Share of Cost: Share of Cost is a program designed to help Californians. Californians with low income and resources pay for their medical expenses. The program is a part of Medi-Cal, California’s Medicaid program. The Share of Cost program requires recipients to pay a certain amount out of pocket for their monthly medical expenses before Medi-Cal begins to pay.

This amount is called “meeting your Share of Cost.” Your Share of Cost is calculated based on your income and expenses, a set amount you agree to pay monthly. Once you meet your Share of Cost for the month, Medi-Cal will pay for the rest of your medical expenses.

It is important to note that you only need to meet your Share of Cost in the months that you receive medical care. If you don’t receive medical care in a month, you won’t have to pay anything towards your Share of Cost.

The Share of Cost program can significantly help those who need medical care but can’t afford it. It allows them to get the care they need without worrying about the high medical expenses. If you are eligible for Medi-Cal, consider enrolling in the Share of Cost program to help manage your medical expenses.

• Medicare may pay for skilled care in a nursing home for a very short period but no longer than 100 days and only when the patient meets all the Medicare requirements for daily professional care. While people get personal care services simultaneously, Medicare will not pay unless there is a need for daily skilled services that only a nurse or therapist can provide. Medicare may pay for some personal care services at home, but again, only if you also need skilled care daily that only a licensed person can provide. For more details, see the Medicare benefits book available from your Social Security office or call the Social Security Administration toll-free at 800-772-1213.
• Medi-Cal (called Medicaid outside California) pays for necessary health care that Medicare does not cover, but only if you meet federal and state poverty guidelines. You can get the most current information about Medi-Cal from your local county Department of Social Services, legal services Program, or an elder law attorney.
• Most people commonly use Personal Resources to pay for long-term care expenses. These funds come from personal income and resources. When family members and friends at home provide care, necessary skilled care such as equipment, transportation, and other costs not paid by Medicare are also produced from the patient’s income or savings. People who use up their assets paying for long-term care are “spending down” and may become eligible for Medi-Cal.
• Long-Term Care Insurance is designed to pay or reimburse covered long-term care costs. Understanding the coverage provided and how benefits will be paid/refunded before you purchase a Long-Term Care Policy is critical. Long-term care insurance is available from insurance companies selling in California and may be cost-effective for you if you have sufficient available income to pay the premiums.
• Source CA Dept of Ins

Whether you want basic dental coverage for preventive dental care to maintain your oral health care or a specialty referral for more extensive dental care needs, California Dental Insurance has HMO insurance plans to help address your current and future dental care. 

What is a Dental HMO Insurance Plan? A Dental HMO Insurance plan is a type of dental insurance in which you must choose a primary care dentist who will provide most of your dental care. You can only see specialists if your primary care dentist refers you to them. Dental HMO plans typically have lower out-of-pocket costs than other dental insurance plans, but they also have less flexibility regarding which dentists you can see.

For people who may have a lower spend down amount, these HMO plans work well for that. These California dental HMO insurance plans range from $7.95 to $12.95 and $18.95 monthly for an individual. Making so you do not have to overspend for lower spend-down requirements. Our office can help you meet your spend-down requirement on a low-high spend-down cost requirement.

Whether you have questions about California Dental or any of our other insurance plan options, please call our member service line at 310-534-3444, as we will be happy to assist you in buying the best dental plan for your needs.

Too often, people either buy or receive dental insurance without knowing the terms and conditions of the plan. Knowing what is and is not covered and how much is vital if you use the plan. Before using your dental insurance plan and going to the dentist, take the time to read through your dental policy terms and conditions.

Dental insurance plan terms and conditions usually outline the coverage and benefits provided by the plan, as well as any exclusions or limitations. This may include details on the types of dental services covered, such as routine cleanings, fillings, and major procedures like root canals or orthodontics. The policy may also specify any waiting periods or pre-existing condition limitations, as well as any deductibles, copays, or coinsurance requirements that the member is responsible for. Additionally, the terms and conditions may outline the process for filing claims and any deadlines or documentation requirements. Call our member service line at 310-534-3444 if you have any questions about our dental insurance and plan options, as we will be happy to help.

Getting rid of the Share of Cost requirement in Medi-Cal involves meeting the necessary conditions to eliminate or reduce this financial obligation. It’s important to note that Share of Cost is specific to Medi-Cal and is not directly related to purchasing health insurance. Instead, it’s about demonstrating that your medical expenses are high enough to fulfill the Share of Cost amount, thus making you eligible for full Medi-Cal coverage.

