Medi-Cal can pay your Medicare deductible if you meet income and asset limits

If you have both Medicare and Medi-Cal, Medi-Cal may pay the costs Medicare doesn't cover — including your deductible. This happens automatically in most cases: when you go to the doctor or hospital, Medicare processes the bill first, then Medi-Cal steps in to cover what Medicare leaves behind. You do not have to file a separate claim or ask for permission each time.

The catch is that Medi-Cal has strict income and asset rules. If your income or savings are above the limit, you lose Medi-Cal coverage entirely, even if you have Medicare. This means you would owe the full deductible yourself. The income limit varies slightly by county, but as of 2024 it is roughly 138% of the federal poverty level — about $1,900 per month for a single person, though this changes yearly.

Your assets also matter. Medi-Cal allows you to keep a home and one vehicle, but limits other savings to $2,000 for a single person or $3,000 for a couple. Money in a retirement account does not count toward this limit, but a regular savings account does.

Key Takeaways

  • Medi-Cal pays Medicare deductibles and other out-of-pocket costs automatically if you are enrolled in both programs and meet income and asset limits.
  • Your monthly income must stay below roughly 138% of the federal poverty level (about $1,900 for one person in 2024) or you lose Medi-Cal entirely.
  • You can have up to $2,000 in savings as a single person; amounts above that make you ineligible for Medi-Cal.
  • If you are close to the income or asset limit, a change in circumstances — like a raise, inheritance, or pension increase — can end your coverage mid-year.

How Medi-Cal pays when you have both programs

When you have Medicare and Medi-Cal, the two programs coordinate. Medicare is your primary insurance and pays first. Medi-Cal is secondary and covers the gap. This means Medi-Cal pays your Medicare Part B deductible ($240 in 2024), your Part A deductible (which varies by hospital stay), and your copays and coinsurance.

You do not need to do anything to make this happen. When you show your Medicare card and tell the provider you also have Medi-Cal, the provider's billing office sends the claim to Medicare first. Once Medicare pays its share, the office automatically sends the remaining balance to Medi-Cal. Medi-Cal then pays what it owes. You should receive no bill.

If you do receive a bill, call the provider's billing department and ask them to resubmit the claim to Medi-Cal. Sometimes claims get lost or are sent to the wrong address. Medi-Cal has 30 days to process a claim once it arrives.

Income limits and how they are calculated

Medi-Cal uses a specific income calculation called "Modified Adjusted Gross Income" or MAGI. This includes wages, self-employment income, Social Security, pensions, and interest or dividends. It does not include certain income like Supplemental Security Income (SSI) or some veteran benefits.

The income limit is set at 138% of the federal poverty level. In 2024, the federal poverty level for a single person is about $1,380 per month, so 138% is roughly $1,900. For a couple, it is about $2,600. These numbers increase each January. You can find the current year's limits on the California Department of Health Care Services website.

If your income goes above the limit during the year, Medi-Cal will end your coverage. You will receive a notice in the mail. If your income drops back below the limit, you can reapply. Some people lose coverage temporarily when they receive a one-time payment like a tax refund or inheritance, then regain it the following month when that income is no longer counted.

Asset limits and what counts toward them

Medi-Cal limits the total value of assets you can own. For a single person, the limit is $2,000. For a couple, it is $3,000. These limits have not changed since 1989, even though the cost of living has risen significantly.

Assets that count include savings accounts, checking accounts, money market accounts, stocks, bonds, and cash on hand. A home you live in does not count. One vehicle does not count. A burial plot does not count. Retirement accounts like IRAs and 401(k)s do not count, even if you could withdraw the money.

If your assets exceed the limit, you are ineligible for Medi-Cal. This is true even if your income is well below the limit. Some people have to spend down their savings to may have access to — a process called "spend-down." Others choose to keep their savings and pay Medicare costs out of pocket instead.

What happens if you lose Medi-Cal coverage

If your income or assets rise above the limit, Medi-Cal will send you a notice saying your coverage ends on a specific date. After that date, you have only Medicare. You will owe the full deductible and all copays and coinsurance yourself.

If you lose coverage because of income, you may be able to regain it if your income drops. You can reapply at any time. If you lose coverage because of assets, you have to get your assets back below the limit before you can reapply.

Some people in this situation look into other programs that might help pay Medicare costs. Medicare Savings Programs (MSP) have higher income limits than Medi-Cal — up to 200% of poverty level in some cases — and can pay your Part B premium, deductible, and copays. You explore through your county social services office. may be able to access and benefits vary by which MSP you may have access to for.

how the process works for Medi-Cal if you have Medicare

You can explore for Medi-Cal online through the California Department of Social Services website, by phone at 1-888-421-4365, or in person at your county social services office. You will need to provide proof of income (recent pay stubs, tax returns, or a Social Security statement), proof of assets (bank statements), and proof of citizenship or legal residency.

The process asks about your household size, income, and assets. It also asks whether you are a U.S. citizen or legal resident. If you are approved, your coverage usually starts the first day of the month you applied, or sometimes the month before if you applied early in the month.

Processing takes about 30 days. You will receive a notice in the mail telling you whether you were approved, denied, or need to send more information. If you are approved, you will receive a Medi-Cal card in the mail. You should carry both your Medicare card and your Medi-Cal card when you go to the doctor.

When to contact your county office about coverage questions

Call your county social services office if your income or assets change during the year. You are required to report changes that might affect your coverage, such as a raise, a new job, the loss of a job, or an inheritance. Some changes end your coverage when ready; others do not take effect until the next month.

If you receive a notice that your coverage is ending and you believe it is wrong, you have the right to request a hearing. The notice will explain how to ask for one. You have 90 days from the date on the notice to request a hearing. During the hearing process, your coverage usually continues while the state reviews your case.

If you move to a different county in California, your Medi-Cal coverage continues, but you should notify your new county office so your case file is transferred. If you move out of California, your coverage ends on the last day of the month you move.

Frequently Asked Questions

If I have Medi-Cal, do I still need to pay my Medicare Part B premium?

Medi-Cal pays your Part B premium for you if you have both programs. The premium is deducted from your Social Security check, but Medi-Cal reimburses you for it. You should not see the premium come out of your pocket.

What if my income is just slightly over the limit?

If you are over the limit, you do not may have access to for Medi-Cal, even by a small amount. However, you may may have access to for a Medicare Savings Program, which has higher income limits. Contact your county social services office to ask about MSP programs in your area.

Can I give away money or assets to get below the limit?

Medi-Cal has rules about transfers of assets. If you give away money or property within 30 months before explore, Medi-Cal may penalize you by delaying your coverage. It is best to speak with a social worker or legal aid attorney before moving money around.

Does my spouse's income count if we are married?

Yes, Medi-Cal counts both spouses' income and assets when determining if you may have access to. If you are married, the income limit is higher (roughly $2,600 per month in 2024), and the asset limit is $3,000 for the couple combined.

What if I am approved for Medi-Cal but the provider says they do not take it?

Most providers in California take Medi-Cal, but some do not. If your provider does not accept Medi-Cal, you will need to find a different provider or pay out of pocket. You can search for Medi-Cal providers on the Medi-Cal website or call your county office for a list.