Is IEHP Medicare or Medicaid? Understanding What Type of Coverage You Have

IEHP is Medicaid, not Medicare

IEHP (Inland Empire Health Plan) is a Medicaid managed care plan, not a Medicare plan. If you are enrolled in IEHP, you have Medicaid coverage through a private insurance company that contracts with the state of California. This matters because Medicaid and Medicare are two separate government programs with different rules, covered services, and costs.

IEHP serves people in Riverside and San Bernardino counties in Southern California. The plan is run by a private health insurance company, but the money comes from Medicaid — the joint federal and state program for people with low incomes, certain disabilities, or other may have access to circumstances. You do not pay a monthly premium for IEHP Medicaid coverage, though you may have small copays when you use services.

If you are over 65 and have both Medicare and Medicaid, you might also have an IEHP plan that works alongside your Medicare. That plan would still be Medicaid — it would just coordinate with your Medicare benefits. The two programs work together in that case, but IEHP itself remains a Medicaid product.

Key Takeaways

IEHP is a Medicaid managed care plan run by a private insurance company under contract with California, serving Riverside and San Bernardino counties.
Medicaid and Medicare are separate programs: Medicaid is for people with low incomes or disabilities, while Medicare is for people 65 and older or with certain disabilities regardless of income.
If you have IEHP, you pay no monthly premium for your Medicaid coverage, though you may have small copays for doctor visits or prescriptions.
Some people over 65 have both Medicare and Medicaid (called dual may be able to access), and IEHP can be their Medicaid plan while they also keep their Medicare coverage.
Your IEHP member card will say "Medicaid" on it, and you should bring it to every doctor visit and pharmacy.

How Medicaid and Medicare differ

Medicaid and Medicare sound similar but serve different groups of people. Medicare is a federal program for people 65 and older, regardless of income. It also covers some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and then you become may be able to access when you turn 65.

Medicaid is a joint federal and state program for people with low incomes, pregnant people, children, people with disabilities, and some seniors. Each state runs its own Medicaid program with its own rules about who qualifies and what services are covered. California's Medicaid program is called Medi-Cal. IEHP is one of the companies that delivers Medi-Cal benefits in two counties.

The key difference for you: if you have IEHP, you are receiving Medicaid benefits. You do not need to be 65 to have IEHP — you could be younger and may have access to through low income or disability. If you are 65 or older and have IEHP only (not Medicare), you may have access to for Medicaid through age and low income, not through the Medicare program.

When you might have both IEHP and Medicare

Some people have both Medicare and Medicaid at the same time. This happens when you are 65 or older and also have a low enough income to may have access to for Medicaid. People in this situation are called dual may be able to access. In California, if you are dual may be able to access, you can enroll in an IEHP plan that coordinates your Medicaid benefits with your Medicare coverage.

If you are dual may be able to access with IEHP, you will have two separate coverage programs working together. Your Medicare covers hospital stays, doctor visits, and some other services. Your IEHP Medicaid plan covers things Medicare does not, like long-term care, dental, and vision. You will have both a Medicare card and an IEHP Medicaid card, and you should bring both to medical appointments.

The IEHP plan you use as a dual may be able to access person is still Medicaid — it is just Medicaid that works alongside your Medicare. Do not confuse it with a Medicare Advantage plan, which is a different type of Medicare coverage sold by private insurance companies. IEHP Medicaid plans and Medicare Advantage plans are not the same thing.

What IEHP covers

IEHP Medicaid covers doctor visits, hospital stays, emergency care, prescription medications, mental health services, and substance use treatment. The plan also covers preventive services like screenings and vaccines at no cost to you. Depending on your age and situation, IEHP may cover dental, vision, and hearing services — coverage varies by plan type.

You choose a primary care doctor through IEHP, and that doctor coordinates your care. If you need to see a specialist, your primary care doctor usually has to refer you first. You can find IEHP doctors and hospitals on the plan's website or by calling the member services number on your card.

IEHP may require you to pay a small copay — usually a few dollars — when you visit a doctor or fill a prescription. Some services, like preventive care, have no copay. You should never be asked to pay the full cost of a service upfront; if you are, contact IEHP member services to ask about financial hardship programs.

How to confirm your coverage type

The easiest way to know whether you have IEHP Medicaid or another type of coverage is to look at your member card. Your IEHP card will clearly state "Medicaid" or "Medi-Cal" on the front. If you have both Medicare and Medicaid, you will have two separate cards — one from Medicare and one from IEHP.

You can also call IEHP member services at the number on your card and ask a representative to confirm your coverage type. Have your member ID number ready. The representative can tell you exactly what services are covered under your plan and what your copays are.

If you are unsure whether you may have access to for IEHP or want to understand your coverage options in Riverside or San Bernardino counties, you can contact the California Department of Health Care Services or call 211 for a referral to local enrollment help. These resources can explain Medicaid, Medicare, and how they work together if you may have access to for both.

What to ask your doctor or IEHP

When you start care with a new doctor or specialist, tell them you have IEHP Medicaid coverage. Bring your member card to every visit. If a doctor's office says they do not take IEHP, ask for a referral to a doctor who does — IEHP is required to have a network of providers in your area.

If you are prescribed a medication and the pharmacy says it is not covered, call IEHP member services before you leave. The plan may cover the medication with prior approval, or a representative can help you find a covered alternative. Do not pay out of pocket without first asking whether IEHP can help.

If you have questions about whether a service is covered — such as a test, procedure, or specialist visit — call IEHP member services before you go. They can tell you whether the service is covered and what your cost will be. This prevents surprise bills and helps you plan your care.

Frequently Asked Questions

Can I switch from IEHP to a different Medicaid plan?

Yes. California allows you to change Medicaid plans during open enrollment periods, which usually run from November through January. You can also change plans if you have a may have access to life event, such as moving out of IEHP's service area. Contact the California Department of Health Care Services or call 211 to learn about other plans available in your county.

Do I need to pay a monthly premium for IEHP Medicaid?

No. Medicaid is free — you do not pay a monthly premium. You may have small copays when you use services, but the plan itself costs you nothing. If someone asks you to pay a monthly fee for IEHP Medicaid, that is a scam.

If I have IEHP and turn 65, do I have to switch to Medicare?

You must enroll in Medicare Part A and Part B when you turn 65, even if you have IEHP Medicaid. Once you have both, you become dual may be able to access. You can keep your IEHP Medicaid plan to work alongside your Medicare, or you can choose a different Medicaid plan. Contact Social Security or Medicare three months before your 65th birthday to enroll in Medicare.

What happens if I move out of Riverside or San Bernardino County?

IEHP only serves those two counties. If you move, you will need to enroll in a different Medicaid plan in your new county. Contact your local county social services office or call 211 to find out which plans serve your new area and how to switch.

Is IEHP the same as a Medicare Advantage plan?

No. IEHP Medicaid is a Medicaid plan, not a Medicare plan. Medicare Advantage is a type of Medicare coverage sold by private insurance companies to people 65 and older. They are completely different programs. If you have IEHP only, you do not have Medicare coverage.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.