What a D-SNP costs when you have full Medi-Cal

Who this example fits

Full Medi-Cal means the county approved full-scope Medi-Cal. Help with only the Part B premium is a smaller program. You also need Medicare Part A and Part B, and you have to live in the plan’s service area. This Blue Shield plan’s 2027 file is for Los Angeles County.

Having both programs does not enroll you. The plan and the state decide whether you meet the rule for that plan. This website cannot see a Medi-Cal case.

The premium, and the 20% line in the file

The 2027 file lists a $0 monthly plan premium and a $0 medical deductible. You still have a Part B premium. In 2026 that premium is $202.90 a month. If you have full Medi-Cal, a Medicare Savings Program usually pays it. The amount on your Medi-Cal notice is the one that counts.

The same file then lists 20% coinsurance for a primary care visit, many specialist visits, the emergency room, an ambulance, outpatient care, imaging, lab work, and X-rays. It lists a $9,850 in-network maximum. Those are the Medicare Advantage amounts in the file. They are not the amount a person with full Medi-Cal should expect to pay.

A person with full Medi-Cal who is also a Qualified Medicare Beneficiary is generally not billed Medicare deductibles or coinsurance. Ask the plan which row applies to a full-benefit dual, and read that row in the Summary of Benefits. Do not pay from the 20% line until that row says you owe it.

What the 2027 Blue Shield file lists besides the premium

These lines are for Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP), H2819-001, in the 2027 CMS file. Another D-SNP in the same county can list different amounts.

• Preventive dental and comprehensive dental: $0 copay in the file.
• Routine eye exam: $0 copay, once a year.
• Routine hearing exam: $0 copay, once a year. Hearing aids: $0 copay, two aids a year.
• Rides to care: 24 one-way trips a year, $0, by taxi, rideshare, or medical transport.

What Blue Shield’s own page adds

Blue Shield’s Medicare and Medi-Cal page describes extras that the short CMS lines do not spell out. Read them as the company’s description. The Evidence of Coverage is the check.

The page says $0 for Tier 1 preferred generic drugs and Tier 2 generic drugs. It says $0 for eyeglass frames priced up to $500 every two years, and each year either $0 lenses or a $500 contact-lens allowance, not both. It says a Flex Card of $240 every three months for food and over-the-counter items. The food part is a Special Supplemental Benefit for the Chronically Ill. Blue Shield’s attestation says not every member qualifies. The same $240 every three months, shared with over-the-counter items, is how this site read the 2027 file on SSBCI benefits.

Prescriptions

The 2027 file lists a $700 Part D deductible for this plan. Full Medi-Cal usually comes with Extra Help. Extra Help generally sets that deductible to $0 and replaces a percentage with a copay.

The copay levels published for 2026 are on Extra Help copay levels. A full dual with income at or under 100% of the federal poverty level pays $1.60 for a generic and $4.90 for a brand-name covered drug. Other people with full Extra Help pay $5.10 and $12.65. Blue Shield’s page says the generic tiers on this plan are $0, which can be lower than those Extra Help copays. A brand-name drug can still have a copay. After the yearly cap, covered Part D drugs are generally $0 for the rest of that year. The cap is $2,100 in 2026 and $2,400 in 2027. Premiums usually do not count. Check a drug on Check drug costs.

What stays with Medi-Cal

Joining this plan does not cancel Medi-Cal. In-Home Supportive Services and long-term care stay with Medi-Cal unless the Evidence of Coverage says the plan covers that service.

Crowns and dentures are the clearest example. The CMS file says comprehensive dental is a $0 copay. Blue Shield’s page says those services go through Denti-Cal, need approval from a Medi-Cal dentist, and are generally covered every five years or when medically necessary. A $0 line is not an approval for a crown this year.

When both the plan and Medi-Cal list dental

Original Medicare does not pay for most dental care. The dental line on this D-SNP is an extra the plan added. Full Medi-Cal already includes Medi-Cal Dental, still often called Denti-Cal. In Los Angeles County that can be fee-for-service Medi-Cal Dental or a Medi-Cal dental plan. Smile California, at smilecalifornia.org, is the state’s member site.

The two benefits do not pay the same procedure twice. The Department of Health Care Services tells dentists that any other insurer is billed first, and Medi-Cal Dental is the payer of last resort. For a cleaning or an exam the D-SNP covers, the dentist bills the D-SNP first. If that dentist is also a Medi-Cal dental provider, Medi-Cal may pay the difference between its rate and what the plan paid. You do not receive a second payment.

A service the D-SNP does not cover can still be billed to Medi-Cal Dental if Medi-Cal covers it. That is why a crown can show as $0 on the plan’s file and still need Denti-Cal approval. Medi-Cal’s own rule still applies, including the general five-year limit on crowns and dentures unless a dentist documents that a new one is medically necessary. Using the plan does not reset that clock, and Medi-Cal’s limit does not create a second crown from the plan.

Ask the office two questions before you sit down: “Will you bill this D-SNP first? ” and “Are you a Medi-Cal dental provider if Medi-Cal has to pay the rest? ” An office that takes only one of the two can leave the other share unpaid.

When both the plan and Medi-Cal list rides

The 24 one-way trips are the D-SNP’s own ride benefit. You book them through the plan, for appointments that plan covers. Medi-Cal has two different ride benefits. Nonmedical transportation is a car, taxi, rideshare, or bus when you have no other way to get to a covered appointment. Non-emergency medical transportation is a wheelchair van, litter van, or ambulance when a doctor, dentist, or podiatrist writes that an ordinary car is not safe. An emergency ambulance is neither benefit.

You do not add the 24 trips on top of Medi-Cal and send two cars to the same appointment. One ride is booked with one program. A visit the D-SNP covers can use one of the 24 trips. If those trips are used up, or the appointment is a Medi-Cal service the plan does not transport, such as a Denti-Cal visit or a specialty mental-health visit, you ask the Medi-Cal plan for its ride. Disability Rights California’s transportation guide says a person with both Medicare and Medi-Cal can request Medi-Cal transportation through the Medi-Cal plan, including to a Medicare appointment, when the Medi-Cal rule is met. For a regular car, that rule is that you have no other way to get there. For a medical van, it is the written order.

Call the plan’s ride line for a plan visit. Call the Medi-Cal plan’s ride line for a Medi-Cal visit. Ask which line to use before the day of the appointment. A ride that was not booked with the program that covers it can become a bill.

The doctor list

This plan is an HMO. The doctor, the medical group, and the hospital have to be in the plan this year, at the address you use. “We take Medicare” means the office bills Original Medicare. It does not mean the office takes this plan. Ask which plan names they take at that address, then check the same names on Medicare.gov. Keeping your doctors is that check.

When you can join, and when you may have to leave

For 2027 coverage, Annual Enrollment is October 15 – December 7, 2026. A choice made then starts January 1, 2027. Some people with full Medi-Cal can also join certain integrated Dual Special Needs Plans once a month. Medicare and the plan decide whether that month applies. Find My Enrollment Window is a start. It is not the plan’s decision.

If full Medi-Cal ends, you may no longer meet the rule for this plan. Ask the plan what the next window is before the Medi-Cal end date. Other D-SNPs in Los Angeles County are on Medicare.gov. This page does not rank them.