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

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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.

Key Takeaways

  • Medicare is federal health insurance that is age-based, serving seniors 65 or older and those with specific disabilities and illnesses no matter their income level.
  • Medi-Cal is California's Medicaid program, which is primarily income-based, serving low-income families, as well as the blind, pregnant women and more.
  • Medicare and Medi-Cal each have their own enrollment processes.
  • You can be enrolled in Medicare and Medi-Cal at the same time and having both can eliminate a substantial portion of your healthcare costs.
  • Medicare is primary insurance and pays first, while Medi-Cal will pay for expenses not covered by Medicare.

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]



Part A Premium

  • Free if you paid Medicare taxes for around 10 years
  • $278 or $506 if ineligible for free Part A depending on how long you or your spouse worked and paid Medicare taxes

Part A deductible and copayment

  • $1,600 deductible for each benefit period
  • Days 1-60: $0 after you pay your Part A deductible.
  • Days 61-90: $400 copayment each day.
  • Days 91-150: $800 copayment each day while using your 60 lifetime reserve days.
  • After day 150: You pay all costs.

Part B premium

  • $164.90 per month

Part B deductible and coinsurance

  • $226 deductible + 20% of most doctor services, outpatient therapy and medical equipment

Part C (Medicare Advantage) premium

  • Varies. Cost will include Part A and Part B premiums

Part D (Prescription drug coverage) premium

  • Varies. Cost will include Part A and Part B premiums

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]

Family Size

Maximum Household Income





​2 Adults






















​Each Additional Person

Add $7,094

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.

medicare versus medi-cal infographic

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






California only


Includes hospital care (Part A), outpatient services (Part B) and prescription drugs (Part D), with an option for private insurance plans through Medicare Advantage (Part C).

Includes hospital and doctor visits, prescription drugs, mental health care and preventive and treatment services

Program administrator

Department of Health & Human Services

California Department of Health Care Services

Individual and/or family coverage

Eligibility is for individuals, not families

Eligibility is for individuals and their immediate family members (household members)

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.

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Can I enroll and combine Medicare and Medi-Cal together?

You can be dually eligible for both Medicare and Medi-Cal, which allows you to have more comprehensive health services for lower costs.

What is the difference between covered California and Medi-Cal?

Covered California is the state’s health insurance marketplace where you can shop for, compare and buy insurance. Medi-Cal is a separate government program that provides free or low-cost health coverage for low-income families.

Is Medicare part of Medi-Cal?

Medicare is a federal program, while Medi-Cal is a state program. They are distinct but can be combined under certain conditions.

Who pays first — Medi-Cal or Medicare?

When you have both, Medicare generally pays first and Medi-Cal fills in the gaps in coverage.[13]

Are there penalties for canceling Medicare or Medi-Cal?

For Medicare, failing to enroll when you are first eligible could result in paying higher premiums when you finally do enroll. Medi-Cal does not have such penalties but disenrolling may leave you without coverage until you can reapply successfully.


  1. National Archives. “Medicare and Medicaid Act (1965).” Accessed September 8, 2023.
  2. Kaiser Family Foundation. “Can Immigrants Enroll in Medicare?” Accessed September 8, 2023.
  3. Medicare.gov. “Costs.” Accessed September 8, 2023.
  4. California Department of Health Care Services. “​​​​​​​​​​​​​​​​Medi-Cal Eligibility & Covered California - FAQs.” Accessed September 8, 2023.
  5. Covered California. “What Does Medi-Cal for Children Cost?” Accessed September 8, 2023.
  6. California Department of Health Care Services. “​​Do You Qualify for Medi-Cal Benefits?” Accessed September 8, 2023.
  7. California Department of Health Care Services. “Full Scope Medi-Cal Coverage and Affordability and Benefit Program for Low-Income Pregnant Women and Newly Qualified Immigrants.” Accessed September 8, 2023.
  8. California Department of Health Care Services. “Office of Medicare Innovation and Integration.” Accessed September 8, 2023.
  9. Social Security Administration. “When to Sign Up for Medicare.” Accessed September 8, 2023.
  10. Medicare.gov. “Joining a Plan.” Accessed September 8, 2023.
  11. Medicare.gov. “When Does Medicare Coverage Start?” Accessed September 8, 2023.
  12. California Department of Health Care Services. “My Medi-Cal: How To Get the Health Care You Need,” Page 6. Accessed September 8, 2023.
  13. California Department of Health Care Services. “​​​​​​​Medicare Advantage Options for Dual Eligible Beneficiaries .” Accessed September 8, 2023.

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