2018 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

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 supplemental Medicare benefits in addition to the Medi-Cal dental services you can receive through Denti-Cal. For a list of supplemental Medicare 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 $200 limit for supplemental eyewear every two years
  • Emergency and Urgently needed services coverage:
    • $0 co-pay for emergency and urgently needed care services received anywhere in the world up to a $10,000 limit per calendar year. You may get covered emergency and urgent medical care wherever and whenever you need it.
  • Transportation services that are available to L.A. Care Cal MediConnect members include:
    • Non-Emergency Medical Transportation (NEMT)
      *NEMT Physician Certification Statement Form is required

      This transportation type can include transport by ambulance, litter van, wheelchair van medical transportation services, and/or coordinating with para transit.

      The forms of transportation are authorized when:

      • Your medical and/or physical condition does not allow you to travel by bus, passenger car, taxicab, or another form of public or private transportation, and
      • Transportation is required for the purpose of obtaining needed medical care.
    • Non-Medical Transportation (NMT) 
      *NMT Referral may be required

      This benefit allows for transportation to approved medical services by passenger car, taxi, or other forms of public/private transportation.

      • You will have access to an unlimited number of round-trips per year.
      • This benefit does not limit your non-emergency medical transportation benefit.
  • Prescription drugs**:
    • Generic Drugs (Tier 1 drugs): $0 co-pay for a 30-day supply
    • Brand-Name Drugs (Tier 2 drugs): $0 - $8.35 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
  • 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_2018CMC
CMS Pending
Updated 09/29/2017

 

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