Medi-Cal vs. Medicare: Who’s Eligible & What’s Covered?
Medi-Cal provides health care coverage to those in California who have a low income, while Medicare is a nationwide program that covers seniors and those with certain disabilities.
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Eligibility for Medi-Cal is based on your income. You’ll usually qualify for Medi-Cal's free coverage if you’re an individual earning $22,025 or less a year or a family of four making $45,540 or less annually. If you earn more, you may still qualify if you are pregnant, have a disability or are under 18.
In contrast, Medicare has no income or state residency requirements. You qualify when you turn 65 or if you have a qualifying disability. If you meet the eligibility requirements for both programs — for example, turning 65 and having a low income — you can be dually enrolled in both Medi-Cal and Medicare.
What is the difference between Medicare and Medi-Cal?
Medi-Cal and Medicare are two separate programs.
As a Medicaid program, Medi-Cal serves as a health care safety net, paying the medical expenses for people who have low incomes. This can include individuals, families, children and those who are pregnant, as well as seniors and people who have disabilities. With Medi-Cal, you have to meet certain income requirements, a condition not required by Medicare.
Medicare, by contrast, is a federal program that operates on a nationwide basis, providing health care coverage to nearly 70 million seniors and people with disabilities under the age of 65.
Medi-Cal | Medicare | |
|---|---|---|
| Eligibility | Individuals and families who have low incomes and/or certain health conditions | Seniors age 65+ and people with certain disabilities |
| Location | California | Nationwide |
| Coverage | Medical care, hospitalization, prescription drugs. Often covers long-term care nursing homes and extended stays in skilled nursing facilities | Coverage varies by the part of Medicare and can include medical care, hospitalization and prescription drugs. Usually, no coverage for long-term care and extended stays in skilled nursing facilities. |
| Cost | Free | Typically, a few hundred dollars per month. Plus, there are costs for medical care and prescriptions including copays and deductibles. |
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What is Medi-Cal, and who’s eligible?
Medi-Cal provides free and low-cost health benefits to about 15 million low-income beneficiaries in California.
Medi-Cal coverage includes services like doctor visits, dental and vision care, prescription medications, hospital care and lab tests.
To get Medi-Cal coverage, you have to meet the income limits. Adults can qualify by making up to 138% of the Federal Poverty Level.
Household size | Income limit for Medi-Cal eligibility |
|---|---|
| 1 | $22,025 |
| 2 | $29,863 |
| 3 | $37,702 |
| 4 | $45,540 |
While 138% of the federal poverty level is the general guideline, it does not apply to everyone. For example, if you're pregnant, you can qualify for Medi-Cal more easily because the income limit is higher. A pregnant woman can make up to about $33,995 per year and get Medi-Cal.
Starting in 2026, Medi-Cal is no longer allowing people age 19 or older who don't have proper legal documentation of their immigration status to enroll in Medi-Cal. This means if you're an "undocumented" immigrant or can't show sufficient proof of your immigration status, you can't get Medi-Cal coverage.
When is Medi-Cal free?
Starting in 2022, Medi-Cal is free for everyone who qualifies.
However, you may still have to pay for some of your medical bills depending on your income and the Medi-Cal program you're in.
What is Medicare, and who’s eligible?
Medicare, unlike Medi-Cal, is a national health care program that's funded and operated by the federal government.
Most people become eligible for Medicare by turning 65.
This means you can qualify without having to meet income or health status, which is a big difference from Medi-Cal and other state Medicaid programs.
About 7 million people with disabilities or medical conditions such as end-stage renal disease (ESRD) also qualify for Medicare. And like seniors in the program, these beneficiaries do not have to meet income requirements.
Medicare coverage is based on each person's eligibility. It won't cover your family members or spouse. For example, a couple can become eligible for Medicare at different times based on when each person’s 65th birthday is. That differs from Medi-Cal, where coverage can extend to family members within the household when the program’s income requirements are met.
Medicare is divided into four parts, and each part corresponds with at least one specific area of care.
- Part A helps to pay for hospitalizations and short-term skilled nursing facility care and hospice. Most beneficiaries do not pay premiums because they have paid Medicare tax through employment for at least 10 years.
- Part B helps to pay for outpatient care such as doctor appointments. Beneficiaries are required to pay a Part B premium of $202.90 a month, and those who have higher incomes will pay more. Plus, beneficiaries are required to meet an annual deductible of $283 before Medicare Part B coverage begins.
