2017 Plan Benefits

L.A. Care Cal MediConnect Plan will coordinate all Medicare and Medi-Cal benefits under one health plan:

  • Medical care
  • Prescription Medications, including Part D Prescription coverage
  • Mental Health and Behavioral Health Care
  • Long-Term Services and Supports (LTSS)
  • Connection to Social Services (such as meal delivery)

As a Member of L.A. Care Cal MediConnect Plan you will have*:

  • A $0 monthly premium
  • No out-of-pocket costs to see your primary care doctor and specialists
    • You must get your care from network providers. Usually, the plan will not cover care from a provider who does not work with the health plan.
  • Dental Services:
    • L.A. Care Cal MediConnect Plan will offer additional supplemental benefits. For a list of supplemental dental benefits, please reference our Dental Benefit Guide in the Member Materials section of this website.
  • Vision Services:
    • $0 co-pay for up to 1 supplemental routine eye exam every year,
    • 1 pair of eyeglasses (lenses or frames) or contact lenses every two years, and
    • A $175 limit for supplemental eyewear every two years
  • Emergency services coverage:
    • You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories without prior authorization.
  • Routine transportation (non-emergency):
    • $0 co-pay for up to 40 one-way trips to plan-approved locations every year
  • Prescription drugs**:
    • Generic Drugs (Tier 1 drugs): $0 co-pay for a 30-day supply
    • Brand-Name Drugs (Tier 2 drugs): $0 - $8.25 co-pay for a 30-day supply
    • Non-Medicare Rx Drugs (Tier 3 drugs): $0 co-pay
    • Over-the-Counter (OTC) Drugs (Tier 4 Drugs): $0 co-pay
  • NEW Acupuncture Services:
    • $0 co-pay for up to two outpatient acupuncture services in any one calendar month, or more often if they are medically necessary. 

*This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.

** Co-pays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Limitations, copays, and restrictions may apply. For more information, call L.A. Care Cal MediConnect Plan Member Services or read the L.A. Care Cal MediConnect Plan Member Handbook.

Benefits and/or copayments may change on January 1 of each year.

L.A. Care Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

You can get this information for free in other languages. Call 1-888-522-1298 (TTY 711), 24 hours a day, 7 days a week, including holidays. The call is free.
 

For more information, contact us by:

Phone:

For more information on becoming a member, call us at 1-855-522-8243 (TTY: 711), 24 hours a day, 7 days a week, including holidays.

If you are a member of L.A. Care Cal MediConnect Plan and have questions, call Member Services at 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays.

Mail:

L.A. Care Cal MediConnect Plan
Attn: Member Services Department
1055 W. 7th Street
Los Angeles, CA 90017

L.A. Care Health Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

 

H8258_15129_2017CMC
CMS Approved
Updated 02/03/2017

 

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