We're sorry the Cal MediConnect plan is not available in your area.
Eligibility & Enrollment
We would like to help answer your questions about Cal MediConnect. We will be glad to help you make the right health care decisions for you and your family.
To be a member of Health Net Cal MediConnect, you must:
- Live in the Health Net Cal MediConnect service area (Los Angeles and San Diego counties).
- Be age 21 or older.
- Have full Medi-Cal coverage, and
- Be enrolled in Medicare Parts A and B, and
- Be eligible for Part D.
- Have no cost-share.
- Or, if you have cost-share, you must
- Be in a Medi-Cal-funded nursing facility, or
- Be enrolled in the Multipurpose Senior Services Program (MSSP), or
- Be getting In-Home Supportive Services (IHSS)
- How To Enroll
How do I enroll?
Call Health Care Options at:
Monday through Friday, 8:00 a.m. to 5:00 p.m.
You can also visit www.healthcareoptions.dhcs.ca.gov.
Need More Information?
For more information on Health Net's Cal MediConnect plan, please call:
- Los Angeles County: 1-888-788-5395 (TTY: 711), 8:00 a.m. to 8:00 p.m., Monday through Friday
- San Diego County: 1-888-788-5805 (TTY: 711), 8:00 a.m. to 8:00 p.m., Monday through Friday
To talk to a health insurance counselor about your options, call the California Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.
- Rights and Responsibilities upon Disenrollment
Rights and responsibilities upon disenrollment
Cal Medi Connect members may not be able to stay enrolled every year in Health Net's Cal MediConnect Plan. There are many reasons for this. They include:
- Medicare and Medi-Cal (Medicaid) may not renew their contract with Health Net to offer a Cal MediConnect Plan.
- Health Net may not renew their own contract with Medicare and Medi-Cal (Medicaid) to offer a Cal MediConnect Plan.
- Health Net may need to offer their Cal MediConnect Plan to a smaller service area.
If one of these occurs, you'll be disenrolled from Health Net's Cal MediConnect Plan. Before you're disenrolled, Health Net will send you a letter with information of the change taking place.
The letter will include:
- The date the change will occur.
- Information about your health care coverage choices and the Special Election Period.
Below are your health care coverage options during the Special Election Period:
- Enroll in another Cal MediConnect Plan.
- Enroll in a Medicare Advantage Plan with drug coverage for your Medicare benefits. You must also enroll in a Medi-Cal Managed Care Plan for your Medi-Cal benefits.
- Enroll in Original Medicare and a stand alone Medicare drug plan. You must also enroll in a Medi-Cal Managed Care Plan for your Medi-Cal benefits.
If you don't choose one of these options, you'll be enrolled in Original Medicare and a standalone Medicare drug plan for your Medicare benefits. You'll also be enrolled in Health Net's Medi-Cal Plan for your Medi-Cal benefits. Health Net will continue to cover your health care services until your new health care coverage begins.
When can you end your membership in our plan?
- Because you get assistance from Medi-Cal, you can end your membership in Health Net Cal MediConnect Plan at any time.
- Your membership will usually end on the first day of the month after we receive your request to change plans. Your enrollment in your new plan will also begin on this day.
How to voluntarily end your membership in our plan?
- If you would like to switch from our plan to another Medicare Advantage plan simply enroll in the new Medicare Advantage plan. You will be automatically disenrolled from Health Net Cal MediConnect Plan, when your new plan's coverage begins.
- If you would like to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan. You must ask to be disenrolled from Health Net Cal MediConnect Plan. There are two ways you can asked to be disenrolled:
- To disenroll, please call Health Care Options (HCO) at 1-844-580-7272, 8am - 5pm (PST), Monday - Friday. TTY/TDD users should call 1-800-430-7077. For more information visit the DHCS website.
- Or you can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Until your membership ends, you are still a member of our plan.
If you leave Health Net Cal MediConnect Plan, it may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through our plan.
- You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services.
- If you are hospitalized on the day that your membership ends, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).
Involuntarily ending your membership
Health Net Cal MediConnect Plan must end your membership in the plan if any of the following happen:
- If you do not stay continuously enrolled in Medicare Part A and Part B.
- If you move out of our service area for more than six months.
- If you become incarcerated.
- If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
- If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
- If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan.
- We cannot make you leave our plan for this reason unless we get permission from Medicare first.
- If you let someone else use your membership card to get medical care.
- If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
- If you no longer qualify for Medi-Cal. Our plan is for people who qualify for both Medicare and Medi-Cal. If you no longer qualify for Medi-Cal or your circumstances have changed so that you are no longer eligible for Cal MediConnect, you may continue to get your benefits from Health Net Cal MediConnect for an additional one-month period. This additional time will allow you to correct your eligibility information if you believe that you are still eligible. You will receive a letter from us about the change in your eligibility with instructions to correct your eligibility information.
- To stay a member of Health Net Cal MediConnect, you must qualify again within the one-month period.
- If you don't qualify by the end of the one-month period, you'll be disenrolled from Health Net Cal MediConnect.
- Best Available Evidence (BAE) For Low Income Subsidy (LIS) Members
Best Available Evidence (BAE) For Low Income Subsidy (LIS) members
There are times when Centers for Medicare and Medicaid Services (CMS) does not have the right information about a Medicare beneficiary's LIS status. This means that the wrong information can be given to Health Net or your plan sponsor.
CMS created the Best Available Evidence (BAE) policy in 2006 to deal with this issue. The policy requires plan sponsors to offer the right amount of cost-sharing for low-income beneficiaries when CMS reports the wrong LIS information.
Go to the CMS.gov website
Provider and Pharmacy Search
Monday through Friday
8:00 a.m. to 8:00 p.m.
Select your county:
Los Angeles 1-888-788-5395
San Diego 1-888-788-5805
TTY users should call 711.
P.O. Box 10422
Van Nuys, CA 91410-0422
Have questions? We're here.
Information last updated 09-14-2017