In California, a Medi-Cal beneficiary with income above the standard eligibility threshold may still qualify under a 'share of cost' arrangement, which requires the beneficiary to:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The Medi-Cal share of cost applies to beneficiaries, such as many aged, blind, or disabled individuals, whose income exceeds the Medi-Cal eligibility limit. The beneficiary agrees to pay medical expenses up to a specified monthly share-of-cost amount; once that amount is met in a month, Medi-Cal pays for covered services for the rest of the month. The arrangement is a bridge between partial eligibility and full benefits, letting higher-income applicants participate by contributing toward their own care. D-SNPs that serve dual-eligible members interact directly with this Medi-Cal cost-sharing structure, which is why the concept appears in the senior products material.
Why the other options are wrong
- B) Share of cost is a monthly amount based on income and incurred medical expenses, not a one-time enrollment fee paid to the county. There is no enrollment fee for Medi-Cal.
- C) Share of cost does not require surrendering Medicare Part B. Dual-eligible members keep their Medicare benefits alongside Medi-Cal, which helps pay their Medicare cost-sharing.
- D) Beneficiaries with income above the threshold must meet the monthly share of cost before Medi-Cal pays. Coverage is not free at that income level.
Memory hook
Medi-Cal share of cost = spend down to your monthly amount, then Medi-Cal picks up the rest.