Medicare and Medi-Cal are two separate programs run by different agencies

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). It is based on age (65 and older), disability status, or end-stage renal disease — not on how much money you have. You pay into Medicare through payroll taxes during your working years, and it covers hospital care, doctor visits, and prescription drugs.

Medi-Cal is California's version of Medicaid, a joint federal-state program run by the California Department of Health Care Services. It is based on income and household size, not age. You do not need to have paid into it to receive it. Medi-Cal covers hospital care, doctor visits, prescription drugs, and some services Medicare does not, like dental and vision care for adults.

The two programs operate independently. You can have Medicare alone, Medi-Cal alone, or both at the same time. If you have both, they work together — Medi-Cal typically pays what Medicare does not cover, which is why people with both are sometimes called "dual may be able to access."

Key Takeaways

  • Medicare is a federal program based on age or disability; Medi-Cal is California's state program based on income.
  • You can have Medicare, Medi-Cal, or both — they are separate programs with separate enrollment processes.
  • If you have both programs, Medi-Cal usually covers costs that Medicare leaves you responsible for, like copays and deductibles.
  • Most people over 65 in California are enrolled in Medicare automatically; Medi-Cal requires a separate step to enroll.
  • Medi-Cal covers some services Medicare does not, including adult dental, vision, and hearing care.

Who pays for what: Medicare versus Medi-Cal

Medicare has four parts. Part A covers hospital stays and skilled nursing. Part B covers doctor visits and outpatient care. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A, B, and D offered by private insurers. Most people pay a monthly premium for Part B and Part D, and there are deductibles and copays.

Medi-Cal covers the same basic services — hospital, doctor, prescription drugs — but with different cost-sharing rules. In many cases, Medi-Cal has no copay or a very small one. Medi-Cal also covers services Medicare does not: dental work, vision care (including glasses), hearing aids, and some mental health and substance use treatment.

If you have both Medicare and Medi-Cal, the order of payment is set by law. Medicare pays first on any service it covers. Medi-Cal pays second, covering what Medicare left you responsible for — your deductible, copay, or coinsurance. This is called "coordination of benefits."

Income limits and how they differ

Medicare has no income limit. Anyone 65 or older, or anyone with a disability who has received Social Security Disability Insurance (SSDI) for two years, or anyone with end-stage renal disease, is may have access to to Medicare regardless of wealth.

Medi-Cal has strict income limits that change each year. For 2024, a single adult can earn up to about $1,550 per month and still be within the limit for most Medi-Cal programs. A couple can earn up to about $2,100. These numbers rise slightly each year. Your household size, citizenship status, and whether you are pregnant or disabled also affect whether you may have access to.

Because of these different rules, a person can be too wealthy for Medi-Cal but still may have access to to Medicare. Conversely, a younger person with a low income might have Medi-Cal but not Medicare.

How to enroll in each program

Most people are enrolled in Medicare automatically. If you are a U.S. citizen or permanent resident and you turn 65, Social Security will enroll you in Medicare Parts A and B automatically three months before your birthday, unless you ask them not to. You do not have to do anything. If you are not automatically enrolled, you can contact Social Security to enroll.

Enrolling in Part D (prescription drug coverage) is a separate step. You must choose a plan and enroll during the annual enrollment period (October 15 to December 7 each year) or when you first become may be able to access. If you miss this window, you may pay a penalty for late enrollment.

Medi-Cal enrollment is separate and requires you to take action. You can explore through the California Department of Social Services website, by phone at 1-888-421-8080, by mail, or in person at your county social services office. You will need to provide proof of income, citizenship or immigration status, and residency. Processing usually takes 30 to 45 days.

When you might have both programs

You are most likely to have both if you are 65 or older and your income is below the Medi-Cal limit. This is common among people who are retired and living on Social Security alone, or on a small pension. Having both programs is valuable because Medi-Cal covers your Medicare premiums, deductibles, and copays, and also covers services Medicare does not.

You can also have both if you are under 65, disabled, and receiving SSDI. Once you have received SSDI for two years, you become may be able to access for Medicare. If your income is still low enough, you may also be may be able to access for Medi-Cal at the same time.

Some people have Medicare but not Medi-Cal because their income is too high for Medi-Cal. Others have Medi-Cal but not Medicare because they are under 65 and do not have a may have access to disability. The two programs are independent, so your situation depends on your age, disability status, and income.

Services covered by Medi-Cal that Medicare does not cover

If you have both programs, Medi-Cal fills important gaps. Medicare does not cover routine dental care, dentures, or dental implants. Medi-Cal covers dental care for adults, though the scope varies by county. Medicare does not cover eyeglasses or contact lenses for adults. Medi-Cal covers one eye exam and one pair of glasses per year. Medicare does not cover hearing aids. Medi-Cal covers hearing aids and hearing exams.

Medi-Cal also covers some mental health and substance use treatment that Medicare covers only partially. Medi-Cal covers transportation to medical appointments, which Medicare does not. If you are on Medi-Cal, ask your doctor or local Medi-Cal office what services are covered in your county, because coverage varies.

What happens if you lose Medi-Cal but keep Medicare

If your income rises above the Medi-Cal limit, you will lose Medi-Cal coverage. You will still have Medicare, but you will be responsible for all Medicare premiums, deductibles, and copays yourself. If you cannot afford these costs, you may be able to enroll in a Medicare Savings Program, which is a state program that helps pay your Medicare premiums and cost-sharing. You can also look into a Medigap plan, which is private insurance that covers some of what Medicare does not.

If you lose Medi-Cal, you have 60 days to enroll in Part D prescription drug coverage without a penalty. If you miss this window, you will pay a penalty for each month you were without coverage. Contact Social Security or Medicare (1-800-MEDICARE) right away if your income changes.

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 below the Medi-Cal limit, you can have both. You will be enrolled in Medicare automatically at 65, and you can explore for Medi-Cal separately. Having both is common and means Medi-Cal covers costs that Medicare leaves you responsible for.

Do I have to pay for Medicare if I have Medi-Cal?

If you have both programs, Medi-Cal pays your Medicare Part B premium for you. You will not see a bill. Medi-Cal also covers your deductibles and copays. You still need to enroll in Part D separately to cover prescription drugs.

What if I am under 65 and have a disability?

If you receive SSDI, you become may be able to access for Medicare after two years of receiving benefits. You may also be may be able to access for Medi-Cal if your income is low enough. Contact Social Security to confirm your Medicare enrollment and the California Department of Social Services to explore for Medi-Cal.

Does Medi-Cal cover things Medicare does not?

Yes. Medi-Cal covers dental care, eyeglasses, and hearing aids for adults — services Medicare does not cover. Medi-Cal also covers transportation to medical appointments and some mental health services. Coverage varies by county, so check with your local Medi-Cal office about what is covered where you live.

What happens to my coverage if my income goes up?

If your income rises above the Medi-Cal limit, you will lose Medi-Cal but keep Medicare. You will then be responsible for Medicare premiums and cost-sharing. You may be able to enroll in a Medicare Savings Program or a Medigap plan to help cover these costs. Contact Social Security when ready if your income changes.