Medi-Cal and Medicare are separate programs with different rules

Medi-Cal and Medicare are not the same. Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS) for people 65 and older, some younger people with disabilities, and people with end-stage renal disease. Medi-Cal is California's state Medicaid program for low-income residents of any age. You can have one, the other, or both at the same time.

The confusion happens because both programs help pay for health care, both are government-run, and both use the word "care" in their names. But they come from different budgets, have different income limits, cover different services, and work with different doctors and hospitals. Understanding which one you have — or whether you have both — matters because it changes what you pay, which providers you can see, and what services are covered.

Key Takeaways

  • Medicare is a federal program for people 65 and older; Medi-Cal is California's program for low-income people of any age.
  • You can have both programs at the same time, and when you do, Medicare pays first and Medi-Cal covers some costs Medicare does not.
  • Medicare has the same rules nationwide; Medi-Cal rules and covered services vary by county in California.
  • Income limits for Medi-Cal are much lower than for Medicare, and Medi-Cal counts your assets, while Medicare does not.

How Medicare and Medi-Cal differ

Medicare is based on age or disability status, not income. If you are 65 or older, you are may have access to to Medicare regardless of how much money you have. Medi-Cal is based on income and assets. To have Medi-Cal, your income and savings must fall below limits set by California. Those limits change each year and vary slightly by family size and county.

Medicare has four parts: Part A (hospital care), Part B (doctor visits and outpatient services), Part D (prescription drugs), and Part C (Medicare Advantage plans that combine A, B, and D). Medi-Cal covers hospital care, doctor visits, prescription drugs, dental care, vision care, and mental health services — but the exact list of covered services depends on which county you live in and which Medi-Cal plan you are in.

Medicare costs money. You pay a monthly premium for Part B, a deductible when you use hospital care, and copays when you see doctors or fill prescriptions. Medi-Cal is free or very low cost. Most Medi-Cal members pay nothing for doctor visits or prescriptions, though some pay small copays depending on their income.

When you have both Medicare and Medi-Cal

If you are 65 or older and your income is low enough, you can have both programs. When you do, you are called a dual-may be able to access or dual-may be able to access beneficiary. Medicare is your primary insurance, meaning it pays first. Medi-Cal is your secondary insurance and covers some costs that Medicare does not pay.

For example, if you see a doctor and Medicare pays 80 percent of the bill, Medi-Cal may pay part or all of the remaining 20 percent. If you need a service that Medicare does not cover but Medi-Cal does — like dental work or vision care — Medi-Cal may cover it. This combination often means you pay very little out of pocket.

If you are dual-may be able to access, you will receive materials from both programs. You will have a Medicare card and a Medi-Cal card (or a single card that shows both). You will get a Medicare Summary Notice and a Medi-Cal Explanation of Benefits. Both programs will send you information about changes to your coverage. It can feel like a lot of paperwork, but having both programs is usually better than having one alone if you may have access to.

Income and asset limits for each program

Medicare has no income or asset limits. You can be wealthy and still have Medicare at 65.

Medi-Cal has strict income limits. In 2024, the limit for a single person is roughly 138 percent of the federal poverty level, though this varies by county and changes yearly. For a single person, that is approximately $1,700 per month in gross income, but the exact number depends on where you live in California. Medi-Cal also counts your assets — savings, investments, property you own. If your assets are above the limit (which varies by program type), you may not be able to have Medi-Cal.

Because Medi-Cal limits are low, many seniors on Medicare do not have Medi-Cal. If your Social Security check is above the Medi-Cal income limit for your county, you will not be able to have Medi-Cal, even if you have high medical bills.

How to find out which program you have

Check your insurance cards. A Medicare card says "MEDICARE" at the top and has a red, white, and blue design. A Medi-Cal card says "Medi-Cal" and is usually blue and gold. If you have both, you will have two separate cards (or one card showing both).

You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) to confirm your Medicare coverage. Call your county's Medi-Cal office or visit the Medi-Cal website at medi-cal.ca.gov to confirm Medi-Cal coverage. Your doctor's office can also tell you which programs they see you have on file.

If you think you should have Medi-Cal but do not, or if you are not sure, contact your county's social services office. They handle Medi-Cal enrollment and can tell you whether you meet the income and asset limits for your area.

What to ask your doctor about coverage

When you see a doctor, bring both your Medicare card and your Medi-Cal card if you have both. Tell the front desk staff that you have both programs. This ensures the office bills correctly and you are not charged for services that should be covered.

If your doctor recommends a test, procedure, or medication, ask whether Medicare covers it. If the answer is no, ask whether Medi-Cal covers it. If you have both programs, there is a better chance the service will be covered by one of them. If neither program covers it, ask your doctor what the cost will be and whether there are alternatives that are covered.

If you are told a service is not covered and you believe it should be, you can file an appeal with either program. Your doctor's office can help you understand the appeal process.

When to contact Medicare or Medi-Cal

Contact Medicare if you turn 65 and need to enroll, if you want to change your Part D prescription drug plan, if you want to switch to a Medicare Advantage plan, or if you receive a bill you think Medicare should have paid. You can reach Medicare at 1-800-MEDICARE or online at medicare.gov.

Contact your county's Medi-Cal office if your income changes, if you move to a different county, if you want to change your Medi-Cal plan, or if you are denied coverage for a service. You can reach Medi-Cal through your county's social services office or at medi-cal.ca.gov. Response times vary by county.

If you have a medical emergency, go to the nearest emergency room. Both Medicare and Medi-Cal cover emergency care, and you do not need to call ahead or get approval first.

Frequently Asked Questions

Can I have Medicare and Medi-Cal at the same time?

Yes. If you are 65 or older and your income is low enough to meet Medi-Cal limits for your county, you can have both. Medicare is your primary insurance and pays first; Medi-Cal covers some costs Medicare does not. Having both programs usually means lower out-of-pocket costs than having Medicare alone.

If I have Medi-Cal, do I still need to pay for Medicare?

Yes, if you are 65 or older. You are may have access to to Medicare and must pay the Part B premium (about $175 per month in 2024, though it varies by income). Medi-Cal does not replace Medicare; it works alongside it. Some low-income seniors have programs that help pay the Medicare premium, so ask your county office.

What if I move out of California?

Your Medicare coverage moves with you — it works the same in every state. Your Medi-Cal coverage ends when you move out of California. You will need to look into your new state's Medicaid program if you still meet income limits. Contact your new state's Medicaid office to learn about enrollment.

Does Medi-Cal cover things Medicare does not?

Yes. Medi-Cal often covers dental care, vision care, and hearing aids — services Medicare does not cover. Medi-Cal also covers some long-term care services. If you have both programs, you may be able to get these services through Medi-Cal even though Medicare does not pay for them.

How do I know if I make too much money for Medi-Cal?

Medi-Cal income limits are roughly 138 percent of the federal poverty level, which is about $1,700 per month for a single person in 2024, but the exact limit varies by county and changes yearly. Contact your county's social services office or visit medi-cal.ca.gov to find the current limit for your area and to learn whether your income qualifies.