Transition to DualConnect

SCFHP has sent you the following mailings about your transition to SCFHP DualConnect:

• Annual Notice of Changes (ANOC)
  • English
  • Español
  • Tiếng Việt
  • 中文
  • Tagalog
• 90-day Transition Notice
  • English
  • Español
  • Tiếng Việt
  • 中文
  • Tagalog
• 45-day Transition Notice
  • English
  • Español
  • Tiếng Việt
  • 中文
  • Tagalog

Coming soon:

• Your replacement ID card

In late November, the Department of Health Care Services (DHCS) and SCFHP mailed Disenrollment Letters to SCFHP Cal MediConnect Plan members. These letters were sent in error, and not part of the outreach plan for the January 1, 2023 transition. SCFHP Cal MediConnect Plan members are still in SCFHP Cal MediConnect Plan until December 31, 2022, able to receive services and will remain there until they are systematically enrolled into SCFHP DualConnect for January 1, 2023.

SCFHP DualConnect will have many of the same providers you have now. To find out if your providers are in the new SCFHP DualConnect network, you can call Customer Service at 1-877-723-4795 (TTY: 711), 7 days a week, 8 a.m. to 8 p.m. The call is free.

Your new Medicare Medi-Cal Plan will coordinate your providers. If you have a provider who is not in the network, you may be able to keep that provider for up to 12 months. We will also help you find network providers you like and that meet your needs.

Remember, your health plan will change to the Medicare Medi-Cal plan with the same company as the plan you have now. You do not need to do anything. You cannot stay in your Cal MediConnect plan. The Cal MediConnect plans will end in California on December 31, 2022.

If your PCP is no longer an SCFHP DualConnect provider:

To make sure that your care continues during this transition, we have assigned you a new PCP. We will send you a new ID card with your new PCP’s information. When you get that card, please destroy your old card.

You can change your PCP at any time. You can choose a PCP on the mySCFHP member portal at member.scfhp.com or call Customer Service at 1-877-723-4795 (TTY: 711), 7 days a week, 8 a.m. to 8 p.m. The call is free.

If your specialist is no longer an SCFHP DualConnect provider:

If you need to continue this care, please call Customer Service at 1-877-723-4795 (TTY: 711), 7 days a week, 8 a.m. to 8 p.m. The call is free.

On January 1, 2023, your current Cal MediConnect health plan will change to a new plan. The new plan is called a Medicare Medi-Cal Plan (“Medi-Medi Plan”). It will cover both your Medicare benefits and your Medi-Cal benefits. Your new plan will be with the same company as the plan you have now. Your new Medicare Medi-Cal Plan coordinates care for people who have both Medicare and Medi-Cal.

Your new plan will coordinate services you get now or might need. This includes:

• All Medicare covered services, including doctors, hospitals, labs, and x-rays
• You will have access to a provider network that includes many of the same providers as your current plan
• Prescription drugs covered by Medicare
• Coordination of the services you get now or that you might need
• Transportation to medical services
• Community-Based Adult Services (CBAS)
• Medical supplies
• Durable Medical Equipment (DME)
• Vision, dental, and hearing benefits
• Nursing home care

You do not need to do anything to join your new plan. You will get all your services through your current Cal MediConnect plan until December 31, 2022. Your new Medicare Medi-Cal Plan will start on January 1, 2023.

You will get most of your prescriptions and medications the way you do now. Medicare will still cover most prescription and medication benefits and services. Your new Medicare Medi-Cal Plan will coordinate this coverage.

Medi-Cal Rx may cover some prescriptions and medications. Your new Medicare Medi-Cal Plan will help you get these through Medi-Cal Rx.

To learn more about your prescription drug coverage, call the health plan you have now.

To learn more about Medi-Cal Rx prescription drug coverage and pharmacies that take Medi-Cal:

• Go to medi-calrx.dhcs.ca.gov
• Or call the Medi-Cal Rx Customer Service Center at 1-800-977-2273 (TTY: 711)

Have your Medi-Cal Benefits Identification Card (BIC) number when you call.

A Medicare Medi-Cal Plan is type of Medicare Advantage plan. It is for people who have both Medicare and Medi-Cal. It is a voluntary program. It combines your Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan. This means you have:

• One care team to coordinate care.
• One set of benefits, doctors, hospitals, lab tests, x-rays, and some medical equipment. Your new plan will include most of the doctors you have now or will help you find a new doctor you like.
• One health plan to coordinate delivery of services, including medical supplies, transportation, and long-term services and supports.
• You might also get extra benefits like dental, hearing, or vision coverage, in addition to what Medi-Cal covers.

• Your health care benefits that you have now, such as doctors, hospitals, labs, and x-rays will not change.
• Your provider network (group) with many of the same providers.
• Your other medical care if you go to a provider in your plan network.

No. You will not have a gap in your coverage. Your Medicare Medi-Cal Plan will start when the plan you have now ends. If you want to change to a different plan, read Question 8.

You don’t have to do anything. Your Medicare Medi-Cal Plan will start on January 1, 2023.

You will get the same health care benefits. Your provider network will have many of the same providers as your Cal MediConnect plan.

The Medicare Medi-Cal Plan will have a care coordinator to help you manage your providers and services. They will coordinate long-term services and support, and other services like transportation.

Yes. You have five options for coverage. If you want to talk to someone about your options, read the list of phone numbers in Question 9. Here are your options:

Option 1: Keep the Medicare Medi-Cal Plan listed in the letter you received.

