What Is a Medi-Cal Share of Cost (SOC)?
When you don’t meet Medi-Cal’s
full eligibility income limits, you may be approved for
“Share of Cost” Medi-Cal — a program where:
- You pay a monthly dollar amount (like a deductible)
- Medi-Cal pays only after you meet that amount
SOC = the amount Medi-Cal expects you to pay out of pocket each month before they help
Example:
If your SOC is
$1,200/month, you must
pay $1,200 in medical bills before Medi-Cal helps with anything —
every month.
Why Share of Cost Feels Like You Have No Insurance
- You might not hit the threshold every month
- You must track, prove, and submit medical expenses
- Many providers won’t see SOC patients because Medi-Cal won’t pay until you meet the SOC
It feels like you're uninsured unless you have
major medical bills every month — not ideal for most seniors.
How a Medicare Advantage (MAPD) Plan Can Help
Even if you have a high SOC, you still have
Medicare — and
you’re allowed to enroll in a Medicare Advantage plan.
MAPD plans = Medicare Advantage Prescription Drug Plans
These are
private plans that:
- Replace Original Medicare
- Include drug coverage (Part D)
- Have a maximum out-of-pocket limit per year (not monthly!)
- Include extras like dental, vision, OTC, transportation, and more
Key Point:
With a MAPD plan, you no longer have to meet a
monthly threshold — instead, you’re protected by a
yearly maximum out-of-pocket (MOOP).
Real-World Example
Maria, age 68, was assigned a
$1,000 Medi-Cal Share of Cost.
She enrolled in a
MAPD plan with a $3,500 annual MOOP and now:
- Pays copays instead of full price
- Gets routine care and prescriptions with no delay
- Has coverage even if she doesn’t hit $1,000 each month
Instead of losing $1,000/month, she’s protected by a
single cap for the year — and still gets managed care and benefits.
FAQs: Share of Cost & MAPD Plans
1. Can I have a MAPD plan and Medi-Cal Share of Cost at the same time?
Yes! You can enroll in a MAPD plan regardless of your SOC status.
2. Will my SOC go away if I get an MAPD plan?
No — but you’ll have
another form of coverage that pays
before Medi-Cal kicks in. This means fewer delays and lower bills.
3. What if I’m healthy and don’t meet my SOC most months?
Then you’re likely paying out of pocket for everything — and an MAPD plan can protect you with
flat copays and an annual limit.
4. Is it expensive to join a MAPD plan?
Many MAPD plans in California have
$0 premiums and
low copays. You may still qualify even with a high SOC.
Local Help for California Residents With Share of Cost Medi-Cal
At
Peace & Grace Insurance Services, we help people:
- Understand how their Share of Cost works
- Find Medicare Advantage plans that fit their needs
- Limit out-of-pocket risk through smarter plan choices
Call/Text:
209-812-4026
Email:
CSinsurepng@icloud.com
Proudly serving all counties in California.
