How Medi-Cal and Medicare Work Together on Deductibles

Medi-Cal covers some or all of your Medicare deductible, depending on your income and which program you may have access to for

If you have both Medicare and Medi-Cal, Medi-Cal can pay part or all of your Medicare Part B deductible (currently $240 per year) and your Part A deductible (currently $1,676 per stay). Whether Medi-Cal actually pays yours depends on which Medi-Cal program you are in and your income level. The amount varies by program and changes yearly.

When you have both programs, Medi-Cal is called your "secondary payer." That means Medicare processes your claim first, then Medi-Cal steps in to cover costs Medicare did not pay — including deductibles, copays, and coinsurance. You do not have to do anything extra; the two programs coordinate automatically once both know about each other.

Key Takeaways

Medi-Cal can pay your Medicare Part A and Part B deductibles if you meet income limits for the specific Medi-Cal program you are in.
You must be enrolled in both Medicare and Medi-Cal at the same time for Medi-Cal to cover your deductible.
The Medi-Cal program that covers your deductible depends on your income: Medicaid for Seniors and Persons with Disabilities (MSPD) or may have access to Medicare Beneficiary (QMB) are the most common.
Medi-Cal deductible coverage is automatic once both programs know you are enrolled in each; you do not need to file a separate claim.

Which Medi-Cal programs cover Medicare deductibles

Three Medi-Cal programs can pay your Medicare deductibles, and which one covers you depends on your monthly income. Medicaid for Seniors and Persons with Disabilities (MSPD) is the main program for people 65 and older. If your income is below the limit (which varies by county but is roughly $1,150 per month for a single person), MSPD covers your Part A and Part B deductibles in full.

may have access to Medicare Beneficiary (QMB) is a narrower program for people with slightly higher income. QMB covers your Medicare deductibles, copays, and coinsurance if your income falls between the MSPD limit and roughly $1,370 per month. Income limits change each year and differ slightly by county.

Specified Low-Income Medicare Beneficiary (SLMB) covers your Part B premium if you do not may have access to for QMB but your income is still low enough. SLMB does not cover deductibles, only the monthly Part B premium. If you are in SLMB, you still owe your deductibles.

How to learn about Medi-Cal will pay your deductible

Contact your county Medi-Cal office and ask which program you are in. You can find your county office at dhcs.ca.gov or call 1-800-541-5555. Have your Social Security number and proof of income (recent pay stub, tax return, or bank statements) ready. The county will tell you whether you are in MSPD, QMB, SLMB, or not enrolled in any of these programs.

You can also ask your Medicare plan or your doctor's office to check your Medi-Cal status. Many medical offices have staff who can look this up for you. If you are unsure whether you have Medi-Cal at all, call 1-800-541-5555 and they will tell you.

If you are not currently in a Medi-Cal program that covers deductibles but your income is low, you may be able to enroll. Income limits are higher than many people expect, and they change each year. It is worth checking even if you think you earn too much.

What happens when you see a doctor or go to the hospital

When you receive care, show both your Medicare card and your Medi-Cal card. The provider will bill Medicare first. Once Medicare processes the claim and applies your deductible, the claim automatically goes to Medi-Cal. If you are in MSPD or QMB, Medi-Cal will pay the deductible amount that Medicare did not cover.

You should not receive a bill for your deductible if Medi-Cal is covering it. If you do get a bill, contact your provider's billing department and tell them you have Medi-Cal. Ask them to resubmit the claim to Medi-Cal. Sometimes claims are not forwarded automatically, especially if the provider's office is not familiar with dual coverage.

Keep copies of any bills you receive. If you are billed for a deductible that Medi-Cal should have paid, you can dispute it with the provider or contact your county Medi-Cal office for help.

Income limits and how they affect your coverage

Medi-Cal income limits are set by the state and change each year. They also vary slightly by county. For 2024, MSPD income limits are roughly $1,150 per month for a single person and $1,550 for a couple, but these numbers shift annually. QMB limits are higher — roughly $1,370 for a single person.

Income includes Social Security, pensions, wages, and some other sources. It does not include certain assets like your home or car. If you are close to the income limit, it is worth asking your county office exactly how they count your income, because the rules have exceptions.

If your income goes above the limit, you may lose Medi-Cal coverage. If it drops back below the limit, you can re-enroll. Report income changes to your county Medi-Cal office so your coverage stays accurate.

What to do if you are denied Medi-Cal or lose coverage

If your county tells you that you do not meet the income limit for MSPD or QMB, ask whether you may have access to for SLMB (which covers your Part B premium) or any other Medi-Cal program. Some people who do not may have access to for deductible coverage still may have access to for other help.

If you believe the county made a mistake about your income or may be able to access, you have the right to request a hearing. Ask your county Medi-Cal office for the appeal form. You have 90 days from the date of the denial letter to file.

If you lose Medi-Cal because your income increased, you may be able to enroll in a Medicare Savings Account (MSA) or other Medicare plan that helps with costs. Talk to your Medicare plan or call 1-800-MEDICARE to explore other options.

Frequently Asked Questions

Do I have to pay my deductible upfront if Medi-Cal is supposed to cover it?

No. If you are in MSPD or QMB and show both your Medicare and Medi-Cal cards, the provider should not bill you for the deductible. If you receive a bill, contact the provider's billing office and ask them to resubmit to Medi-Cal. You can also call your county Medi-Cal office for help disputing the bill.

What if I have Medicare Advantage instead of Original Medicare?

Medi-Cal still covers your deductible if you are in MSPD or QMB. Medicare Advantage plans have different deductible amounts than Original Medicare, but Medi-Cal will cover whatever deductible your plan has. The coordination between the two programs works the same way.

Can I enroll in Medi-Cal if I already have Medicare?

Yes. You can enroll in Medi-Cal at any time, even if you already have Medicare. There is no waiting period. Contact your county Medi-Cal office to start the process. You will need proof of income and citizenship or legal residency.

What if my income is just slightly above the Medi-Cal limit?

Ask your county office exactly how they calculate your income, because some income sources are not counted or are counted differently. Also ask about the "spend-down" option, which allows some people with higher income to become may be able to access by setting aside medical expenses. Rules vary by county.

Does Medi-Cal cover my Medicare Part D prescription drug deductible?

No. Medi-Cal covers your Part A and Part B deductibles and copays, but not your Part D drug deductible. However, if you have low income, you may may have access to for Extra Help, a federal program that reduces Part D costs. Call 1-800-MEDICARE to learn whether you may have access to.

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.