Here are some key points to consider:

1. Meeting the Share of Cost: To eliminate the Share of Cost requirement for a particular month, you need to ensure that your medical expenses exceed the specified Share of Cost amount for that month. Once you have paid medical expenses equal to or higher than the Share of Cost, your Share of Cost for that month is considered met, and you become eligible for full Medi-Cal coverage for the remainder of that month.
2. Approved Dental Plan and Share of Cost: While Medi-Cal covers various medical services, dental services are handled separately through the Medi-Cal Dental Program. Approved dental plans or dental services alone generally do not count towards meeting your Share of Cost for general medical services. Dental services under Medi-Cal Dental Program have their own set of rules and coverage.
3. Regular Medical Expenses: The Share of Cost is often met by regular medical expenses such as doctor visits, prescriptions, hospital stays, and other covered medical services. These expenses need to accumulate throughout the month until they reach or exceed the Share of Cost amount.
4. Income and Deductions: The Share of Cost amount is determined based on your income and certain allowable deductions. If your financial situation changes, your Share of Cost might also change.
5. Reporting and Documentation: Keeping accurate records of your medical expenses and submitting the necessary documentation to Medi-Cal is crucial for the Share of Cost process. This documentation helps demonstrate that you have met the requirement.
6. Renewal and Recalculation: Share of Cost is recalculated periodically, often during annual reviews or when there are changes in your financial situation. Ensuring your information is up to date is important.

It’s important to check with your local Medi-Cal office or their official resources for the most accurate and current information about Share of Cost requirements, eligible expenses, and how to meet them. If you’re looking to reduce or eliminate your Share of Cost, consider consulting with a Medi-Cal representative to understand the specific rules and procedures that apply to your situation. ShareOfCost.com has an alternative approved dental health care plan to meet the spend down requirements.

What is Share of Cost (SOC)?

Share of Cost (SOC) is a financial obligation that individuals must meet before they become eligible to receive benefits under certain government assistance programs, particularly Medi-Cal in California. It is somewhat analogous to an insurance deductible in private health insurance plans. The purpose of SOC is to ensure that individuals with higher incomes but still facing significant medical expenses receive necessary assistance while also sharing in the costs of their care.

How Does Share of Cost Work?

1. Calculation: The Share of Cost amount is calculated based on the individual’s income, allowable medical expenses, and family size. It is determined on a monthly basis and can vary from person to person.
2. Monthly Obligation: Once the Share of Cost amount is determined, the individual must pay that amount out of their own pocket towards their medical expenses each month.
3. Eligibility for Medi-Cal: Once the individual’s medical expenses exceed the Share of Cost amount for that month, they are considered to have “met” their Share of Cost for that month. At this point, they become eligible for full Medi-Cal coverage for the remainder of the month.
4. Coverage Period: The Share of Cost and eligibility cycle resets at the beginning of each month. Any medical expenses paid in excess of the Share of Cost in a month do not carry over to the next month.

Example:

Let’s say an individual has a Share of Cost of $200. This means they need to pay the first $200 of their medical expenses themselves each month. Once they have paid $200 out of pocket, their Share of Cost for that month is considered met, and Medi-Cal coverage becomes effective, covering the remaining eligible medical expenses for that month.

Key Points:

• Share of Cost bridges the gap between having higher income levels and still needing financial assistance with medical expenses.
• It ensures that individuals are actively participating in sharing the costs of their healthcare.
• SOC applies to a wide range of medical services, from doctor visits to prescriptions to hospital stays.
• It’s important to keep track of medical expenses and ensure they exceed the Share of Cost to activate full Medi-Cal coverage for the month.
• The Share of Cost amount varies based on individual circumstances and is recalculated regularly.

In summary, Share of Cost is a mechanism used to determine an individual’s financial participation in their healthcare expenses before becoming eligible for full Medi-Cal coverage. It aims to strike a balance between affordability for the individual and sharing the costs of healthcare. Find out how ShareOfCost.com can help you meet your spend down needs for the California Share

The Medi-Cal “Look-Back” period in California is 30 months. “Transfer” means an outright gift or a “sale” made at less than “fair market value.” If a disqualifying transfer of property is made, Medi-Cal will calculate the period of ineligibility for nursing facility level of care. It will be the number of months resulting when the “net fair market value” of the transferred asset, which would have resulted in excess property at the time of the transfer, is divided by the monthly average private nursing facility cost. In 2002, the average cost used to calculate the period length is $4,322 per month. In 2001, this amount was $4,163.

Question: What are the community spousal resource limits for 2002 when qualifying for the Medi-Cal nursing home benefit?

The 2002 community spouse resource allowances are $89,280 in assets and $2,232 in monthly income. For a married couple with one spouse in a nursing home and the other spouse at home, the spouse at home may keep up to $89,280 in resources (property and other assets) while the spouse in a nursing home may keep $2,000. The spouse at home may keep all of the income received in his or her name, regardless of the amount. If the amount is below $2,232 per month, the spouse in the nursing home may allocate income to bring the at-home spouse’s income up to the $2,232 per month limit. The spouse in the nursing home is permitted to keep $35 a month for personal needs. (For 2001, the amounts were $87,000 in assets and $2,175 in income).

