Healthcare Plans Eligibility
A summary of the eligibility requirements and coverage for Healthy Kids, Healthy Families, Healthy Way LA, Medicare, and AIM follows:
| Plan | Eligibility | Coverage |
|
Healthy Kids
(LA Care Health Plan)
Monthly premium - $0-$15 per child; maximum $45 per family based on income
Copay - $5-$15 for most visits (no charge for physicals, immunizations, and dental checkups) |
- Under 19 (enrollment closed for children 6-18)
- L.A. County resident
- Not enrolled in any other health insurance program (except emergency medical or CSS, or have limited employer-sponsored dental and vision services coverage)
|
- Doctor visits
- Lab and x-rays
- Immunizations
- Dental checkups
- Vision
- Mental health
- Hospital and emergency room care
- Prescription drugs
|
|
Healthy Families
Monthly premium - $4-$24 per child; maximum $72 per family
Copay - $5-$15 for most visits (no charge for physicals, immunizations, and dental checkups) |
- Under 19
- Not eligible for Medi-Cal or has had employer-sponsored insurance within the last 3 months of enrollment
- U.S. citizens or permanent legal residents
- Family must meet income requirements
|
- Doctor visits
- Lab and x-ray services
- Dental checkups
- Vision
- Mental health care
- Prescription drugs
- Hospital and emergency room care
|
|
Healthy Way LA Matched
(For low-income uninsured adults)
Monthly premium - $0
Copay - $0 |
- Ages 19-64
- Uninsured
- Suffer from a chronic disease (asthma, diabetes, hypertension, congestive heart failure, dyslipidemia)
- U.S. citizen or permanent resident 5 years or more
- Meet income eligibility guidelines
|
- Routine checkups, including labs, x-rays, and prescription drugs
- Chronic disease management services
- Health education
- 24/7 Nurse Advice Line
- Specialty care
|
|
Medicare
(Health Plan Options for services to be rendered at EPFMC)
- SCAN
- Care 1st
- Molina
- LA Care (including SNP)
- Health Net
|
- 65 or older
- Under 65 with certain disabilities
- U.S. citizen or have been a legal resident for 5 years or more
- Eligible for Medicare Part A
- Enrolled in Medicare Part B
|
- Annual physical exam
- Doctor visits
- Hospital and emergency services
- Lab tests and x-rays
- Mental health services
- Prescription drugs
*Other benefits based on which health plan you choose |
|
AIM (Access for Infants and Mothers)
- Low-cost coverage for pregnant women
- Must choose a health plan
- EPFMC only accepts Health Net
|
- No more than 30 weeks pregnant
- Current California resident
- Uninsured
- Meet income requirements
- Not on Medicare
|
- All medically necessary services while pregnant
- Hospitalization
- Coverage for 60 days after delivery for postpartum services
|
Contact Managed Care Operations (213-747-5542, ext. 3202) for an eligibility or enrollment appointment.
