Help in Meeting the Share of Cost Needs with Dental Insurance

We have custom designed dental insurance indemnity plans to help meet your threshold obligations or requirements.

Thus, our online dental insurance premiums are flexible with affordable adjustable rates to qualify you for your share of cost suggested by your advocate in meeting your obligation threshold. After you meet your share of cost state assistance pays for your care the rest of that month.

County Welfare Departments Generally Determine the Share of Cost Amount

Some Medi-Cal subscribers (recipients) must pay, or agree to pay, a monthly dollar amount toward their medical expenses before they qualify for Medi-Cal benefits. This dollar amount is called Share of Cost (SOC). A Medi-Cal subscriber’s SOC is similar to a private insurance plan’s out-of-pocket deductible.

If you are a spouse or a parent, you have the choice of listing your medical expenses in any case number on the reverse side of this form in which your name appears. You may list all your medical expenses in a single case number, or you may divide up the expense and list it in two or more case numbers in which your name appears. However, the total being reported for the single service cannot be more than the original bill.

Changes to Denti-Cal not Affected by Share of Cost

The Denti-Cal handbook contains basic information about the California Medi-Cal dental program. This is different than the Share of Cost dental plans offered at this web site. The criteria and policies contained in this Handbook are subject to the provisions of the Welfare and Institutions (W & I) Code and regulations under California Code of Regulations (CCR), Title 22. When changes in these criteria and/or policies occur, bulletins and revised pages will be issued for purposes of updating the information in this Handbook.

Effective July 1, 2009 what optional adult dental services will be eliminated? Effective July 1, 2009, all optional adult dental services will be eliminated. Optional services are services that are not mandated by the federal government to be provided. Optional services that are being eliminated include:

Comprehensive oral evaluations for new or established patients.
Prophylaxis and fluoride treatments.
Amalgam and resin based composite restorations.
Prefabricated and laboratory processed crowns.
Endodontic treatment.
Periodontal procedures including scaling and root planing.
Removable prosthodontic treatment including complete and partial dentures, relines and tissue conditioning and adjustment and repairs.
Fixed prosthodontic procedures.
Implant procedures.

Processing Procedures for Space Maintainers and New Adjudication Reason Codes

Which beneficiaries or services will not be affected? The following beneficiaries or services administered by the Department of Health Care Services for adults will not be affected by this policy on or after July 1, 2009:

Medical and surgical services provided by a doctor of dental medicine or dental surgery, which, if provided by a physician, would be considered physician services, and which services may be provided by either a physician or dentist in this state. Federal law requires the provision of these services. The services that are allowable as Federally Required Adult Dental Services (FRADS) can be found in Table 1 in the Denti-Cal Bulletin Volume 25, Number 22, May 2009.
Pregnancy-related services and services for the treatment of other conditions that might complicate the pregnancy. This includes 60 days of post partum care. Services for pregnant beneficiaries who are 21 years of age or older are payable if the procedure is listed in either Table 1 (FRADS) or Table 2 (Allowable Procedure Codes for Pregnant Women) as found in the Denti-Cal Bulletin Volume 25, Number 22, May 2009.
Beneficiaries under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program (under the age of 21).
Beneficiaries receiving long-term care in an intermediate care facility (ICF) or a skilled nursing facility (SNF), as defined in the Health and Safety Code (H&S Code), Section 1250, subdivisions (c) and (d), and licensed pursuant to H&S Code Section

Providing and Billing for Anesthesia Services for Denti-Cal Beneficiaries, Registering and Using the National Provider Identifier (NPI)

1250, subdivision (k). Dental services do not have to be provided in the facility to be payable. See Denti-Cal Bulletin Volume 25, Number 22, May 2009 for further details. Dental service precedent to a covered medical service. Beneficiaries may receive dental services that are necessary (precedent) in order to undergo a covered medical service. The majority of these dental services are covered under the FRADS procedures. A precedent dental service that is not on the FRADS list will be evaluated and adjudicated on a case by case basis. An adult dental service may be reimbursable if any one of the above exceptions is met. The Manual of Criteria (MOC) will remain in effect and unless otherwise stated all policies remain the same for payable dental services.

Effective January 31, 2011 Denti-Cal will Begin Processing Claims and Treatment Authorization Requests (TARS) for the Genetically Handicapped Person’s Program (GHPP)

We support: HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare.

HICAP (the Health Insurance Counseling & Advocacy Program) offers free, one-on-one Medicare counseling. Trained volunteer counselors can answer your questions and help you understand your Medicare rights and benefits, including how to appeal denials of coverage; Medicare supplemental insurance (Medigap policies); Medicare Advantage plans; employee and retiree coverage; and long-term care insurance. Legal help and representation at Medicare appeals or adminstrative hearings are also available.

HICAP provides free educational presentations on Medicare and related topics. Call your local HICAP to schedule a presentation or find out about one happening in your area.

HICAP counselors do not sell, recommend, or endorse any insurance product, agent, insurance company, or health plan.

The California Department of Aging administers this volunteer-supported program and CHA supports the HICAPs through trainings, technical assistance and up-to-date consumer materials, including our website and fact sheets.

Nearest County Office

Medicare is a federally-sponsored health insurance program for people age 65 and older; people younger than 65 with a disability; people diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease; and those with end-stage renal disease (ESRD). Medicare provides coverage for hospital care (Part A), medical services (Part B) and prescription drugs (Part D).

Medicare Part C, also known as Medicare Advantage, offers beneficiaries the option of receiving their Medicare benefits through private health plans.

Who is Eligible for Medicare?

You are eligible for Medicare if you are a citizen of the United States or have been a legal resident for at least 5 years and:

You are age 65 or older and you or your spouse has worked for at least 10 years (or 40 quarters) in Medicare-covered employment.
You are age 65 or older and you or your spouse has worked 30-39 quarters in Medicare-covered employment.

You are age 65 or older and you or your spouse has worked 0-29 quarters in Medicare-covered employment. You must enroll as a voluntary enrollee and pay the full Part A monthly premium. Note: Low-income programs can help you pay these premiums if you meet the income and asset levels.
You are younger than age 65 with a disability and have received Social Security Disability Insurance (SSDI) or Railroad Retirement disability payments for 24 months. Learn more.
You have amyotrophic lateral sclerosis (ALS) — also known as Lou Gehrig's disease — and have received your first month of SSDI payments. Learn more.
You have end-stage renal disease (ESRD) — permanent kidney failure — and require dialysis or transplant. Learn more.

To find out if you qualify for Medicare, contact the Social Security Administration online or by phone at 1-800-772-1213.

Advocacy & Policy

Advocacy: Advocating on behalf of Medicare beneficiaries and their families, we target federal and state level legislators and their staff through media and educational campaigns. We also build and lead coalitions of strategic partners concerned with Medicare-related issues, such as the California Medicare Coalition.

Policy: As the premiere watchdog organization for Medicare in California, we conduct public policy research to support improved rights and protections of Medicare beneficiaries and their families. We frequently partner with other statewide and national Medicare organizations to promote policies that positively impact Medicare.

Education

We provide accurate and up-to-date Medicare information for both Medicare beneficiaries and their families — and the professionals, advocates and providers who serve them.

For California beneficiaries and their families: Our website provides Medicare information organized by topic, with English and Spanish podcasts available in several sections. We also support the state’s Health Insurance Counseling & Advocacy Program (HICAP) who work directly one-on-one with California’s Medicare population through our trainings, technical assistance and educational materials.

California County Office Information Updated July 25, 2012