What Your Health Plan Covers

This section explains your covered services as a member of L.A. Care.

Your covered services are free as long as they are medically necessary and provided by an in-network provider.
You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services.

Your health plan may cover medically necessary services from an out-of-network provider.
But you must ask L.A. Care for pre-approval (prior authorization) for this.
Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury.

For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition.

For more details on your covered services, call Member Services at 1-888-839-9909 (TTY 711)

Members under 21 years old get extra benefits and services.
Visit the Child and Youth Well Care section of this handbook for more information.

Some of the basic health benefits L.A. Care offers are listed below.
Benefits with a star (*) may need pre-approval.

  • Acupuncture*
  • Acute (short-term treatment) home health therapies and services
  • Adult immunizations (shots)
  • Allergy testing and injections*
  • Ambulance services for an emergency
  • Anesthesiologist services*
  • Audiology*
  • Behavioral health treatments*
  • Cardiac rehabilitation*
  • Chiropractic services*
  • Chemotherapy & Radiation therapy*
  • Dental services - limited (performed by medical professional/PCP in a medical office)
  • Dialysis/hemodialysis services*
  • Durable medical equipment (DME)*
  • Emergency room visits
  • Enteral and parenteral nutrition*
  • Family planning office visits and counseling (you can go to a non-participating provider)
  • Habilitative services and devices*
  • Hearing aids*
  • Home health care*
  • Hospice care*
  • Inpatient medical and surgical care*
  • Lab and radiology*
  • Long-term home health therapies and services*
  • Maternity and newborn care
  • Major organ transplant*
  • Occupational therapy*
  • Orthotics/prostheses*
  • Ostomy and urological supplies*
  • Outpatient hospital services*
  • Outpatient mental health services
  • Outpatient surgery*
  • Palliative care*
  • PCP visits
  • Pediatric services
  • Physical therapy*
  • Podiatry services*
  • Pulmonary rehabilitation*
  • Rehabilitation services and devices*
  • Skilled nursing services*
  • Specialist visits*
  • Speech therapy*
  • Surgical services*
  • Telemedicine/Telehealth
  • Transgender services*
  • Urgent care
  • Vision services
  • Women’s health services

Definitions and descriptions of covered services can be found in the Words to Know section of this handbook