IEHP Insurance: Who Qualifies, Plans, and What’s Covered

IEHP insurance, short for Inland Empire Health Plan, is a not-for-profit managed care plan that covers residents of Riverside and San Bernardino counties in California. It delivers coverage mainly through Medi-Cal, the state’s Medicaid program, and also runs a plan for people eligible for both Medicare and Medi-Cal along with a Covered California option for households that earn too much for Medi-Cal.¹ Most members pay nothing out of pocket for doctor visits, hospital stays, and prescriptions.

The Three Plans IEHP Offers

IEHP runs three separate programs, each tied to a different eligibility group.

IEHP Medi-Cal is no-cost coverage for qualified low-income residents. This is what most IEHP members have, and it covers medical, behavioral health, pharmacy, vision, and transportation services.
IEHP DualChoice is a no-cost integrated plan for adults 21 and older who have Medicare Part A and Part B and also qualify for full Medi-Cal. It is structured as an HMO Dual Special Needs Plan, bundling Medicare and Medi-Cal benefits under one plan and one provider network.²
IEHP Covered is a low-cost option sold through the Covered California marketplace for people whose income is above the Medi-Cal cutoff.

Most of what follows describes the Medi-Cal plan, since that is the plan people usually mean when they talk about IEHP.

Who Qualifies

To get IEHP’s Medi-Cal plan you have to live in Riverside or San Bernardino County and meet the state’s income rules. California uses the Modified Adjusted Gross Income (MAGI) method for most adults, which compares your household income to the federal poverty level. For 2026, the poverty level is $15,960 for a single person and $33,000 for a family of four.³

Most adults qualify at or below 138% of that number. In 2026 that works out to $22,025 a year for a single adult and $45,540 for a family of four. Children qualify up to 266% of the poverty level, and pregnant people up to 213%.⁴

Asset Limits for Seniors and People with Disabilities

Working-age adults and families qualify under MAGI rules, which ignore savings and property. Seniors, people with disabilities, and people in long-term care go through non-MAGI programs, and those programs look at assets. Effective January 1, 2026, California brought asset limits back for non-MAGI Medi-Cal after a period without them.⁵

The 2026 limits are $130,000 for an individual and $195,000 for a couple in the same household, plus $65,000 for each additional household member. Your primary home, one vehicle, household goods, personal effects, burial plots, and a prepaid irrevocable burial plan are all exempt. IRAs and work pensions also don’t count while you’re taking regular distributions. Current beneficiaries covered by these rules will report their asset information at their next annual renewal after January 1, 2026.

How to Sign Up

You apply for Medi-Cal through Covered California’s website or through your county’s social services office.⁶ Expect to submit proof of identity, residency in Riverside or San Bernardino County, and income. The county has 45 days from your application date to approve or deny you.

Once you’re approved, you get assigned to a managed care plan. In Riverside and San Bernardino, IEHP is typically one of the options. If you’re already on Medi-Cal but ended up with a different plan, you can switch to IEHP by contacting Health Care Options, the office that runs Medi-Cal managed care plan assignments statewide.

What’s Covered

The Medi-Cal plan covers the full range of essential health benefits required by the Affordable Care Act and California law. For most members there are no premiums, copays, or deductibles. Covered services include:

Preventive care, including routine checkups, screenings, immunizations, and wellness visits
Hospital care, including inpatient stays, surgeries, and emergency room visits
Maternity and newborn care, including prenatal visits, labor and delivery, postpartum care, and doula services¹
Lab and diagnostic services such as bloodwork and imaging
Rehabilitative services, including physical and occupational therapy
Chronic disease management for conditions like diabetes, asthma, and heart disease
Durable medical equipment when medically necessary, such as wheelchairs and oxygen equipment

Emergency care is treated differently from everything else. It must be covered even when the provider is out of network, and no prior authorization is required.⁷ You will not be billed for a real emergency wherever you go.

Vision, Dental, and Rides to Appointments

IEHP covers eye exams and eyeglasses or contact lenses when needed.¹ Dental care runs through the separate Medi-Cal Dental program (formerly Denti-Cal), which covers exams, X-rays, cleanings, fillings, and other services for both adults and children.

Transportation is a benefit many members overlook. Federal Medicaid law requires every state to make sure beneficiaries can actually get to their medical appointments.⁸ IEHP arranges no-cost round-trip rides to primary care visits, specialists, urgent care, and behavioral health appointments. DualChoice members book rides by calling IEHP Transportation directly.²

Prescriptions Through Medi-Cal Rx

Pharmacy benefits for Medi-Cal members run through Medi-Cal Rx, a statewide program administered by the Department of Health Care Services (DHCS) rather than by IEHP or any other managed care plan.⁹ Every Medi-Cal member statewide uses the same formulary and pharmacy network no matter which plan they belong to.

