Medicare and Medi-Cal are two separate government programs with different rules, funding sources, and who they cover

Medicare is a federal program run by the Centers for Medicare & Medicaid Services (CMS). It covers people age 65 and older, some younger people with disabilities, and people with end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and it works the same way no matter which state you live in.

Medi-Cal is California's version of Medicaid, a joint federal-state program. It covers low-income adults, children, pregnant people, seniors, and people with disabilities. Medi-Cal is funded partly by the federal government and partly by California, and its rules are different from Medicaid in other states.

The biggest practical difference: Medicare is based on age or disability status and what you paid in taxes. Medi-Cal is based on income and household size. You can have both programs at the same time — in fact, many California seniors do.

Key Takeaways

  • Medicare is a federal program for people 65 and older, some younger people with disabilities, and people with end-stage renal disease, regardless of income.
  • Medi-Cal is California's program for low-income people of any age, and income limits determine whether you may have access to.
  • You can be enrolled in both Medicare and Medi-Cal at the same time, and many California seniors are.
  • Medicare Part A covers hospital stays, Part B covers doctor visits and outpatient care, and Part D covers prescription drugs; Medi-Cal covers all of these with no separate parts.
  • If you have both programs, Medicare pays first for most services, and Medi-Cal covers costs Medicare does not pay.

How Medicare is structured and what it covers

Medicare has four parts. Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient services, lab work, and medical equipment. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A, B, and D offered by private insurance companies.

You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. Part B has a monthly premium that increases based on your income. Part D premiums vary by plan. If you choose Part C, the private insurer sets the premium, deductibles, and copays.

Medicare has deductibles and copays. For example, in 2024, Part A has a deductible for hospital stays, and Part B has an annual deductible plus a 20% copay for most services after you meet it. These amounts change each year.

How Medi-Cal is structured and what it covers

Medi-Cal is one program, not divided into parts. It covers doctor visits, hospital stays, emergency care, prescription drugs, mental health services, dental care, and vision care. There is no separate enrollment for different types of coverage — you are either in Medi-Cal or you are not.

Medi-Cal has no monthly premium for most people. You may have small copays for some services, but many services are free. Copays are capped based on your income, so they are usually lower than Medicare copays.

Medi-Cal income limits change each year and depend on household size. In 2024, a single adult can earn up to a certain amount and still be covered; the limit is higher for families. California also covers some people with slightly higher incomes through special programs. You can check your household's income against the current limits through the Medi-Cal website or by calling your county social services office.

When you have both Medicare and Medi-Cal

If you are 65 or older and your income is low enough, you may have both programs. This is called being "dual may be able to access." Medi-Cal is called the "secondary payer," which means Medicare pays first for services both programs cover, and Medi-Cal covers what Medicare does not pay.

Having both programs is usually better than having Medicare alone. Medi-Cal covers the deductibles and copays that Medicare requires, and it covers services Medicare does not, like dental and vision care. You still use your Medicare card when you see a doctor, but you also show your Medi-Cal card so the provider knows to bill Medi-Cal for the costs Medicare leaves behind.

If you are dual may be able to access, you do not choose between the programs — you have both. Your doctor's office or hospital will handle the billing to both programs. If you are unsure whether you are dual may be able to access, you can call your county Medi-Cal office or the State Health Insurance information Program (SHIP) in California, which is called Health Insurance Counseling and Advocacy Program (HICAP), to find out.

Income and resource limits

Medicare has no income or resource limits. Anyone who is 65 or older, or who qualifies through disability or end-stage renal disease, can enroll regardless of how much money they have.

Medi-Cal has income limits and resource limits. Income limits are based on the federal poverty level and vary by household size and age. Resource limits mean you cannot have more than a certain amount of savings or assets — in 2024, the limit for a single person is $2,000 and for a couple is $3,000, though these amounts can change. Some resources do not count, such as your home, one car, and certain retirement accounts.

If your income is slightly above the Medi-Cal limit, you may still be covered through a "spend-down" program, which means you can deduct medical expenses from your income to bring it below the limit. Ask your county Medi-Cal office whether you are a candidate for spend-down.

How to enroll in each program

You enroll in Medicare through Social Security. You can enroll online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. Most people enroll when they turn 65. If you miss the initial enrollment window, you can enroll during the General Enrollment Period from January 1 to March 31 each year, though you may pay a late penalty.

You enroll in Medi-Cal through your county social services office or through the California Department of Health Care Services website. You can explore online, by mail, by phone, or in person. There is no enrollment important date for Medi-Cal — you can explore at any time. If you are already receiving Supplemental Security Income (SSI) or California Work Opportunity and Responsibility to Kids (CalWORKs), you are automatically enrolled in Medi-Cal.

If you are turning 65 and think you might be low-income enough for Medi-Cal, explore for Medi-Cal at the same time you enroll in Medicare. Your county office can tell you whether you are within the income limit.

Prescription drug coverage

Medicare Part D covers prescription drugs through private insurance plans. You choose a Part D plan during the annual enrollment period (October 15 to December 7). Different plans cover different drugs and have different copays and deductibles. If you do not enroll in Part D when you first become may be able to access, you may pay a late penalty for as long as you have Medicare.

Medi-Cal covers prescription drugs with no separate enrollment. Your copay is usually small or free. Medi-Cal covers a broad list of drugs, though some require prior approval from your doctor. If you have both Medicare and Medi-Cal, Medi-Cal usually covers the Part D copay you would otherwise owe.

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's limit, you can have both. Medicare pays first, and Medi-Cal covers the costs Medicare leaves behind. Having both programs usually saves you money on deductibles, copays, and services Medicare does not cover.

What if my income is too high for Medi-Cal but I cannot afford Medicare costs?

You may be able to get help paying Medicare premiums and cost-sharing through the Medicare Savings Program (MSP), which is run by Medi-Cal. Income limits for MSP are higher than for regular Medi-Cal. You can ask your county Medi-Cal office whether you may have access to for MSP.

Do I have to choose between Medicare and Medi-Cal?

No. If you are may be able to access for both, you are enrolled in both. You do not choose one or the other. You use your Medicare card at the doctor's office and show your Medi-Cal card so the provider knows to bill Medi-Cal for costs Medicare does not cover.

What happens to my Medi-Cal if my income goes above the limit?

Your Medi-Cal coverage will end. You will receive a notice from your county office telling you when coverage ends. If you lose Medi-Cal, you can look into other coverage options, such as Covered California (California's health insurance marketplace) or Medicare Advantage plans if you are 65 or older.

How do I know if I am may be able to access for Medi-Cal?

Your county Medi-Cal office can tell you based on your household income and size. You can also use the online screening tool on the California Department of Health Care Services website, or call your county social services office. There is no cost to explore, and you can explore online, by mail, or in person.