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 at ssa.gov/medicare/part-d-extra-help.
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 |
Speak with one of our SFHP Care Plus Medicare Specialists to get your questions answered.
You can fill out an online form or call us to make an appointment:
1(415) 727-2273, 1(888) 765-7327 (toll-free), or 711 (TTY)
October–December: Seven days a week, 8:00am–8:00pm
January–September: Monday, Tuesday, Thursday, and Friday, 8:00am–5:00pm; Wednesday, 8:00am–8:00pm