RCMG Has the Expertise to Help
Californians with Medicare and Medi-Cal, people who are dually eligible, face many options when exploring how to get the health they need. This is a unique and diverse group who have low incomes, high-needs, and account for a disproportionate share of spending in both programs. Medi-Cal Managed Care offers more choices in how care is delivered for people who qualify for both of these programs. River City Medical Group has high quality programs for dually eligible beneficiaries. They have access to integrated care choices that are valuable to people with high-needs. With its close ties to the community and a long history of serving high need populations, RCMG is uniquely positioned to help provide health home related services which include helping patients meet their individual health goals.
What is integrated care?
When people have two forms of health coverage such as Medicare and Medi-Cal, there can be inefficiencies in how care is paid for and provided. Integrated care means that an individual can access medical care and non-medical services by working through River City Medical Group (RCMG) which is responsible to provide and/or organize care. RCMG uses care coordination to connect the individual to a range of services and supports to meet his/her overall needs. RCMG experienced social workers also provide assistance to patients who can benefit from programs that provide needed non medical services. Overall, RCMG uses thoughtful care coordination through a range of community service programs to better manage care.
RCMG Coordinates Total Health
Many people assume that health is mostly a function of an individual seeing the doctor regularly for good medical care. However, it is estimated that medical care, healthy behaviors, genes and biology altogether account for only about half of an individual’s overall health status. The other half is made up of numerous social determinants of health that provide or limit the opportunities for health.
RCMG knows it is important to manage care by understanding the patient as well as the patients social health determinants. These factors are found through the conditions of how one lives, learns, works, and plays. When any combination of these conditions is lacking, an individuals’ health can break down, resulting in significantly reduced and challenged health outcomes. Through quality coordinated programs, RCMG works to manage patient health with an understanding of their lifestyle and life circumstances as part of the overall care evaluation.
What are Medicare and Medi-Cal Benefits for Dual Eligible
- Medicare includes Part A (hospital costs) and Part B (doctor and outpatient care). You may also choose to enroll in Part D (prescription drug coverage) or a Medigap policy (supplemental insurance) for an additional cost.
- Long-term services and supports
- Services not covered by Medicare
What Is Medi Medi?
Medi Medi is the short-hand term for having Medicare and Medi-Cal at the same time. Generally speaking, Medicare is based on either age (65 and over) or permanently disable status. Medi-Cal is the California version of Medicaid which is generally based on income and assets.
It’s possible for people to be eligible for both at the same time. Hence the term Medi Medi.
The two plans will generally coordinate benefits or out of pocket costs together for people who are eligible.
Can people have both at the same time?
Most people have Medicare or they have Medi-cal. But for many Californians there is an overlap and 100’s of thousands qualify.
Are Medicare and Medi-Cal the same?
This is a common question and the quick answer is NO!
Medicare is a Federal program to provide health coverage to individuals under age 65 who are permanently disabled or blind individuals age 65 and over who are eligible
Medi-cal is California’s version of Medicaid which provides coverage and assistance to individuals who qualify based on income and assets as well as individuals who are SSI (permanently disabled or blind).
They are two separate plans. But when used together they can be coordinated well for those individuals who qualify for both.
That’s where the Medi Medi or dual eligible program through RCMG comes into play.
If you’re eligible for Medi-Cal and Medicare, they will work together to reduce your out of pocket costs as well as better coordinate you health care services.
Medicare Advantage Plans (Part C)
Medicare Advantage plans are approved by Medicare to provide you with coverage for Medicare Part A and Part B. Most plans combine medical and prescription drug coverage. Extra benefits for dental care, hearing aids and vision may also be offered.
River City Medical Group participates in several Medicare Advantage health plans. In order to access the physicians and health services offered through RCMG, it is important to select RCMG at the same time a Medicare Advantage health plan option is being selected.
As a Dual eligible beneficiary, you are entitled to year-round enrollment opportunities. Medi-Medi eligible individuals may make health plan changes one time per quarter.
For additional information on Medicare in general, please call 1.800.MEDICARE (TTY users call 1.877.486.2048) 24 hours a day, 7 days a week, or visit medicare.gov.