What's the difference between Medi-Cal and Medicare?

Asked by: Kayley Swift  |  Last update: September 27, 2023
Score: 4.3/5 (23 votes)

Medi-Cal is California's Medicaid health care program. Medi-Cal pays for a variety of medical services for children and adults with limited income and resources. Medicare is a federally funded insurance program for eligible participants 65 or over.

Can you have Medi-Cal and Medicare together?

Some people qualify for both Medicare and Medi-Cal and are “dual eligible” or Medi Medi beneficiaries. When an individual has both Medicare Parts A and B, Medicare is the primary insurance and pays for most medical care.

Does Medi-Cal cover more than Medicare?

Medi-Cal also provides additional benefits beyond what's usually included with Medicare Parts A and B, covering prescription drugs, dental, vision care, extended stays in skilled nursing facilities and long-term care in nursing homes.

What's the difference between Medicaid and Medi-Cal?

Medi-Cal is what we call the joint Federal-State Medicaid program in California (just like Covered California is what we call Obamacare in California). Medi-Cal and Medicaid are essentially the same thing.

What is the downside of Medi-Cal?

There is a fundamental problem with Medi-Cal that is hindering patient access to care, and to specialists in particular – Medi-Cal physician reimbursement is so low that physicians cannot cover the cost of providing care.

Difference Between Medicare and Medicaid and Medi-Cal?

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Does Medi-Cal cover all bills?

Medi-Cal covers most medically necessary care. This includes doctor and dentist appointments, prescription drugs, vision care, family planning, mental health care, and drug or alcohol treatment. Medi-Cal also covers transportation to these services. Read more in “Covered Benefits” on page 12.

How much income is too much for Medi-Cal?

Most single individuals will qualify for Medi-Cal if there income is under $1,676 per month. Most couples will qualify if their income is under $2,267 per month. If you have disabilities, your income can be slightly higher. You can qualify for Medi-Cal even if you have assets.

Is Medi-Cal free?

Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements. Most applicants who apply through Covered California and enroll in Medi-Cal will receive care through managed health plans.

What happens to my Medi-Cal when I turn 65?

If you qualify for Supplemental Security Income (SSI), you automatically qualify for full Medi-Cal coverage. To qualify for SSI, you must be age 65 or older, blind or disabled.

What does it mean to be on Medi-Cal?

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources.

Does Medi-Cal cover surgery?

medications. Inpatient hospital services • Anesthesiologist services • Surgical services (bariatric, reconstructive surgery, etc.) Organ & tissue transplantation • Outpatient laboratory and X-ray services o Various advanced imaging procedures are covered based on medical necessity.

Is Medicare free in California?

Medicare Part A is usually free if you or your spouse paid Medicare payroll taxes for approximately ten years while working (this is called “premium-free Part A”). If you don't qualify for premium-free Part A, you may have the option to pay for hospital insurance, also called “premium Part A”.

What other benefits can I get with Medi-Cal?

​​​​What are the Medi-Cal Benefits?
  • Outpatient (Ambulatory) services.
  • Emergency services.
  • Hospitalization.
  • Maternity and Newborn care.
  • Mental Health and Substance Use Disorder Services​
  • Prescription Drugs.
  • Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices.

What is the highest income to qualify for Medicaid?

Federal Poverty Level thresholds to qualify for Medicaid

The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. In 2023 these limits are: $14,580 for a single adult person, $30,000 for a family of four and $50,560 for a family of eight.

What are the different types of Medi-Cal?

​​​Find Out More About Medi-Cal Programs​​​
  • Medi-Cal Dental Program. Dental services are currently provided as one of the many benefits under the Medi-Cal program.
  • Fair Hearing. ...
  • Health Insurance Premium Payments. ...
  • Medi-Cal. ...
  • Medi-Cal Eligibility. ...
  • Medi-Cal Estate Recovery. ...
  • Medi-Cal Managed Care.

What age does Medi-Cal stop?

All California residents under the age of 26 who meet the eligibility requirements can qualify to receive Medi-Cal, regardless of U.S. citizenship or immigration status.

What are the benefits of Medi-Cal for seniors?

Medi- Cal provides many of the state's poorest seniors with vital health insurance coverage, including wrap- around coverage for medical services Medicare does not cover. It also provides a safety net for seniors re- quiring long-term care who have exhausted their own financial resources.

Does Medi-Cal expire every year?

Local Medi-Cal offices review each member's eligibility once a year or when they report changes to their household. Everyone's renewal date is different.

How much is Medi-Cal monthly?

Medi-Cal monthly premium amounts have been reduced to $0.00 effective July 1, 2022. Monthly billing and collection of premiums for the Medi-Cal for Families program will no longer be required.

Is Medi-Cal for poor families?

This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources.

Is Medi-Cal only for low income?

Medicaid income eligibility in California is based on household size. To qualify for free Medi-Cal coverage, you need to earn less than 138% of the poverty level, based on the number of people who live in your home.

What is California Medi-Cal changing to in 2023?

Starting January 2023, Medi-Cal health coverage for most remaining dually eligible beneficiaries changed from Fee-For-Service (FFS) Medi-Cal to Medi-Cal Managed Care.

Who is eligible for Medi-Cal seniors?

​​Basic Information​​ Beginning May 1, 2022, a new law in California will give full scope Medi-Cal to adults 50 years of age or older and immigration status does not matter. All other Medi-Cal eligibility rules, including income limits, will still apply.