- Part C, also known as Medicare Advantage, provides "all-in-one coverage" encompassing Medicare Parts A and B and usually prescription drug coverage. Costs will vary, and on average, a Medicare Advantage plan costs $27 per month, on average, on top of what you pay for Medicare Part B.
- Part D provides prescription drug coverage for beneficiaries enrolled in Parts A and B but not enrolled in Medicare Advantage. The average cost is $62 per month.
Another add-on for those who are not enrolled in Medicare Advantage is a Medicare Supplement (Medigap) plan. Because Medicare Parts A and B only cover about 80% of your medical costs, a Medigap plan can fill in the coverage gaps so that you can spend less on your medical care.
Can you be enrolled in both Medi-Cal and Medicare?
You can get both Medi-Cal and Medicaid if you have a low income and you're also a senior or have a disability.
If you're enrolled in both programs, Medi-Cal and Medicare work together to coordinate coverage and provide care.
- Medi-Cal could help to pay for Medicare premiums, copayments and deductibles.
- Medi-Cal also provides extra benefits beyond what's usually included with Medicare Parts A and B, covering prescription drugs, dental, vision care, extended stays in skilled nursing facilities and long-term care in nursing homes.
If you have a low income (including those enrolled in Medi-Cal and Medicare), you may qualify for free or low-cost prescription drug coverage through Medicare's Extra Help program.
Plus, many Medicare Advantage plans offered in California are Special Needs Plans (SNPs) that are specifically designed for those who are dually eligible for Medicare and Medi-Cal.
Frequently asked questions
Is Medicare the same as Medi-Cal?
No. Medicare and Medi-Cal are two separate health insurance programs. Medicare is available nationally to cover seniors and people under the age of 65 with certain disabilities. Medi-Cal is California’s Medicaid program, covering those who have a low-income.
What’s the maximum income to qualify for Medi-Cal?
In general, to qualify for Medi-Cal, a single adult can earn up to $22,025 per year and a couple can earn up to $29,863 per year. Certain Medi-Cal programs, such as those for children and pregnant women, have higher income limits that make it easier to qualify.
How much is Medi-Cal per month?
All Medi-Cal programs are free and there isn't a monthly rate. Before a 2022 policy change, some people had a monthly cost for Medi-Cal insurance.
What is the difference between Medi-Cal and Covered California?
Medi-Cal, California’s Medicaid program, provides free and low-cost health care coverage to those who have a low income. Covered California is the state's health insurance marketplace, where people can shop for health insurance plans and qualify for subsidies to get discounted rates.
Methodology and sources
Average rates for Medicare Advantage and Part D plans are from the Centers for Medicare & Medicaid Services (CMS) public use files.
Medicare Advantage rates are for plans that include prescription drug coverage. Employer-sponsored plans, health care prepayment plans (HCPPs), Medicare medical savings account (MSA) plans, Program of All-Inclusive Care for the Elderly (PACE) plans, sanctioned plans and Special Needs Plans were excluded. Part D rates are for both basic and enhanced coverage. Rates for both Medicare ADvantage and Part D plans include costs for all 50 states and Washington, D.C. but exclude U.S. territories.
Other sources include:
- California Department of Health Care Services
- CA.gov
- California Health Care Foundation
- Covered California
- Medicaid.gov
- Medicare.gov
- U.S. Department of Health & Human Services (HHS)
About the Author
Insurance Writer
Cate Deventer is a ValuePenguin writer who specializes in health insurance, Medicare, auto and home insurance. She's been a licensed insurance agent since 2011.
She started her insurance career working as a customer service agent for State Farm. She later moved to an independent agency, where she worked with several insurance companies and hundreds of clients. She quoted policies, filed claims and answered insurance questions. In 2021, she pivoted her career and began writing about insurance for Bankrate. She moved to ValuePenguin in 2023 and began writing about health insurance and Medicare.
Cate has a passion for helping readers choose insurance to fit their needs. She enjoys knowing that her research and knowledge help people choose insurance products that make a positive difference in their lives.
How insurance helped Cate
Cate used her health insurance knowledge to navigate a surgery in 2023. Understanding how her policy worked let her focus on recovery instead of worrying about bills.
Expertise
- Health insurance
- Medicare & Medicaid
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- Home insurance
- Life insurance
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- Licensed Life, Accident & Health Insurance Agent
- Licensed Property & Casualty Insurance Agent
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- BA, Theatre, Purdue University
- BA, English, Indiana University
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