This Medicare Medi-Cal Plan will start on January 1, 2023. You do not need to do anything.

The Medicare Medi-Cal Plan:

• Will cover all your Medicare benefits including prescription drugs, and many Medi-Cal benefits
• May offer extra coverage such as vision, hearing, or dental in addition to what is covered by Medi-Cal
• Has a network of doctors and other providers to give you care

Option 2: Join a different health plan that combines your Medicare and MediCal coverage.

Choose from the list of plans in your county that combine Medicare and Medi-Cal. The list came with this letter. You can call other plans for more information and can call the plan you choose directly to enroll.

The Medicare Medi-Cal Plans on the list:

• Will cover all of your Medicare, including Medicare Part D, and many MediCal benefits, such as prescription drugs
• May offer extra coverage such as vision, hearing, or dental
• Has a network of doctors and other providers you can see to receive care

To learn more about Medicare Medi-Cal Plans in your county, call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048), 24 hours a day, 7 days a week and ask about dual eligible special needs plans (D-SNPs). Or go to www.Medicare.gov.

To learn more about the Medi-Cal Plans in your county, call Health Care Options at 1-800-430-4263 (TTY: 1-800-430-7077), Monday – Friday, 8 a.m. to 6 p.m. Or go to Health Care Options at www.healthcareoptions.dhcs.ca.gov.

Option 3: Join a Medicare Advantage health plan.

Medicare Advantage plans:

• Cover all services that Original Medicare covers
• May offer extra coverage such as vision, hearing, or dental
• May not coordinate with your Medi-Cal plan

Remember, if you decide to choose a Medicare Advantage plan:

• Your Medi-Cal plan may change.
• If the Medicare Advantage plan doesn’t also offer a Medi-Cal plan, you can enroll in any Medi-Cal plan in your county.
• If the Medicare Advantage plan has a matching Medi-Cal plan in your county, you will be enrolled in that Medi-Cal plan.

To join a Medicare Advantage plan, call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048), 24 hours a day, 7 days a week. Or go to www.Medicare.gov.

To learn more about Medi-Cal Plans in your county, call Health Care Options at 1800-430-4263 (TTY: 1-800-430-7077), Monday – Friday, 8 a.m. to 6 p.m. Or go to Health Care Options at www.healthcareoptions.dhcs.ca.gov.

Option 4: You can change to Original Medicare (sometimes called Fee-For-Service coverage).

• The federal government manages Original Medicare.
• If you choose Original Medicare and don’t choose a Part D prescription drug plan by December 31, 2022, Medicare will enroll you in a Part D prescription drug plan. They will send you a letter with the name of your new drug plan.
• If you choose Original Medicare, your Medi-Cal plan will stay the same.
• You may also be able to change your Medi-Cal plan.

To change to Original Medicare call 1-800-MEDICARE (1-800-633-4227) (TTY: 1877-486-2048), 24 hours a day, 7 days a week or visit www.Medicare.gov.

To learn more about Medi-Cal Plans in your county, call Health Care Options at 1800-430-4263 (TTY: 1-800-430-7077), Monday – Friday, 8 a.m. to 6 p.m. Or go to Health Care Options at www.healthcareoptions.dhcs.ca.gov.

Option 5: If you qualify, you can join the Program of All-Inclusive Care for the Elderly (PACE).

PACE will cover your Medicare and Medi-Cal benefits, including prescription drugs. It will coordinate your healthcare, homecare, transportation, and dental care. PACE also offers social centers and senior gyms. If you choose to join a PACE plan, your Medi-Cal Plan and Medicare Advantage Plan will change, and your providers may change.

To find out if PACE is available in your county or to learn more about PACE, go to www.CalPACE.org. Or call Health Care Options Monday – Friday, 8 a.m. to 6 p.m. at 1-800-430-4263 (TTY 1-800-430-7077). Or go to Health Care Options at www.healthcareoptions.dhcs.ca.gov.

• Call your Cal MediConnect plan.

• Call your Cal MediConnect plan.

• Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. Or go to Medicare.gov (TTY: 1-877-486-2048).

• Call the California Health Insurance Counseling & Advocacy Program (HICAP) 1-800-434-0222 (TTY: 711).
• Call the Medicare Medi-Cal Ombudsman Program (also called the Cal MediConnect Ombudsman) at 1-855-501-3077. The Ombudsman helps with complaints, grievances, and concerns for free. They are not part of your health plan.

• Call your current Cal MediConnect
• Call Health Care Options at 1-844-580-7272 (TTY: 1-800-430-7077).
• Call the Medi-Cal Helpline at 1-800-541-5555, Monday – Friday, except national holidays, 8:00 a.m. to 5:00 p.m.
• Call the Department of Health Care Services (DHCS), Office of the Ombudsman at 1-888-452-8609 (TTY: 711), Monday – Friday, except state holidays, 8:00 a.m. and 5:00 p.m.

• Call your current Cal MediConnect
• Call the Medicare Medi-Cal Ombudsman Program (also called the Cal MediConnect Ombudsman) at 1-855-501-3077. The Ombudsman helps with complaints, grievances, and concerns for free. They are not part of your health plan.
• Call Health Consumer Allianceat 1-888-804-3536. Or go to healthconsumer.org.

• Read the list to find matching Medicare Medi-Cal plans in your county. The list came with this letter.
• Go to Medicare.gov.
• Read the list of all Medicare health and prescription drug plans in your area in your “Medicare & You” handbook.
• Compare your Medicare choices for people with both Medicare and Medi-Cal at MyCareMyChoice.org.