Member Costs
L.A. Care serves people who qualify for Medi-Cal. In most cases, L.A. Care members do not have to pay for covered services, premiums or deductibles.
If you are an American Indian, you do not have to pay enrollment fees, premiums, deductibles, co-pays, cost sharing, or other similar charges. MCPs must not charge any American Indian member who gets an item or service directly from an IHCP or through a referral to an IHCP or reduce payments due to an IHCP by the amount of any enrollment fee, premium, deductible, copayment, cost sharing, or similar charge.
If you are enrolled in the California Children’s Health Insurance Program (CCHIP) in Santa Clara, San Francisco, or San Mateo counties or are enrolled in Medi-Cal for Families, you might have a monthly premium and co-pays.
Except for emergency care, urgent care or sensitive care, you must get pre-approval from L.A. Care before you visit a provider outside the L.A. Care network.
If you do not get pre-approval and you go to a provider outside of the network for care that is not emergency care, urgent care or sensitive care, you may have to pay for care from providers who are out of the network.
Except for emergency care, urgent care, or sensitive care, you must get pre-approval (prior authorization) from L.A. Care before you visit a provider outside the L.A. Care network. If you do not get pre-approval (prior authorization) and you go to a provider outside the network for care that is not emergency care, urgent care, or sensitive care, you might have to pay for care you got from that provider. For a list of covered services, visit What your Health Plan Covers in this online handbook.
You can also find a list of In-Network Providers by visiting the L.A. Care online Provider Directory.
For members with long term care and a share of cost
You might have to pay a share of cost each month for your long-term care services. The amount of your share of cost depends on your income and resources.
Each month, you will pay your own health care bills, including but not limited to Long-Term Support Service (LTSS) bills, until the amount you have paid equals your share of cost. After that, L.A. Care will cover your long-term care for that month.
You will not be covered by L.A. Care until you have paid your entire long-term care share of cost for the month.