Medicare Vs Medi-Cal
While Medicare and Medi-Cal are healthcare insurance assistance plans designed to help people, they are not the same. Medicare is federal health insurance that is age-based. It helps seniors 65 or older and those with specific disabilities and illnesses to access affordable healthcare, no matter their income level. Medicare can provide coverage for essential hospital services, outpatient care, diagnostic tests and prescription drugs, but it does not cover everything. Medi-Cal is California's Medicaid program, which is income-based, serving low-income families, the blind, pregnant women and more. Medi-Cal provides additional services that Medicare does not and fills in gaps in coverage. You can be eligible for both Medicare and Medi-Cal.
Let's take a closer look at both.
What is Medicare?
Established in 1965, Medicare is a federal health insurance plan available for people 65 or older, people with disabilities, and those of any age with certain illnesses like Amyotrophic Lateral Sclerosis or End-Stage Renal Disease. Medicare does not fully cover every medical expense; there are some regulations and limitations for what it will cover. There are two forms of Medicare: Original Medicare (Part A and Part B) is managed by the federal government. Part A covers hospital insurance and Part B covers physician services. Part D covers prescription drugs and can be purchased by anyone on Original Medicare. Medicare Advantage (Part C) is offered through private insurers. Part C often rolls Parts A, B and D together. The amount of coverage you get varies by the plan.
Not everyone is eligible for Medicare. You can qualify for Medicare benefits once you turn 65 or before 65 if you have specific disabilities or medical conditions. Some groups have mandatory eligibility, including anyone receiving Supplemental Security Income, pregnant women and children. If you think you are eligible for Medicare, or to find out if you qualify, you can use the Medicare eligibility tool online.
What is Medi-Cal?
Medi-Cal is California's no-cost or low-cost health insurance program that helps cover medical expenses for low-income families, individuals, seniors, pregnant women, those with disabilities and those with foster care children. Medi-Cal offers coverage for some medical services that Medicare does not cover, like hearing aids, dental services, adult daycare centers, long-term care and home health care. It can also help supplement Medicare premiums, copayments and deductibles.
Medi-Cal is available to U.S. citizens, permanent residents or legal aliens residing in California. You can qualify for Medi-Cal based on your income, age or if you have specific health issues. For instance, you can qualify if your monthly income is 138% less than the federal poverty level as a single person or if you are a dependent with a household income of 266% less than the federal poverty level. Medi-Cal is available in the following scenarios:
Age 65 or over
Under age 21
Live in a nursing home
If you think you are eligible for Medi-Cal, or to find out if you qualify, you can log into the Medi-Cal online portal.
Medicare vs. Medi-Cal: What Are the Differences?
Medicare is a federal insurance program that serves seniors 65 and up, no matter their income level, younger people with disabilities and dialysis patients. Medi-Cal is California's form of the Federal Medicaid program and serves low-income individuals of any age or families. They are both government-sponsored programs aimed at providing assistance for healthcare costs for American residents.
Below, we note a few critical takeaways between Medicare and Medi-Cal:
Type of Program
What it does
Who is eligible
What it covers
What it costs
Who pays first
How to enroll
Do I Need to Enroll in Medicare if I Have Medi-Cal?
You do not need to enroll in Medicare if you have Medi-Cal. Medi-Cal is a state-run, government-funded health insurance program designed to help low-income people. If you don't qualify for Medicare and are a U.S. citizen or permanent resident, you may still qualify for Medi-Cal.
People 65 or older or disabled may be eligible for both Medicare and Medi-Cal. If you qualify for both, you will get most of your prescription drugs and medical services through Medicare. Medi-Cal helps provide nursing home care, long-term services, vision care, dental care and other benefits that Medicare does not provide.
Cover Your Healthcare Needs
Those with Medicare may not have all their healthcare needs and costs covered. If you are not happy with your plan, you can shop around for Medicare Advantage, which also offers dental and vision coverage as well as prescription drug coverage. If you prefer to stay with Original Medicare you can buy Medigap (Medicare Supplements), especially Part D for prescription drugs.
However, if you're a low-income California resident, Medi-Cal can help bridge the gap between what Medicare covers and what you must pay for out-of-pocket.
If you want to buy Medicare Advantage or Prescription Part D, SmartFinancial can find you the cheapest rates for free. Just enter your zip code below and answer a few short questions to get started.
Compare Medicare Plans Online Now.
Looking for Medicare Plans?
Compare rates from dozens of companies in less than 3 minutes.