I’m leaving my job soon and will be living off savings and investments. I can control my reportable income, meaning I could either qualify for Medi-Cal by keeping it low or adjust it to be eligible for Covered California.
Which one is the better choice? I’m healthy but take an expensive prescription and need stomach ultrasounds twice a year. Dental coverage for cleanings is also important to me.
Medi-Cal would be free, but I’m concerned about finding doctors who accept it and how the drug coverage compares to Covered California. I don’t mind paying for Covered California if it’s worth it.
Anyone been in a similar situation? Would love to hear your experiences.
Medi-Cal is free, but the biggest issue is finding doctors who take it. A lot of providers don’t accept it because the reimbursement rates are low.
With Covered California, you’ll pay something, but depending on your income, you might qualify for subsidies to reduce the cost. If you’re considering Medi-Cal, I’d recommend checking if your current doctors accept it before making a decision.
@Ripley
Exactly. The biggest downside of Medi-Cal is the limited provider network. If you already have doctors you like, call them and ask if they accept Medi-Cal. If they don’t, you might be better off adjusting your income to qualify for Covered California.
If you’re managing your income, remember that Covered California looks at your annual income, while Medi-Cal goes by your monthly income. This matters when deciding how much to report.
For Medi-Cal, dental is included, but you’ll likely be limited to community clinics or dental schools. Standalone dental insurance isn’t great, so if you don’t have major dental needs, you might just want to find a dentist with good cash rates.
Also, check Medi-Cal’s drug list to see if your prescription is covered. If it is, you should be fine, but Covered California plans can vary a lot when it comes to medication costs.
@Erie
Good point on the income differences. I’ll check with my doctors and see what they say. For dental, I might just buy a Delta Dental plan if needed. My prescription is on Medi-Cal’s drug list, but I’m not sure if Covered California would mean higher out-of-pocket costs for it.
@Ridge
Covered California plans vary, so it depends. Some plans cover expensive meds with a reasonable copay, while others require a higher share of the cost. When browsing plans, check how each one handles your medication—it should be listed in their formulary tool.
If your monthly income is $0, you’ll automatically get placed into Medi-Cal, even if your annual income is higher.
Medi-Cal has a limited provider network, but some big hospital systems like UC hospitals accept it. If you go that route, it’s worth checking which providers take it in your area.
It depends on where you live and what kind of medical care you need. In some areas, Medi-Cal is terrible because there aren’t enough providers. In others, it’s fine. For prescriptions, Medi-Cal covers everything, but you might have trouble getting brand-name meds instead of generics.
Medi-Cal often assigns you to a residency clinic, so you might see a different doctor every visit. If continuity of care matters to you, Covered California might be a better choice.
Also, about the income thing—if you’re adjusting your withdrawals from different accounts to qualify for one or the other, that’s totally legal. A lot of people do it when planning for taxes or benefits.
@Caden
Yeah, I control how much I withdraw from my traditional 401k, Roth 401k, and cash. The only taxable income is from my traditional 401k, so I can keep it low enough for Medi-Cal or increase it to qualify for Covered California.
@Ridge
I was in a similar situation. The key thing I learned is that Medi-Cal only looks at steady monthly income, not lump sums. If you take a single big 401k withdrawal, they might treat it as an asset instead of income, keeping you in Medi-Cal.
What did you end up going with? I have to decide between COBRA or Medi-Cal, and I take an expensive specialty medication. I’m worried about wait times and provider availability with Medi-Cal.
Sawyer said:
What did you end up going with? I have to decide between COBRA or Medi-Cal, and I take an expensive specialty medication. I’m worried about wait times and provider availability with Medi-Cal.
Still deciding, but leaning toward Medi-Cal since my prescription is covered. I’m in Southern California, so I should be able to find providers even if I have to drive a bit.
@Ridge
If you were laid off, timing matters. When I first signed up on Covered California, I listed my expected income for the year, but Medi-Cal only looked at my monthly income and placed me in their system. It took months to fix, and I ended up paying more than I needed to for coverage because of it. Be careful with how you report your income.
@Tallis
So if I were planning an exit, it might be best to leave my job at the end of the year and apply for Medi-Cal in January when I have no reported income? That way, I don’t accidentally get pushed into Covered California mid-year?
Sawyer said:
What did you end up going with? I have to decide between COBRA or Medi-Cal, and I take an expensive specialty medication. I’m worried about wait times and provider availability with Medi-Cal.
How’s it going with Medi-Cal? I also lost my insurance after getting laid off and trying to figure out my options.