Medicare Vs Medi-Cal

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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.

Medicare is federal health insurance that is age-based. It helps seniors 65 or older and those with specific disabilities and illnesses.

Medicare eligibility

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 California’s Medicaid program, which serves low-income families, the blind, pregnant women and more.

Medi-Cal eligibility

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

  • Pregnant

  • Blind

  • Disabled

  • Live in a nursing home

  • Foster children

  • Refugee

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.

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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

  • Federal program
  • California state program

What it does

  • Health coverage for people 65 or older, or those with disabilities or certain diseases
  • Health coverage for low-income individuals and families.

Who is eligible

  • People 65 years or older
  • People of any age with specific disabilities
  • People with end-stage renal disease
  • California residents
  • Low-income people of any age
  • The blind
  • Pregnant women

What it covers

  • Hospital facilities (Part A)
  • Doctors (Part B)
  • Prescription drugs (Part D)
  • Durable medical equipment
  • Deductibles and copays
  • Doctor visits
  • Dental care
  • Hospital and nursing-home care
  • Hospice care
  • Home health care
  • Adult day care centers
  • Long-term nursing facilities
  • X-ray and laboratory tests
  • Certain prescription drugs
  • Hearing aids
  • Medical equipment
  • Prosthetics and orthopedics
  • Medical transportation

What it costs

  • Low monthly premiums
  • Deductible for hospital stays
  • Possible out-of-pocket expenses
  • No premiums
  • Potential co-payment

Who pays first

  • Medicare pays first for healthcare services like lab tests, doctor's visits, prescription drugs and hospital stays
  • Medi-Cal pays for Medicare co-payments, deductibles and coinsurance
  • Prescription drugs not covered by Part D plan
  • Long-term and nursing home care

How to enroll

  • Three months before or after your 65th birthday
  • During Oct 15th - Dec 7th open enrollment
  • Enroll any time

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.

If you want to buy Medicare Advantage or Prescription Part D, SmartFinancial can find you the cheapest rates for free.


Is Medi-Cal part of Medicare?

While similar, Medi-Cal and Medicare are two very different programs. Medicare is a federally-run and funded program that provides health insurance to seniors 65 and older and those with severe disabilities or end-stage renal disease. At the same time, Medi-Cal is California's state-run and funded program that provides health coverage to very low-income families, pregnant women, the blind and more.

Can you be on Medicare and Medi-Cal at the same time?

Yes, you can have both Medicare and Medi-Cal at the same time, making you dual-eligible if you qualify for both. Many people on Medi-Cal age into the Medicare program once they reach 65, and there are other forms of eligibility to allow for dual coverage.

Who pays first — Medi-Cal or Medicare?

If you are a dual-eligible beneficiary, Medicare pays costs first, and Medi-Cal pays second. Medi-Cal closes the gaps in Medicare coverage by providing additional benefits like dental care or long-term care.

What is the maximum income to qualify for Medi-Cal?

In 2022, an individual can earn up to $1,564 monthly and qualify for Medi-Cal. The annual maximum income to qualify for Medi-Cal is $18,755 for a single person. If you are a dependent under 19 years old, your household income must be 266% or less of the federal poverty line.

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.

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