Can I have both Medi-Cal and Covered California?

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You cannot enroll in both Medi-Cal and a subsidized Covered California plan at the same time.

Rules for Enrollment

  • Choose one: You must pick either Medi-Cal or Covered California for your personal coverage.
  • No dual subsidies: If you qualify for Medi-Cal, you cannot get government financial help (subsidies) to pay for a private Covered California plan.
  • Single application: You use the same application for both. The system checks your income and places you in the correct program.

Mixed Households

  • Different members: A household can have a "mixed program" setup.
  • Example: Parents might buy a plan through Covered California while their children qualify for Medi-Cal based on different income rules.

Can I have both Medi-Cal and private insurance?

✅ Yes, you can have both Medi-Cal and private health insurance at the same time.

💡 How Dual Coverage Works

  • Primary Payer: Your private insurance pays first for all covered medical care.
  • Secondary Payer: Medi-Cal acts as the secondary payer of last resort.
  • Claim Order: Providers must bill your private insurance first, then submit the remaining balance to Medi-Cal.
  • No Balance Billing: Providers who accept Medi-Cal cannot charge you for remaining copays or balances.

⚠️ Important Rules to Consider

  • Provider Network: The doctor or hospital must accept Medi-Cal as a secondary insurer to process remaining costs.
  • Marketplace Subsidies: You cannot receive financial subsidies (tax credits) through Covered California while simultaneously enrolled in free Medi-Cal.
  • Reporting Requirement: You must legally report your private insurance (Other Health Coverage) to the California Department of Health Care Services.

What is the 3 month rule for Medi-Cal?

The "3-month rule" in Medi-Cal most commonly refers to the three-month grace period to re-enroll after losing coverage, or historically, the 3-month retroactive coverage period for past medical bills.

1. Three-Month Re-enrollment Grace Period

  • What it is: If your full-scope Medi-Cal coverage ends (such as missing a renewal deadline), you have a 3-month window to sign up again and restore your full benefits.
  • Who it affects: Recently, under updated enrollment guidelines for certain adult groups (such as specific adult immigrants or those undergoing eligibility transitions), missing this 3-month re-application window means you may lose full-scope coverage and be downgraded to restricted-scope Medi-Cal (which only covers emergency, pregnancy, and nursing home care).
  • Managed Care Plan Protection: If you temporarily lose Medi-Cal and re-enroll within 3-month grace parameters, you can also retain your previous health plan.

2. Retroactive Coverage (Past Medical Bills)

  • What it is: Medi-Cal previously allowed up to 3 months of retroactive coverage, meaning the program could help pay for medical services you received in the three months before the month you officially applied, provided you were eligible during those months.
  • Current Limits: Due to recent federal policy adjustments, retroactive coverage has been shortened for many groups (reduced to 1 month for ACA expansion adults and 2 months for children, older adults, and individuals with disabilities). You must request retroactive help through your local county social services office within one year of receiving the service.

What will disqualify you from Medi-Cal?

Exceeding income limits, having excess assets (for seniors or people with disabilities), or failing to meet residency and renewal requirements will disqualify you from Medi-Cal.

Income Limits

  • Adults (Ages 19–64): Household income above 138% of the Federal Poverty Level (FPL) can disqualify you from free coverage, though higher earners may qualify for a "share of cost" or Covered California.
  • Aged, Blind, and Disabled: Strict monthly income caps apply depending on your specific category.

Asset Limits (Seniors 65+ and Disabled Individuals)

  • Excess Property/Cash: For non-MAGI programs (seniors and disabled individuals), countable assets over $130,000 for a single person or $195,000 for a couple will disqualify you.
  • Asset Transfers: Transferring assets for less than fair market value within the 30-month look-back period can trigger penalties and loss of long-term care coverage.

Residency and Documentation

  • State Residency: You must be a resident of California. Moving out of state permanently disqualifies you.
  • Failure to Renew: Not responding to annual eligibility checks or failing to report household changes within 10 days can result in termination.
  • Immigration Status Rules: New enrollment restrictions apply to certain undocumented adults under current state guidelines.

You can check your status or ask questions through the Medi-Cal Helpline.

What is the downside of Medi-Cal?

The primary downsides of Medi-Cal include limited doctor networks, longer wait times for appointments, and strict income or asset rules.

Limited Provider Access and Wait Times

  • Fewer Doctors: Many physicians and specialists do not accept Medi-Cal because the state reimbursement rates are lower than private insurance or Medicare.
  • Longer Waits: Finding a doctor who takes new Medi-Cal patients can be difficult, leading to longer wait times for specialized care.
  • Restricted Networks: Your choice of hospitals and medical groups may be more restricted compared to private plans found through Covered California.

Strict Rules and Paperwork

  • Income and Asset Limits: Qualification depends strictly on your income, and certain programs enforce asset limits or look-back periods on transferred property or gifts.
  • Renewal Challenges: You must complete regular renewal paperwork. Missing a notice or failing to update your address can result in losing coverage due to administrative errors.

Covered California Vs. Medi-Cal: What’s the Difference?

9 related questions found

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

For most adults, the highest annual income to qualify for free, comprehensive Medi-Cal is 138% of the Federal Poverty Level (FPL), which is $21,597 for a single person and $44,367 for a family of four.

Income limits change depending on your household size, age, and specific program guidelines.