The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant’s property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets according to the program rules. The Medi-Cal eligibility worker looks at how much an applicant and their family has each month. If their property/assets are below the limit at any time during that month, the applicant will get Medi-Cal, ifotherwise eligible. If a person has more than the limit for a whole month, Medi-Cal benefits will be discontinued. A person’s home, furnishings, personal items, and one motor vehicle are not counted. A single person is allowed to keep $2,000 in property/assets, more if they are married and/or have a family. (If a person has a Partnership policy, however, each dollar the Partnership policy pays out in benefits entitles the insured to keep a dollar of his/her assets should he/she ever need to apply for Medi-Cal Services.) For example, if a person receives an inheritance that puts their property/asset amount to more than $2,000, they would be required to spend that amount down to $2,000 before Medi-Cal would pay for any further care.

Question: How long does a person have to be living in California before they can be deemed a resident of California for Medi-Cal eligibility purposes?

Reply: There is no time period associated with being a California resident. However, a person does have to be physically present in California with the intent to remain in California permanently or indefinitely.

Question: If a Partnership policy covers a patient’s stay in a private room in the nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a SOC, and the nursing facility intends to transfer them out of their private room and into a semi-private room, can the patient use their SOC to guarantee their continued stay in a private room?

Reply: Yes, as long as the patient’s SOC, or some combination of their SOC, their assets and/or any remaining insurance, is high enough to cover the rate for the private room. If the nursing facility charges Medi-Cal for any portion of the facility cost, the patient cannot pay the difference between the Medi-Cal covered accommodation and a private roam. The patient may be able to afford to pay the entire cost of the nursing facility charge as their SOC, because they will no longer need to use any of their income to pay for drugs, Medi-Gap (part B) policy co-pays or deductibles, etc.

This is because once the patient is on Medi-Cal; the Medi-Cal benefits will cover all these medically necessary services. The patient’s income therefore, depending on each individual’s circumstances, may be sufficient to pay the facility costs (while meeting their SOC) so they can be sure to remain in a private. If not, the patient may have to move into Medi-Cal covered accommodations. For example, if the private room cost is $3,500 and the policyholder has $3,500 in income, they can use that amount to pay for the private room. Medi-Cal would then be available to cover any other medically necessary item.

Question: If a Partnership policy covers a patient’s stay in a private room in a nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a Share of Cost (SOC), do they have to spend the SOC for services specifically pertinent to the nursing home?

Reply: No, the patient can spend their SOC on a variety of medical services. This SOC obligation does not necessarily need to be paid to the nursing home. For example, if the nursing home patient needs four occupational therapy treatments per week, but Medi-Cal only allows two per week, the additional occupational therapy treatments could be paid through the SOC. In this example, even though Medi-Cal covers occupational therapy, any additional services a person wants above and beyond what Medi-Cal would have covered could be paid as the SOC. Therefore, the SOC services paid by the patient must not be Medi-Cal covered services in order for their costs to count toward the Medi-Cal SOC. In addition, services that would usually be covered by Medi-Cal, such as the use of a health aide, can be paid as the SOC if the service provider is not a Medi-Cal provider.

If someone you are caring for has dementia and need to see a dentist you will want to make a dental appointment for early in the day, when the person in question is most alert. Also, make sure to tell him/her where they are going and why.

Let the dentist know ahead of time about the condition of the person with dementia. Communication will make the visit easier.

It is best for someone with dementia to see a dentist as soon as possible after they are diagnosed. And if any procedures are needed, they should get them done as soon as possible. That way, as the disease gets worse, then they should only need easier maintenance treatments

Having sensitive teeth can happen to anyone, at any age. Your gum tissue pulls back from your teeth, uncovering some of the root. This can make the area sensitive to temperature hot and cold.

Periodontitis also known as Gum disease is caused by plaque and made worse by food left in teeth, use of tobacco products, poor-fitting bridges and dentures, poor diets, and certain diseases, such as anemia, cancer, and diabetes, this is often a problem for older adults.

If you are a senior may wonder whether dental implants work just as well for older patients as they do for younger ones. You may also wonder whether your dental implants have a different success rate based on your age.

The answer to that question is that dental implants are just as effective and long-lasting in older patients as they are in younger ones. In fact, dental implants can change the lives of older patients for the better, giving them more confidence and improved physical and mental health.

According to a 2004 study, it reviewed success rates after five years for dental implants in patients over 80 years and those that were under 80. This study found that the two groups had the same success rates.

Generally the implant dentists evaluates an older patients for a possibility of getting dental implants, they look at the following factors:

• General health
• Oral health
• Bone health
• Medications

If you are interested in having dental implants or knowing more about them, don’t let your age be a main factor. Talk to your dentist and go over options that are good for you and your overall all health care.