San Francisco Health Plan vs. Medi-Cal: A Guide to Healthcare Coverage

Limited mobility can have a huge effect on one’s quality of life. Fortunately, San Francisco Health Plan and Medi-Cal offer healthcare coverage to help individuals access the care they need. This guide explores the differences between these programs, their coverage options, eligibility requirements, and how to obtain a power wheelchair through them.

What Is San Francisco Health Plan (SFHP)?

San Francisco Health Plan (SFHP) is a non-profit healthcare provider dedicated to offering affordable and high-quality healthcare to Bay Area residents.

What Is Medi-Cal?

Medi-Cal, California’s version of Medicaid, is a free or low-cost healthcare program that provides coverage to low-income individuals and families in California.

SFHP vs. Medi-Cal

How They Compare

Aspect	San Francisco Health Plan	Variable Data Campaign
Coverage Area	Primarily focused on San Francisco	Statewide coverage across California
Provider Network	Extensive network within San Francisco	Broad network covering the entire state
Additional Benefits	Add-on benefits like dental, vision, hearing	Additional benefits like transportation
Eligibility Criteria	Required San Francisco residency, income limits	Statewide eligibility based on income, size, and status
Power Wheelchair Coverage	Covers when medically necessary	Covers when medically necessary, considering daily activities

How They Differ

Coverage and Benefits

Both San Francisco Health Plan (SFHP) and Medi-Cal provide broad coverage for a variety of medical services.

SFHP extends its coverage not only through different health insurance options but also via an extensive network of healthcare providers, clinics, and hospitals in San Francisco. In contrast, Medi-Cal ensures coverage across the entire state of California, guaranteeing eligible individuals access to crucial healthcare services.

While specific benefits may vary by plan, both SFHP and Medi-Cal cover primary care, hospital stays, prescription drugs, and preventive care. SFHP offers extra benefits like dental, vision, and hearing coverage, while Medi-Cal includes additional services such as transportation assistance and family planning.

Eligibility and Enrollment

To qualify for SFHP and Medi-Cal, specific criteria must be met.

SFHP eligibility demands residency in San Francisco, meeting income thresholds, and lacking access to affordable health insurance elsewhere. Medi-Cal eligibility hinges on income, family size, and citizenship or immigration status. Those meeting income criteria can enroll in Medi-Cal, regardless of their California residence.

Enrolling in both SFHP and Medi-Cal involves completing an application, sharing personal and financial details, and submitting necessary documents for eligibility verification.

Power Wheelchair Coverage

Both SFHP and Medi-Cal offer coverage for power wheelchairs when medically necessary.

The coverage criteria include impaired ability to perform mobility-related activities of daily living (ADL) or instrumental activities of daily living (IADL) without the use of a wheelchair. It’s crucial to have a qualified healthcare professional, such as a doctor, prescribe the power wheelchair based on your medical condition and mobility limitations. The supplier and therapist involved in the evaluation and selection process must also accept SFHP or Medi-Cal, depending on the program you are enrolled in.

Additionally, your home environment will be assessed to ensure that the power wheelchair is suitable for your living space.

Contact Our Trusted Complex Rehab Technology Experts Today!

If you're feeling overwhelmed navigating the process of getting a power wheelchair, Freedom Mobility is here to help. With over 15 years of experience as a trusted complex rehab technology provider, we specialize in assisting individuals with mobility challenges.

Our certified experts, including Assistive Technology Professionals (ATPs), will guide you through the process. We handle administrative tasks like requesting prior authorization from Medi-Cal and work with you to customize a power wheelchair that fits your needs. We’ll also collaborate with your doctor, manage equipment purchasing and delivery, and provide ongoing support.

Don't let mobility challenges limit your independence. Contact Freedom Mobility for a free consultation and take the first step toward finding the perfect wheelchair solution for your needs.