number of Persons in Family/HouseholdMonthly Gross Household IncomeAnnual Gross Household Income
1$2,510$30,120
2$3,407$40,880
3$4,303$51,640
4$5,200$62,400
5 more rows
Mar 8, 2024

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