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Transition to DualConnect

Attention SCFHP Cal MediConnect members, you may have received multiple notices from SCFHP about the transition to SCFHP DualConnect (HMO DSNP) from November 14-16. One of those notices incorrectly stated that your SCFHP Cal MediConnect coverage will terminate at the end of the year. Please disregard this notice. If you are an SCFHP Cal MediConnect member, you will transition to SCFHP DualConnect (HMO DSNP), our Medicare and Medi-Cal Plan, on January 1, 2023. You do not need to do anything to stay with SCFHP for your health coverage. We apologize for the error and any confusion.

Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect Plan) is changing to Santa Clara Family Health Plan DualConnect (HMO D-SNP) (SCFHP DualConnect) on January 1, 2023.

You will not have a gap in your coverage. You will be automatically enrolled in a Medicare Medi-Cal Plan offered by SCFHP DualConnect.

SCFHP DualConnect will cover many of the Medicare and Medi-Cal benefits you get now, including:

  • 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
  • Medical supplies
  • Durable Medical Equipment (DME)
  • Nursing home care
  • Community-Based Adult Services (CBAS)
  • Community Supports

You should have received your Annual Notice of Changes (ANOC), an ANOC letter, and instructions to get your Member Handbook, Provider and Pharmacy Directory, List of Covered Drugs (Formulary), and List of Durable Medical Equipment (DME list) online or to ask for hard copies in September. In December, SCFHP DualConnect will send you a new member ID card. You don’t have to do anything if you want to join this plan. If you want to change plans, read your options from the frequently asked question below.

Frequently Asked Questions

How is my health plan changing?

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.

How will I get my prescription drugs?

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:

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

What is a Medicare Medi-Cal Plan?

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.

What will not change when my new plan starts?

  • 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.

Will I be able to keep my doctors with my new plan?

Your health plan will have many of the same providers you have now. To find out if your providers are in the new plan network, you can call your current health plan.

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. The health plan 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 January 1, 2023.

Will there be a gap in my coverage?

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.

I like my current plan. What do I do to stay with the same plan?

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.

Do I have choices for coverage?

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.

What if I have questions about Medicare and Medi-Cal Services?

If you have questions about Medicare and Medi-Cal services:

  • Call your Cal MediConnect plan.

If you want to know if your doctors are in your new Medicare Medi-Cal Plan:

  • Call your Cal MediConnect plan.

If you have a question about Medicare:

  • 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).

If you want to talk with a health insurance counselor for free about these changes and your choices:

  • 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.

If you have a question about Medi-Cal or your Medi-Cal plan choices:

  • 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.

If you need help with health plan problems or have complaints:

  • 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.

If you want to learn more about your Medicare choices:

  • 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.

Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.

Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect Plan) depends on contract renewal.

Last updated 12/30/2021

H7890_17023W Accepted