Member Costs
Co-pays
You may be asked for a co-pay when you present your HPSM ID card and Medi-Cal BIC card at a medical office, hospital or pharmacy.
- Some Medi-Cal members have a $0 co-pay, and some have a $1 co-pay.
- Hospitals can charge a $5 co-pay for going to the emergency room for a non-emergency service.
If you have HPSM Medi-Cal and Medicare, you can join HPSM’s CareAdvantage plan! With CareAdvantage, you pay $0 premiums and low or no co-pays for prescription drugs!
Share-of-cost (SOC) payments
If you have been told that you have a SOC, this means that you have to pay a monthly dollar amount for your medical expenses. This is similar to paying a deductible when you have private insurance. You make payments towards your monthly share-of-cost amount to Medi-Cal providers (doctor, pharmacy, dentist) when they tell you that a SOC payment is due.
These payments are not co-pays.
For more information about your share of cost payments, including how it is calculated, please call the San Mateo Human Services Agency.
Long-Term Care
Nursing Home Services
The plan covers most services received in a skilled nursing home, including vision, limited dental services, medicines and supplies. Daily room and board expenses are also covered.
Community Based Adult Services (CBAS)
This benefit covers the following services received at an approved CBAS center:
- Skilled nursing care
- Social services
- Meals
- Physical and speech therapy
- Occupational therapy
To receive these services, you need a referral from your primary care provider, a hospital, a skilled nursing facility or community agency. HPSM will then review your case and determine if you qualify for CBAS.
Preventive Care
$0 Co-pay
Routine check-ups, screenings, tests, immunizations and other office visits with a primary care provider to prevent problems or identify problems early are covered. Some examples of preventive services are:
- Annual gynecological exams
- Child and adult immunizations
- Well Child Visits for newborns, children and teens
- STD tests
- Vision and hearing tests
- Prenatal care EOC
For more information about Medi-Cal costs, refer to section 2 of the Medi-Cal 2023 Member Handbook / Evidence of Coverage. To order a printed Member Handbook, email CustomerSupport@hpsm.org or call Member Services.