Healthcare Plans Eligibility

A summary of the eligibility requirements and coverage for Healthy Kids, Healthy Families, Healthy Way LA, Medicare, and AIM follows:

Plan Eligibility Coverage

Healthy Kids
(LA Care Health Plan)

Monthly premium - $0-$15 per child; maximum $45 per family based on income

Copay - $5-$15 for most visits (no charge for physicals, immunizations, and dental checkups)
  • Under 19 (enrollment closed for children 6-18)
  • L.A. County resident
  • Not enrolled in any other health insurance program (except emergency medical or CSS, or have limited employer-sponsored dental and vision services coverage)
  • Doctor visits
  • Lab and x-rays
  • Immunizations
  • Dental checkups
  • Vision
  • Mental health
  • Hospital and emergency room care
  • Prescription drugs

Healthy Families
Monthly premium - $4-$24 per child; maximum $72 per family

Copay - $5-$15 for most visits (no charge for physicals, immunizations, and dental checkups)
  • Under 19
  • Not eligible for Medi-Cal or has had employer-sponsored insurance within the last 3 months of enrollment
  • U.S. citizens or permanent legal residents
  • Family must meet income requirements
  • Doctor visits
  • Lab and x-ray services
  • Dental checkups
  • Vision
  • Mental health care
  • Prescription drugs
  • Hospital and emergency room care

Healthy Way LA Matched
(For low-income uninsured adults)

Monthly premium - $0

Copay - $0
  • Ages 19-64
  • Uninsured
  • Suffer from a chronic disease (asthma, diabetes, hypertension, congestive heart failure, dyslipidemia)
  • U.S. citizen or permanent resident 5 years or more
  • Meet income eligibility guidelines
  • Routine checkups, including labs, x-rays, and prescription drugs
  • Chronic diseaseĀ  management services
  • Health education
  • 24/7 Nurse Advice Line
  • Specialty care

Medicare
(Health Plan Options for services to be rendered at EPFMC)

  • SCAN
  • Care 1st
  • Molina
  • LA Care (including SNP)
  • Health Net
  • 65 or older
  • Under 65 with certain disabilities
  • U.S. citizen or have been a legal resident for 5 years or more
  • Eligible for Medicare Part A
  • Enrolled in Medicare Part B
  • Annual physical exam
  • Doctor visits
  • Hospital and emergency services
  • Lab tests and x-rays
  • Mental health services
  • Prescription drugs
*Other benefits based on which health plan you choose

AIM (Access for Infants and Mothers)

  • Low-cost coverage for pregnant women
  • Must choose a health plan
  • EPFMC only accepts Health Net
  • No more than 30 weeks pregnant
  • Current California resident
  • Uninsured
  • Meet income requirements
  • Not on Medicare
  • All medically necessary services while pregnant
  • Hospitalization
  • Coverage for 60 days after delivery for postpartum services

Contact Managed Care Operations (213-747-5542, ext. 3202) for an eligibility or enrollment appointment.