Income Limits by Household Size (138% FPL for Adults)

  • 1 person: $21,597 per year (about $1,800 per month)
  • 2 people: $29,187 per year (about $2,432 per month)
  • 3 people: $36,777 per year (about $3,065 per month)
  • 4 people: $44,367 per year (about $3,697 per month)
  • Each additional person: Add $7,590 per year

Higher Income Limits for Specific Groups

  • Children (Ages 0–19): Qualify with household incomes up to 266% FPL (e.g., up to $41,629 for a single-child household or $85,519 for a family of four).
  • Pregnant Individuals: Qualify with household incomes up to 213% FPL under standard MAGI rules, and specialized programs can extend higher depending on specific family size and medical needs.
  • Share of Cost (SOC): If your income is higher than the free Medi-Cal limit, you may still qualify for Medi-Cal with a Share of Cost. This works like a monthly deductible where you pay a set amount of medical bills before Medi-Cal starts paying.

You can review the full breakdown of limits on the Department of Health Care Services Eligibility Chart.

Is it better to have Medi-Cal or Covered California?

Medi-Cal is better if you have a lower income and need free coverage, while Covered California is better if you earn a higher income and want more doctor choices. You cannot typically choose between them freely; your household income decides which program you get.

Medi-Cal

  • Cost: Most people pay $0 for monthly premiums, deductibles, and co-pays.
  • Income Limit: Generally for individuals making at or below 138% of the Federal Poverty Level.
  • Doctors: Choices are more limited, and fewer specialists accept it.
  • Enrollment: You can sign up at any time during the year.
  • Read more details on the Medi-Cal Eligibility & Covered California FAQ.

Covered California

  • Cost: You pay a monthly premium, but 90% of people get financial help or subsidies to lower the cost.
  • Income Limit: For people who make more than 138% of the Federal Poverty Level.
  • Doctors: You get a wider choice of private insurance companies and bigger doctor networks.
  • Enrollment: You must sign up during open enrollment or after a major life event.
  • Learn more from the Covered California vs Medi-Cal guide.

Is Trump cutting Medi-Cal?

President Donald Trump's 2025 tax and budget legislation enacted federal cuts to Medicaid, which is leading to significant funding reductions and new restrictions for California's Medi-Cal program.

Impact on Medi-Cal

  • Funding Reductions: Federal legislation is projected to cut Medicaid spending by roughly $1 trillion nationally over a decade, translating to an estimated loss of around $30 billion per year for Medi-Cal in California.
  • Work and Eligibility Rules: The changes impose new 80-hour monthly work or community engagement requirements, more frequent six-month verification rules, and reduced retroactive coverage limits.
  • Coverage Loss: Policy analysts and state reports (such as those from CalMatters) estimate that millions of residents could lose coverage or face stricter qualification limits due to these federal shifts and related administrative changes.
  • Immigrant Eligibility: Federal rules have narrowed full-scope Medicaid definitions for certain non-citizens, though state adjustments have attempted temporary stopgap coverage for some impacted groups.

Further administrative actions by the Centers for Medicare & Medicaid Services (CMS) continue to roll out rules that expand these federal cuts.

What is the income limit for Medi-Cal 2026?

For most adults aged 19 to 64, the income limit for free Medi-Cal in 2026 is 138% of the Federal Poverty Level (FPL), which equals an annual income of $21,597 ($1,800 a month) for a single person.

2026 Income Limits by Household Size (138% FPL)

For the general adult expansion group, qualifying yearly limits are:

  • Family of 1: $21,597 per year
  • Family of 2: $29,187 per year
  • Family of 3: $36,777 per year
  • Family of 4: $44,367 per year
  • Each extra person: Add $7,590 per year

Income Limits for Other Groups

Limits vary depending on your category:

  • Children (0–19): Up to 266% of the FPL
  • Pregnant Individuals: Up to 213% of the FPL (with higher limits up to 322% for specific programs like MCAP)
  • Aged, Blind, and Disabled (ABD): Non-MAGI monthly guidelines apply (for instance, individual limits around $1,856/month may apply depending on the specific program stream, or higher with a "Share of Cost").

How much money can I have in my bank account for Medi-Cal?

How much money you can have in your bank account for Medi-Cal depends on which type of Medi-Cal program you are enrolled in.

The asset and resource rules for California's Medicaid program operate under the following limits:

1. Most Adults & Children (MAGI Medi-Cal)

If you qualify for Medi-Cal based primarily on your income (such as lower-income adults ages 19–64, pregnant individuals, and parents/children), there is no asset limit. Your bank account balance, savings, and investments do not affect your eligibility at all; only your monthly income is evaluated.

2. Older Adults & People with Disabilities (Non-MAGI Medi-Cal)

If you are age 65 or older, blind, disabled, or need long-term nursing home care, California has reinstated asset tests.

  • Current Limit (Through June 30, 2027): You can have up to $130,000 in countable assets for an individual ($195,000 for a married couple). You can add $65,000 for each additional household member up to 10 people.
  • Upcoming Limit (Starting July 1, 2027): The asset limit is scheduled to drop to $21,000 for an individual and $31,000 for a couple (plus $1,550 for each additional household member).

Note: Money in checking, savings, and digital wallets (like Venmo or Apple Pay) all count toward these totals. However, your primary home, one vehicle, and household goods are exempt from being counted.

3. SSI-Linked Medi-Cal

If you receive Supplemental Security Income (SSI), your Medi-Cal is automatically tied to your SSI eligibility. SSI retains a strict federal bank account and resource limit of $2,000 for a single person or $3,000 for a married couple.

How to protect your savings

If you have a disability and are worried about the asset limit, you can save money without affecting your Medi-Cal eligibility by using a CalABLE Account. CalABLE allows eligible individuals to save up to $529,000 tax-free for qualified disability expenses, and these funds are entirely excluded from standard Medi-Cal asset limits.

For more details on what resources are counted and how to complete your renewals, you can review the official California Department of Health Care Services Asset FAQs.