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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,
    • OR

    • 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)
  • 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:

Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)
Qualifying Individual (QI)

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

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