SFHP Care Plus Eligibility
If you have both Medicare and Medi-Cal, you can sign up for a Dual Eligible Special Needs Plan (D-SNP), also known as a Medi-Medi plan.
You may want to join SFHP Care Plus to:
- Make it simpler to use your health insurance
- Get extra benefits and services
- Get personalized care and support
You are eligible for SFHP Care Plus if:
- You have dual eligibility, which means you’re eligible for both Medicare Parts A and B and receive full Medi-Cal benefits*
-
You are:
- 65 or older,
-
Under 65 with a qualifying disability, such as:
- Receiving Social Security Disability Insurance (SSDI) for at least 24 months
- Having ALS or End Stage Renal Disease (ESRD)
OR
- You live in San Francisco County
- You are a U.S. citizen or a lawful permanent resident
*Learn more about qualifying for Medi-Cal benefits at sfhp.org/qualify.
Low-Income Subsidy (LIS) Extra Help
Most Medi-Cal members qualify for the Low-Income Subsidy (LIS or Extra Help). LIS assists with Part D prescription drug costs.
If you are eligible for any of the programs below, you will qualify for extra help through LIS:
Joining SFHP Care Plus will automatically enroll you into the LIS program. Learn more about the Extra Help program.
Depending on your LIS eligibility, your 2026 cost share for Care Plus covered drugs are listed below:
| LIS 1 | LIS 2 | LIS 3 | |
|---|---|---|---|
| Tier 1 – Preferred Generic | $0 | $0 | $0 |
| Tier 2 – Generic | $5.10 | $1.60 | $0 |
| Tier 3 – Preferred Brand | $12.65 | $4.90 | $0 |
| Tier 4 – Non-Preferred Generic and Brand | $5.10 generic $12.65 brand |
$1.60 generic $4.90 brand |
$0 |
| Tier 5 – Specialty | $5.10 generic $12.65 brand |
$1.60 generic $4.90 brand |
$0 |
| Tier 6 – Select Care | $0 | $0 | $0 |
You can fill out an online form or call us to make an appointment:
October 1st – March 31st –
April 1st – September 30th –
We are closed on Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving, and Christmas.