Governmental Coverage

Patients with Medi-Cal or Medicare Coverage
If you are currently uninsured, you may qualify for Medi-Cal or Medicare coverage. 

Facts about Medi-Cal
Medi-Cal is an insurance program jointly funded by your state and federal government. Patients have 90 days from date of treatment to apply for Medi-Cal; this applies to inpatient and outpatient treatment. 

Eligibility is determined by:
  1. Disability due to medical reasons
  2. Number of minor children (under the age of 18) in the home   
  3. Inability to return to work for four months or more   
  4. Pregnancy      
  5. Income 
  6. Assets 
For more info visit www.medi-cal.ca.gov/ or contact the Patient Financial Services department at (559) 624-4200.

Facts about Medicare
Medicare is a federally funded health insurance program for people age 65 or older, some people with disabilities under age 65, and people with End-Stage Renal Disease. Medicare has 2 parts, Part A and Part B. Part A is hospital insurance - most people do not pay for Part A coverage. Part B is medical insurance - most people pay monthly for Part B coverage. There are limitations on a number of services and items covered by Medicare and Medi-Cal, depending on the plan you have. You are responsible for co-payments, deductibles, and other services not covered. 

Medicare Premiums and Deductibles/Co-payments (2012 Rates)

Medicare Deductible and Coinsurance Amounts for 2012:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2012 = $1,156) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:
  • A total of $1,156 for a hospital stay of 1-60 days.         
  • $289 per day for days 61-90 of a hospital stay.         
  • $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).        
  • All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
  •  $144.50 per day for days 21 through 100 each benefit period. 
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
  • $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2012 is available in the October 27, 2011 Fact Sheet titled, "Medicare Premiums and Deductibles for 2012" on the www.cms.gov website.

Additional Resources
Blue Cross
Aetna
Medicare
Medi-Cal
United
HealthNet
CCS
CIGNA