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Medical plan benefits

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After you join a medical plan, you will get most of your Medi-Cal benefits through that medical plan. All plans offer the same basic benefits plus some extra services. To learn more about medical plan benefits, read the information below.

Medi-Cal managed care medical plan: no cost to you and no co-pays

  • Choose a doctor or clinic
    After you choose a medical plan, you choose a primary care provider (PCP) — a doctor or clinic that belongs to your medical plan. You must go to your PCP first for your health care. The doctor or clinic you go to now may be part of the medical plan.
  • Specialty care
    Your PCP will send you to specialty doctors who are part of your medical plan, when necessary.
  • Pharmacy and other providers
    Each medical plan has pharmacies and other providers as part of the medical plan. Your PCP will send you to other providers when necessary.
  • Medical advice
    Medi-Cal managed care medical plans have 24-hour toll free numbers you can call with questions about your care.
  • Health education
    All medical plans offer special classes to keep you healthy.
  • Change your doctor or clinic
    If you are not happy with your PCP, you can call the medical plan member services department and choose a different PCP.
  • Change your medical plan
    If you want to choose another medical plan for any reason, you may leave the medical plan and join a different medical plan.
  • Family planning
    You can get family planning services from the doctors, nurse practitioners, nurse midwives, physician assistants, and clinics in your medical plan.
  • Medical plan information
    The medical plan you choose will send you information about their services. They will send you a member identification (ID) card.

Emergencies and family planning

Emergencies

If you or a family member are very sick and think it might be an emergency:

  • Call 911 or go to the nearest emergency room in an emergency.
  • An emergency is when someone reasonably believes that she or he needs medical attention right away. Examples are:
    • Bleeding heavily
    • Trouble breathing
    • In a lot of pain
    • Looks like the person might die or be disabled
  • If you go to any emergency room for an emergency, your medical plan will authorize services.
  • If you go to an emergency room and it is not for an emergency, the emergency room staff will send you to your medical plan PCP.

If you are not sure it is an emergency:

  • Call your doctor or your medical plan's after-hours phone number.
  • The medical plan will see that you get to the emergency room if you need to. Or they will make an appointment for you with your PCP.

Family planning

You can get family planning services from:

  • Doctors, nurse practitioners, nurse midwives, physician assistants, and clinics in your medical plan.
  • Any family planning practitioner or clinic outside of your medical plan that takes Medi-Cal. You do not need to ask your medical plan first.
  • Family planning services do not include the services you need after you become pregnant.

More details about medical plan benefits

After you choose a medical plan, your plan will send you a member handbook with more details about your benefits and services. To view the member handbook for each medical plan, go to the Health plan materials page.

To compare the benefits of each medical plan, go to the Compare medical plans and dental plans page.