The revised amounts for Medi-Cal’s Aged and Disabled Federal Poverty Level (A&D FPL) program come into effect each year on April 1. A&D FPL allows seniors/younger disabled on Medi-Cal to earn above the Social Security Income level, but still enjoy the benefits of full-scope Medi-Cal.
The 2015 limits are gross incomes at or below $1,211 for an individual and $1,638 for a couple. If income is even $1 more than the formula, it can trigger a high share of cost. Sometimes seniors who have received a Social Security cost-of-living adjustment in January find out that as of April 1 they will have a large Medi-Cal share of cost when they did not the year before. For this group, sometimes signing up for a very minor medical or supplemental medical insurance policy might be the trick to returning to no share of cost eligibility. That’s because the A&D FPL formula calculates any amount being paid for other medical-related insurance or unreimbursed medical costs.
For other individuals who earn a couple hundred dollars more than those amounts, it still might be worth purchasing significantly more in medical insurance (for health, dental, vision care, etc.) to receive the benefits of full-scope Medi-Cal: payment of the Medicare B premium; a low-income premium subsidy for Medicare D prescription drug plans; lower prescription co-pays; and payment toward home care for those who qualify for the Medi-Cal-funded In-Home Supportive Services Program.
If you are a senior with a Medi-Cal share of cost, it’s worth asking your Medi-Cal eligibility worker how much over the A&D FPL income limit you are to help you evaluate whether purchasing some health-related insurance in order to be eligible for full-scope Medi-Cal might make sense for you.
For couples, another option is to ask your eligibility worker if opting yourself or your spouse out of the A&D FPL budget will allow the other to receive no share of cost Medi-Cal. This can be helpful when one spouse has a greater need for services than the other. One spouse would still end up with the original share of cost while the other spouse could potentially receive no share-of-cost Medi-Cal.
Kathy Johnson is the community resources specialist for Community Care’s Senior Information & Assistance Program, serving Lake and Mendocino County Seniors Monday through Friday at 468-5132 or 1-800-510-2020.
