Frequent question: How does medical determine share of cost?

How does Medi-Cal calculate share of cost?

SOC Share of Cost is calculated or determined by using your monthly income, with this formula: Medi-Cal subtracts $600 (for an individual) or $934 (for a couple) from your monthly income, and any other health-insurance premiums you may be paying.

How do I avoid share of cost with Medi-Cal?

You will need to submit evidence of the insurance purchase to Medi-Cal and request that they do a recalculation to eliminate your share of cost.

What does Medically Needy share of cost mean?

Definition: Medically Needy / Share of Cost Medicaid. … The Medically Needy Pathway to Medicaid eligibility is intended to assist individuals whose income exceeds the Medicaid limit, but who have unusually high medical expenses that they cannot afford.

What is a share of cost?

A Share of Cost (also referred to as a SOC) is the amount of money an individual is responsible to pay towards their medical related services, supplies, or equip- ment before Medi-Cal will begin to pay. The Share of Cost amount applies to all immediate household members who do not qualify for a free Medi-Cal program.

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What is the monthly income limit for Medi-Cal?

You are 19-64 years old and your family’s income is at or below 138% of the Federal Poverty Level (FPL) ($17,774 for an individual; $36,570 for a family of four).

Income-based Medi-Cal.

Your family size: 1 2 3 4 5 6 7 8 9 10 11 12
$4,540
$12,760
$4,480
Income-based Medi-Cal, adults (138% FPG) $17,774

Does Medi-Cal verify income?

No. This program uses Social Security’s countable income calculation to determine your income. Additionally, the WDP Program does not count unearned income from private or public disability benefits (such as SDI, SSI, SSDI, STD, LTD ) when determining your countable income.

Can Medi-Cal check your bank account?

This is very important, as Medicaid has no tolerance for persons who take advantage of the system. … Furthermore, a Medicaid agency can ask for bank statements at any time, not just on an annual basis. An important note: For long-term care Medicaid, there is a 60-month look back period (30-months in California).

Do you have to pay back Medi-Cal benefits?

The Medi-Cal program must seek repayment from the estates of certain deceased Medi-Cal members. Repayment only applies to benefits received by these members on or after their 55th birthday and who own assets at the time of death. If a deceased member owns nothing when they die, nothing will be owed.

What does Medi-Cal cover?

Medi-Cal covers most medically necessary care. This includes doctor and dentist appointments, prescription drugs, vision care, family planning, mental health care, and drug or alcohol treatment. Medi-Cal also covers transportation to these services.

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How do you use medically needy share of cost?

If you live in a state with a medically needy program, then you can use medical expenses you incur to reduce, or “spend down,” your income to qualify for Medicaid. States establish a spend-down period, during which they look at your income and expenses to see whether you qualify for coverage.

Is Medi-Cal share of cost monthly or yearly?

To receive share of cost Medi-Cal, beneficiaries must contribute to their health care expenses by paying a share of the cost of the services they receive each month. Once they meet the full share amount, they are “certified” and Medi-Cal will cover all other costs for that month.

What is medically needy with share of cost in Florida?

What is the Medically Needy Program? Medically Needy is a Medicaid program that can help pay for Medicaid-covered services. … A certain amount of medical bills must be incurred each month before Medicaid is approved. This is referred to as your “share of cost.”

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