Medically necessary drugs must be covered, though certain higher-cost or specialty medications need prior authorization before the pharmacy can fill them.¹⁰ If your doctor prescribes something not on the standard list, they can request an exception by explaining why the covered alternatives will not work for you. DualChoice members may have their prescription coverage integrated with Medicare Part D, with copays as low as $0.²

Mental Health and Substance Use Care

Behavioral health is part of IEHP’s core benefits. The network has more than 4,000 behavioral health specialists accepting Medi-Cal, and members can get individual therapy, medication management, and walk-in psychiatry visits at no cost.¹¹ IEHP also runs a behavioral health call center Monday through Friday to connect members with care.

One thing to know: Medi-Cal splits mental health services between the managed care plan and the county. IEHP handles non-specialty services, meaning mild to moderate conditions like depression and anxiety. More severe conditions such as schizophrenia or bipolar disorder that need intensive services are typically handled by your county’s specialty mental health plan. You don’t have to sort out which category applies. Your provider or IEHP can route you.

Using Your Coverage

IEHP contracts with doctors, hospitals, specialists, and other providers across the two counties. Your primary care provider is your main contact for routine care and writes referrals when you need a specialist. Specialist visits usually require that referral.

California law sets timely access standards that limit how long a managed care plan can make you wait for an appointment. Some procedures and higher-cost treatments require prior authorization, meaning your provider sends IEHP a request explaining why the service is medically necessary, and IEHP has to respond within set timeframes. Prior authorization doesn’t apply to emergencies. Never delay going to an emergency room because you’re worried about approval.

You can find in-network providers through IEHP’s online directory or by calling member services. The plan runs more than 90 urgent care centers with extended hours and offers a 24-hour nurse advice line for questions that come up outside office hours.¹

If IEHP Denies a Service

If IEHP denies, delays, or modifies a service you believe you need, you have the right to appeal, and it’s worth using because this is where a lot of members stop too soon.

Start by filing an appeal directly with IEHP, in writing or by phone. You can attach medical records or a letter from your provider explaining why the service is necessary. IEHP has to resolve standard appeals within 30 days. If waiting could seriously threaten your health, ask for an expedited review, which must be completed within 72 hours.¹²

If IEHP denies the appeal, you have two more options. You can request an Independent Medical Review through the California Department of Managed Health Care, where an outside panel of doctors evaluates the denial. Most decisions come within 30 days, and a ruling in your favor requires IEHP to authorize the service within five business days.¹³ You can also request a state fair hearing through the California Department of Social Services, where an administrative law judge reviews your case. You have 90 days from the date of the denial notice to ask for a hearing.¹⁴

Renewing Each Year

Medi-Cal isn’t permanent. You go through an annual renewal, sometimes called redetermination, to confirm you still qualify. DHCS tries to renew you automatically using tax records and other government data. When the state can confirm eligibility that way, your coverage keeps going without interruption.

If the state needs more information, a renewal form arrives in the mail. Fill it out and send it back by the deadline printed on the form. Miss it and your coverage can be terminated, which means reapplying from scratch. If you believe your coverage was ended in error, you can request a state fair hearing within 90 days, or within 120 days for redetermination-related eligibility issues under a temporary federal extension.¹⁴

1
IEHP. The Inland Empire’s Most-Loved Health Plan
2
IEHP. IEHP DualChoice
3
HHS ASPE. 2026 Poverty Guidelines – 48 Contiguous States
4
Covered California. Program Eligibility by Federal Poverty Level for 2026
5
California Advocates for Nursing Home Reform. 2026 Asset Limit Reinstatement Frequently Asked Questions
6
Covered California. Medi-Cal
7
Covered California. Medi-Cal Benefits – Health
8
eCFR. 42 CFR 431.53 – Assurance of Transportation
9
Department of Health Care Services. Transitioning Medi-Cal Pharmacy Services from Managed Care to FFS FAQs
10
Department of Health Care Services. Medi-Cal Rx Members – Frequently Asked Questions
11
IEHP. Mental Health and Wellness
12
Medicaid and CHIP Payment and Access Commission. Federal Requirements and State Options – Appeals
13
Department of Managed Health Care. Frequently Asked Questions
14
California Department of Social Services. State Hearing Requests