Medi-Cal is California's Medicaid program. Anthem serves Medi-Cal recipients in these counties: Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, El Dorado, Fresno, Glenn, Inyo, Kings, Los Angeles, Madera, Mariposa, Mono, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, Santa Clara, Sierra, Sutter, Tehama, Tulare, Tuolumne and Yuba.
You may be eligible for Medi-Cal if you’re in one of these groups:
- Pregnant women
- Low-income families with children
- Seniors (age 65 or older)
- People with disabilities
- Children in foster care
- Former foster youth up to age 26
- People with specific diseases like breast or cervical cancer, tuberculosis or HIV/AIDS
What you get with Anthem
There are no copays for covered services, including:
- Primary care doctor visits
- Immunizations and wellness visits
- Specialist visits
- Mental health and substance use disorder services
- Prescription drugs
- Urgent and emergency care
- Lab and X-ray services
- Pregnancy services
- Family planning
- Hospital care
- Children’s services, including dental and vision care
- Physical and occupational therapy
- Speech and hearing services
- Home health care services
- Care coordination services
- Disease management for asthma, diabetes and more
Some services may require a referral or prior authorization before you can get them. See referrals and preapprovals section below for more information.
Your 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.
Preapprovals (also called prior authorizations)
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:
- PCP visits
- Emergency services
- Preventive care services (well-visits)
- Family planning services
- Sexually transmitted disease (STD) services
Your benefits include a wide range of prescription and over-the-counter drugs. There are no copays when you fill your prescription at a plan pharmacy.
Visit the Pharmacy page to find a pharmacy near you and check if your medicine is covered.
Dental benefits are provided through Denti-Cal for members who qualify. For questions about dental benefits or to find a dentist, call Denti-Cal at 1-800-322-6384 (TTY 711). You also can visit the Denti-Cal website.
We offer vision benefits to all members through Vision Service Plan (VSP).
Children and young adults under age 21 get:
- One eye exam and one pair of glasses every two years
Adults over 21 years of age get:
- One eye exam every two years
- A yearly eye exam if you have diabetes
- Medically necessary contact lenses and eyesight aids
To find an eye doctor or ask questions about vision benefits, call VSP at 1-800-877-7195 (TTY 711).
A 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.
Managing 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.
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.
We 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.
We want you to understand your benefits and receive the best possible care. Here are some resources to help.
Medi-Cal member handbooks
Complete benefit information can be found in your member handbook.
For members outside of L.A. County
- Member handbook – English
- Member handbook – Spanish
- Member handbook – Arabic
- Member handbook – Chinese
- Member handbook – Hmong
- Member handbook – Russian
- Member handbook – Tagalog
- Member handbook – Vietnamese
For members in L.A. County
Customer Care Center
Have questions about your benefits? Call our Customer Care Center at 1-800-407-4627 (TTY 1-888-757-6034) outside L.A. County or 1-888-285-7801 (TTY 711) in L.A. County. Our team is available Monday through Friday from 7 a.m. to 7 p.m. Pacific time.
Whether it’s 3 a.m. or a Sunday afternoon, health issues come up. That’s why you can always call our 24/7 NurseLine and speak directly to a nurse. Call 1-800-224-0336 (TTY 711) anytime, day or night.
Thinking about pregnancy?
Not yet a member? Choose Anthem.
You have a choice in your health care. Choose Anthem for the health care you need plus extra benefits to help you live a healthier life. We’ll help you every step of the way. Call us at 1-800-227-3238 (TTY 711) or visit our How to enroll page.How to enroll