What’s the Difference Between Medicare and Medi-Cal?

Medicare and Medi-Cal are government-run health insurance programs with Medicare being run by the federal government and Medi-Cal being run jointly by the state of California and federal bodies. While there are costs associated with Medicare, Medi-Cal can be free depending on your income.

Read to find out about the differences between Medicare versus Medi-Cal.

On This Page

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  What Is Medicare?

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  What is Medi-Cal?

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  Is Medi-Cal the Same as Medicare?

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  Do I Need To Enroll in Medicare if I Have Medi-Cal?

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  How Do I Sign Up for Medicare and Medi-Cal?

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  FAQs

What Is Medicare?

Medicare is a federal health insurance program in the United States that primarily serves individuals aged 65 and older, though it also covers some younger people with certain disabilities and medical conditions like end-stage renal disease. Established in 1965, the program is funded by payroll taxes, premiums and federal revenue.^[1]

Medicare is divided into different parts that cover various healthcare services:

• Part A covers hospital care
• Part B covers outpatient services
• Part D covers prescription drugs

Part C, also known as Medicare Advantage, offers an alternative way to receive Original Medicare benefits through private insurance plans.

Am I Eligible for Medicare?

To be eligible for Medicare, individuals must also be U.S. citizens or legal residents who have lived in the United States for at least five consecutive years.^[2]

How Much Does Medicare Cost?

The table below breaks down the costs of each part of Medicare.^[3]

What is Medi-Cal?

Medi-Cal is California's Medicaid program, providing publicly-funded health insurance to low-income individuals, families and children in the state. It covers a broad range of medical services, including hospital and doctor visits, prescription drugs, mental health care and other preventive and treatment services. The program is jointly funded by the state of California and the federal government.

Am I Eligible for Medi-Cal?

Eligibility for Medi-Cal is primarily based on income level, family size and household composition, with certain income thresholds set relative to the federal poverty level. Additionally, other factors such as age, disability, pregnancy and immigration status can affect eligibility.

Medi-Cal also has specialized programs to cover certain groups like children, pregnant women, elderly individuals and those with specific diseases or conditions, each with its own set of eligibility criteria. You can find a list of these programs here.

How Much Does Medi-Cal Cost?

As of July 1, 2022, premium payments for Medi-Cal were for the most part reduced to zero.^[4] This includes any cost-sharing such as copays, coinsurance and deductibles. However, those with children enrolled in Medi-Cal or the Children's Health Insurance Program (CHIP) may have to pay $13 per month per child, up to $39 per family.^[5]

What’s the Maximum Income To Qualify for Medi-Cal?

Medi-Cal generally uses 138% of the federal poverty level and household size to determine eligibility. The following table shows you the income qualifications based on family size.^[6]

Some groups may find it easier to qualify for Medi-Cal. Pregnant women, for example, with incomes between 138% and 213% of the FPL can receive pregnancy-related Medi-Cal coverage.^[7] This includes a wide range of services necessary for the health of the mother and unborn child, from prenatal to postpartum care. Providers need to document a pregnancy diagnosis code for reimbursement.

Is Medi-Cal the Same as Medicare?

Contrary to some misconceptions, Medicare and Medi-Cal are not the same programs. Both are government-sponsored health insurance programs but they serve different populations and have distinct eligibility criteria, coverage options and cost structures.

What Are the Differences Between Medicare and Medi-Cal?

The image below has been made to help further highlight the many differences between Medi-Cal versus Medicare.

We've also provided a table going deeper into the differences between these two government-funded healthcare programs.

Do I Need To Enroll in Medicare if I Have Medi-Cal?

You are not required to enroll in Medicare if you have Medi-Cal; however, doing so could be financially advantageous and may broaden the coverage for the 1.6 million beneficiaries who are dually eligible.^[8] For instance, those with full Medi-Cal coverage and Medicare will automatically be enrolled in Medicare Extra Help, providing discounts on Part D premiums, deductibles, coinsurance and copays. Keep in mind that if you are receiving Social Security benefits, you will be automatically enrolled in Medicare when you turn 65.^[9]

How Do I Sign Up for Medicare and Medi-Cal?

Medicare and Medi-Cal have different enrollment processes. See below to get a better understanding of how to get coverage from either program.

Enroll in Medicare

You can enroll in Medicare either online or via phone through Social Security, providing details like your Social Security number, birthplace, current health insurance and email address.

The initial enrollment period for Medicare is a seven-month period surrounding your 65 birthday.^[10] If you don’t sign up then, you can always get Medicare during general enrollment between January 1 and March 31.^[11]

Enroll in Medi-Cal

You can apply for Medi-Cal by mailing in a Single Streamlined Application, applying in person at a County Social Services Office or online via the Covered California Website.

Unlike Medicare, you can enroll in Medi-Cal year-round.^[12] There is no open enrollment window.