Important: Are you enrolled in Medi-Cal?
Has your contact information changed in the past two years?
Give your county office your updated contact information so you can stay enrolled.
Medi-Cal is California's Medicaid program. Anthem serves Medi-Cal recipients in these counties: Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Los Angeles, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tulare, and Tuolumne.
You may be eligible for Medi-Cal if you’re in one of these groups:
There are no copays for covered services, including:
Some services may require a referral or prior authorization before you can get them. See referrals and preapprovals section below for more information.
Find a Doctor Referrals and preapprovalsYour primary care provider (PCP) gives you routine care, like checkups and care when you’re sick. Your PCP may need to send you to a specialist for some types of care or treatment. This is called a referral. Your PCP will work with you to choose a specialist to give you the care you need.
Some types of services are known as self-referral services. That means you can get these services without a referral from your PCP. See your member handbook for a list of these services. Make sure you tell your PCP and specialist as much as you can about your health. This will help them make sure you get the right care. You may also need preapproval from us to get this care.
For some services, your provider will need to get a preapproval, or an OK, from us before you get them. Your PCP will work with us to get the preapproval. Getting a preapproval may take five days or up to 14 days if we need more information from you. If urgent, it will take no more than 72 hours. See your member handbook for services that require preapproval.
You can get these covered services without preapproval:
Your care should come from providers who are in our plan (in network). If you need to see a provider who is not in our plan (out-of-network), you may be able to keep seeing them. This is called continuity of care. Call the Customer Care Center at the number on your member ID card and tell us if you need to visit a provider that is out-of-network. We will tell you if you have the right to continuity of care. Learn more about your right to continuity of care
Pharmacy and prescription drugsStarting on January1, 2022 you will receive your Medi-Cal covered prescriptions through Medi-Cal Rx instead of Anthem and IngenioRx .
The Department of Health Care Services (DHCS) will change your pharmacy benefit. Your prescription medications will be covered by “Medi-Cal Rx.” This does not change your Medi-Cal eligibility or benefits.
If you are eligible for both Medicare and Medi-Cal, Medi-Cal Rx may cover prescriptions Medicare does not, so you should talk to your doctor or pharmacy if you have any questions.
DHCS is working with a new contractor, Magellan Medicaid Administration, Inc. (Magellan) to provide Medi-Cal Rx services. There will be no change in how you pay for your medications. For most Medi-Cal beneficiaries, there is no cost.
There is nothing you need to do at this time.
Anthem, your doctors, and pharmacies know about the changes and know what to do. Most people in Medi-Cal will not need to do anything. In addition, most people will be able to use the same pharmacy they do now on January 1, 2022. If your pharmacy does not work with Medi-Cal Rx, you may need to choose another pharmacy.
New Medi-Cal Rx services will provide:
On or before December 31, 2021, if you have questions about your medication or other pharmacy services, please call Anthem’s Customer Care Center Monday through Friday, 7 a.m. to 7 p.m. toll free at 800-407-4627 (TTY 711), or 888-285-7801 (TTY 711) for members in Los Angeles.
If you have questions about these changes or have Medi-Cal Rx general questions, contact the Medi-Cal Member Help Line at 800-541-55555 (TTY 800-430-7077), Monday through Friday, 8 a.m. to 5 p.m.
After January 1, 2022, visit Medi-CalRx.dhcs.ca.gov or call Customer Service at 800-977-2273 24 hours a day, seven days a week or 711 for TTY Monday through Friday, 8 a.m. to 5 p.m. for more details about these changes.
Your other Anthem Medi-Cal benefits will remain the same.
Dental careIf you have questions or want to learn more about dental services, call the Medi-Cal Dental Program Monday through Friday, 8:00 a.m. to 5:00 p.m. toll free at 800-322-6384 (TTY 800-735-2922 or 711). You may also visit the Medi-Cal Dental Program websites at Medi-Cal Dental
or Smile, California.
We offer vision benefits to all members through Vision Service Plan (VSP).
Children and young adults under age 21 get:
Adults over 21 years of age get:
To find an eye doctor or ask questions about vision benefits, call VSP at 1-800-877-7195 (TTY 711).
Transportation servicesA big part of staying healthy is making it to all of your appointments. We can help you get rides to covered health care appointments at no cost.
Go to the Transportation page to learn more Care management programsManaging your health care can be overwhelming. You might need some extra support coordinating your care and services. We’re here to help. We have no-cost programs to connect you with someone who can help you manage the care and services you already get, plus find even more supports in your community.
Learn more about these programs Medi-Cal for Kids and Teens (EPSDT)The Department of Health Care Services (DHCS) is responsible to provide no-cost, all-encompassing, EPSDT services to Medi-Cal beneficiaries under the age of 21. EPSDT services are now referred to as Medi-Cal for Kids & Teens in the state of California.
For additional language options for outreach brochures and Medi-Cal rights materials please visit the DHCS Medi-Cal for Kids & Teens Resources page. For more information on Medi-Cal for Kids and Teens program, please visit the DHCS website.
Do you need extra help with daily living? You may qualify for programs that can help you live in the comforts of your own home or community as independently as possible, for as long as possible.
Learn more about LTSS programs Timely access to careWe want to make sure you get the care you need when you need it. Find out how long you’ll typically wait to see your doctor when you call for an appointment.
Healthy Rewards is a no-cost, optional program for eligible members enrolled in our health plan. The program encourages you to seek the care you need to create a healthy lifestyle. Members can enroll in the Healthy Rewards program and earn dollars for making healthy choices.
Anthem Healthy Rewards incentives:
New Baby, New Life℠ incentives:
Limitations and restrictions apply. Benefits may change.
Register or log in now to start earning rewards.
You can redeem Healthy Rewards or see what you have earned through the Benefit Reward Hub online.
We want you to understand your benefits and receive the best possible care. Here are some resources to help.
Complete benefit information can be found in your member handbook.
Errata describes corrections or changes to the member handbook.
Do you have questions about your health care benefits? Call the Customer Care Center Monday through Friday, 7 a.m. to 7 p.m. toll free at 800-407-4627 (TTY 711), or 888-285-7801 (TTY 711) for members in Los Angeles.