Eligibility and Income Rules
A patient earns 135% of FPL and is a U.S. citizen applying for new coverage. They qualify for this program.
What is Full Scope Medi-Cal?
If an undocumented patient fails to renew Medi-Cal within the allowed timeframe, coverage terminates and they must enroll in this program.
What is Healthy SF?
This part of Medicare combines Parts A, B, and D into one plan.
What is Part C (Medicare Advantage)?
This program covers 100% of HIV medications and related care.
What is ADAP?
A patient is a citizen and earns 150% of FPL and applies for Medi-Cal. They will most likely qualify for this type of Medi-Cal.
What is Share of Cost Medi-Cal?
If a patient’s SOC is $1,000, this is how much they must pay before Medi-Cal pays.
What is $1,000?
Patients with only Medicare Part A and Part B remain responsible for this percentage of approved costs.
What is 20%?
This program is not insurance but a healthcare access program for SF residents.
What is Healthy SF?
If a patient’s renewal date was 60 days ago, they are still within this period.
What is the 90-day grace period?
Staff can locate a patient’s Medi-Cal renewal date in these two systems.
What are Epic Storyboard and CalSAWS?
This part of Medicare covers outpatient services and pays this percentage of the bill.
What is Part B, and 80%?
Patients with Limited Medi-Cal should be referred to this program for broader coverage.
What is Healthy SF?
A non-citizen newly applying today for Full Scope Medi-Cal may qualify for this type of Medi-Cal.
What is Limited Service Medi-Cal?
Hospital Presumptive Eligibility coverage lasts until the end of this time period after approval.
What is the end of the following month?
Enroll into a prescription drug coverage plan.
How to disenroll from a Medicare Advantage Plan?
Patients with income above 138% FPL enrolled in Healthy SF must pay these two types of costs.
What is a quarterly fee and copays?
A patient earns 400% of FPL. They may qualify for these program if within income limits.
What is the Sliding Scale Program and Healthy SF?
All Medi-Cal enrollees must select this type of plan.
What is a managed care plan?
A patient with Medicare Part A & B should be advised to apply for these two programs to help cover remaining costs.
What are Medi-Cal or the Sliding Scale Program?
Patients with this coverage are ineligible for ADAP.
What is Medi-Cal?