Medicare and Medi-Cal in Orange County: Your 2027 Options

What Medi-Medi means

Medi-Medi means you have Medicare (usually from age 65 or because of a disability) and full Medi-Cal at the same time. Medicare pays first, and Medi-Cal helps pay the rest according to its rules.

According to Medicare.gov, people with full Medi-Cal get Extra Help automatically, so Part D drug costs are usually low.

For 2027, Medicare.gov says the standard Part D deductible is $700 and the out-of-pocket threshold is $2,400. These are standard amounts, not a promise about a specific plan's premium or other costs.

Path 1: a Medi-Medi plan such as CalOptima OneCare

A Medi-Medi plan is a type of Medicare Advantage plan just for people who have both Medicare and Medi-Cal. It combines Medicare and Medi-Cal benefits, includes a care coordinator, and is paired with the Medi-Cal plan from the same system. In Orange County, CalOptima Health offers OneCare.

According to CalOptima Health, to join OneCare in 2027 you must live in Orange County, have Medicare Part A and Part B, have full Medi-Cal with no Share of Cost (meaning you do not have to pay part of your costs each month before Medi-Cal starts paying), and be 21 or older. Kaiser Permanente may appear in public Medicare information, but QualitySpace does not offer Kaiser Medicare plans. Contact Kaiser directly for Kaiser Medicare information.

Path 2: Original Medicare with Medi-Cal

You keep Original Medicare (Part A and Part B), have a Part D drug plan, and Medi-Cal helps pay the remaining costs according to its rules.

This path is not limited to a network like an HMO (a plan that usually only pays for doctors on the plan's list, except for emergencies, urgent care when you are away, and some other cases). Ask your clinic how they bill Medicare and Medi-Cal.

Path 3: a Medicare Advantage plan, including plans for chronic conditions

Some people with Medi-Medi choose another Medicare Advantage plan from a private company, while Medi-Cal continues as long as they still qualify. Orange County has many Medicare Advantage plans, including plans just for people with chronic conditions (C-SNPs), for example heart disease, heart failure, diabetes, kidney disease, or lung disease.

Benefits, doctors, and costs differ from plan to plan. Ask how the plan works with Medi-Cal before you choose.

When you can switch

According to CMS, people with Medicare and full Medi-Cal may use a monthly Special Enrollment Period for certain changes, including switching into an integrated Medi-Medi plan such as CalOptima OneCare. This does not mean every Medicare Advantage plan can be changed monthly. The change and available plans depend on the rules in effect each year. Confirm your options with HICAP at 1-800-434-0222 or Medicare.

Switching to other Medicare Advantage plans usually waits for the annual enrollment period (October 15 to December 7). People already in Medicare Advantage can also make one change from January 1 to March 31. According to Medicare.gov, people with a severe chronic condition can join a C-SNP that serves their condition at any time; that chance ends once you join.

I have Medi-Medi. Can I switch plans every month?

People with Medicare and full Medi-Cal may have a monthly Special Enrollment Period for switching into an integrated plan such as CalOptima OneCare. This does not mean every Medicare Advantage plan can be changed monthly. Rules and available plans change each year. Confirm your options with HICAP at 1-800-434-0222 or Medicare.

Who can join CalOptima OneCare?

According to CalOptima Health, people who live in Orange County, have Medicare Part A and Part B, have full Medi-Cal with no Share of Cost, and are 21 or older. Call CalOptima Health OneCare at 1-877-412-2734 (TTY 711) to ask.

If I choose Medicare Advantage, do I lose Medi-Cal?

No, Medi-Cal continues as long as you still qualify. But plans work with Medi-Cal in different ways, so ask before you switch.

I have diabetes. Can I switch outside an enrollment period?

According to Medicare.gov, people with a severe chronic condition can join a C-SNP (a plan for people with chronic conditions) that serves their condition at any time; that chance ends once you join. The plan will confirm your condition.

Is QualitySpace part of CalOptima or Medicare?

No. QualitySpace Insurance Agency is a private insurance agency in Westminster. It is not a government office and is not connected with Medi-Cal, CalOptima Health, or the federal Medicare program.