Share of Cost Flyer

Things to know about Share of Cost…
What is a Share of Cost?

A Share of Cost (also referred to as a SOC) is the amount of money an individual
is responsible to pay towards their medical related services, supplies, or equip-
ment before Medi-Cal will begin to pay. The Share of Cost amount applies to all
immediate household members who do not qualify for a free Medi-Cal program.
Note: Medi-Cal has various zero Share of Cost programs and will consider the
best program for an individual before applying a Share of Cost.
Share of Cost
Who has a Share of Cost?

Families or persons with income too high to qualify for a free Medi-Cal program
may have a Share of Cost.
How can I meet my Share of Cost?

A Share of Cost can be met with payment of medical expenses incurred by
any member of your immediate family, including members not receiving
Medi-Cal (Family members include: mother, father, and minor children, but not
grandparents or adult children).
 In some cases, you may use old unpaid medical bills from any member of your
immediate family to meet a past, current, or future month Share of Cost. Ask
your Medi-Cal Eligibility Worker for more information.
When do I pay my Share of Cost?

You only pay your Share of Cost in the month(s) you receive medical related
services, supplies or equipment, including prescriptions and In-Home Supportive
Services.
How do I pay my Share of Cost?

You can pay or promise to pay your Share of Cost directly to your health care
provider. Your doctor, pharmacist, or medical supplier will update the “point of
service” system with the amount that you paid or promised to pay towards your
Share of Cost.
What is a medical expense?

A medical expense is the cost for medically-related services prescribed by a
licensed health care provider. This includes the cost for items such as
medical supplies, equipment or prescription drugs.
Is a medical expense the same as an allowable medical deduction?

No. A medical expense can only be used to meet your Share of Cost.
An allowable deduction reduces your net countable income.
Medi-Cal
PA 6034 (05/2019)
FAQs
(Frequently Asked Questions)
Q. How will my health care provider know how much my Share of Cost is?
A. Health care providers who accept Medi-Cal will swipe your Medi-Cal Benefits Identification
Card (BIC) through a “point of service” machine, which tells them your Share of Cost
amount.
Q. How can I reduce or eliminate my Share of Cost?
A. The following options could help reduce or potentially eliminate a Share of Cost:
 Purchasing supplemental health, vision, or dental insurance can help reduce your net
countable income.
The chart below shows how the purchase of supplemental health insurance valued at
$105.00 can help lower the net countable income to qualify for the Aged and Disabled
(A&D) Program and prevent a Share of Cost. The following is an example of how in-
come is calculated for an individual over age 65 and the deductions that are allowed if
applicable.
Income Calculation Medi-Cal A&D

Program
Gross Unearned Income $1,300.00 $1,300.00
Standard Medi-Cal Deduction - $20.00 -$20.00
Medicare Part B Premium Payment -$135.50 -$135.50
Supplemental Health Insurance Payment Not purchased -$105.00
Net Countable Income $1,144.50 $1,039.50

Medi-Cal Maintenance Need Level -$600.00
A&D Program Income - Limit $1,041.00
Share of Cost $680.00 -0-
After purchasing supplemental health insurance, the net countable income is now within
the income limit for the A&D Program. Instead of having a $680 Share of Cost, the
individual now qualifies for free Medi-Cal under the A&D Program.
 The 250% Working Disabled Program offers low-cost medical premiums. The program is
available to disabled individuals who are employed and currently receiving or
previously received Social Security Disability benefits.
 The Spousal Impoverishment Program provides no Share of Cost Medi-Cal. The program
is available to married couples or registered domestic partners where one spouse is
residing in a Long-Term Care facility while the other lives at home or if both live at home,
and one spouse is participating or requesting to participate in the Home and Community
Based Services (HCBS) Waiver Programs or the In-Home Supportive Services (IHSS)
Program.
For more information about these options, contact your Eligibility Worker.
PA 6034 (05/2019)
FAQs
(Frequently Asked Questions Continued)
Q. If I paid a medical bill to a health care provider who does not accept Medi-Cal, will this
payment count towards meeting my Share of Cost?
A. Yes, but you must provide proof of payment to your Eligibility Worker so the paid amount
can be applied towards your Share of Cost. This also applies to medical related services
not covered by Medi-Cal. Note: Personal care services paid to an independent provider
must be prescribed by a licensed physician and included in a plan of care to qualify as a
personal care expense.
Q. Can I use medical bills that I charged to my credit card?
A. Yes, however, you must provide the credit card statement showing that you charged the
bills to that account. The amount charged will be applied towards the Share of Cost
month in which the bill was paid. Interest charges cannot be used to meet your Share of
Cost.
Q. What if I have a large bill, can I use it to meet my Share of Cost over several months?
A. Yes, if a monthly payment plan is made with the provider. For example, if you have a bill
for $1,000.00 and your Share of Cost is $100.00, you may request to set up a payment plan
with your health care provider to pay $100.00 per month. Each $100.00 payment will
satisfy your monthly Share of Cost for ten months.
Q. How will my Share of Cost affect my IHSS services?
A. Any Share of Cost balance that exists when your IHSS provider’s timesheet is submitted will
be deducted from your provider’s paycheck and used to meet your Medi-Cal Share of
Cost. You are then responsible to pay your provider the amount that was deducted from
his/her paycheck. Be aware that you may not use a payment made to your IHSS provider
to meet an existing or remaining Medi-Cal Share of Cost balance. Note: The above policy
does not apply to persons receiving IHSS-Residual benefits. Individuals receiving IHSS-
Residual benefits must provide the proof of payment to their Medi-Cal Eligibility Worker so it
can be applied to meet their Medi-Cal Share of Cost.
Q. I paid my doctor for medical services that are not covered by Medi-Cal; can I use this
expense to meet my Share of Cost?
A. Yes, as long as it was a medically necessary expense. For example, a trip to the spa to
ease your stress would not qualify as a medically necessary expense. Consult your
healthcare provider for more information on what services are covered or not covered by
Medi-Cal.
STILL HAVE QUESTIONS?

CONTACT OUR CUSTOMER SERVICE CENTER - OR - ONE OF THE AGENCIES BELOW FOR ASSISTANCE:
Customer Service Center 1-866-613-3777 Health Consumer Center 1-800-896-3202

1-626-569-1399 of Los Angeles
Citrus Valley Health 1-626-851-2748
1-310-258-7400 Partners
1-818-701-8200 Maternal and Child 1-213-749-4261
Health Access
PA 6034 (05/2019)

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Things to know about Share of Cost…

What is a Share of Cost?

Who has a Share of Cost?

How can I meet my Share of Cost?

When do I pay my Share of Cost?

How do I pay my Share of Cost?

What is a medical expense?

Is a medical expense the same as an allowable medical deduction?

Income Calculation Medi-Cal A&D

Net Countable Income $1,144.50 $1,039.50

STILL HAVE QUESTIONS?

Customer Service Center 1-866-613-3777 Health Consumer Center 1-800-896-3202

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