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

Asked by: Brandi Feeney  |  Last update: February 11, 2022
Score: 4.7/5 (66 votes)

Medicare provides health coverage to individuals 65 and older or those with a severe disability regardless of income, whereas Medi-Cal (California's state-run and funded Medicaid program) provides health coverage to those families with very low income, as well as pregnant women and the blind, among others.

Is Medicare and Medi-Cal the same thing?

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 a person have both Medicare and Medi-Cal?

Medi-Cal, the Medicaid program in California, provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. ... People who qualify for both Medicare and full Medi-Cal are known as “dual eligibles” or “Medi-Medis.”

Is Medi-Cal part of Medicare?

Medicare has 3 parts—Part A, B and D. Medi-Cal is your secondary insurance. Medi-Cal closes the gaps in Medicare coverage and provides additional benefits not covered by your Medicare.

What does Medi-Cal cover?

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.

Difference Between Medicare and Medicaid and Medi-Cal?

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How much is Medi-Cal per month?

How much are the premiums? The premiums for Medi-Cal for Families are $13 for each child and no more than $39 per family per month. What can I do if I disagree with paying a monthly premium? Monthly premiums must be paid for the child(ren) to remain eligible for this Medi-Cal program.

What are the two types of Medi-Cal?

This guidebook explains the two kinds of Medi-Cal: Regular Medi-Cal and Medi-Cal Health Plans.

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”.

Is Medicare free after the age of 65?

Most people age 65 or older are eligible for free Medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance (Part B) by paying a monthly premium. ... To learn more, read Medicare Premiums: Rules For Higher-Income Beneficiaries.

Does Medi-Cal check your bank account?

Yes. Asset tests are a part of Medicaid eligibility requirements. Medi-Cal is the State of California's Medicaid program. Bank accounts are one of the easier tests for the government to make.

What is the income limit for Medi-Cal 2021 in California?

According to Covered California income guidelines and salary restrictions, if an individual makes less than $47,520 per year or if a family of four earns wages less than $97,200 per year, then they qualify for government assistance based on their income.

What is the income limit for Medi-Cal 2022?

In 2022, the MMMNA in CA is $3,435 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse to bring their monthly income up to this level.

Is Medi-Cal Medicare Advantage?

Medicare Advantage Plans are a type of Medicare health plan offered by private companies that contract with Medicare to provide Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. ... MA plans pay first, and Medi-Cal pays any remaining cost sharing amounts.

What is the biggest difference between Medicare and Medicaid?

The biggest difference between Medicare and Medicaid is who's eligible. Medicare is based on age or disability. Medicaid is based on income: You're eligible for medicare if you're 65 or over or have a specific illness.

Does Medi-Cal include dental?

Medi-Cal offers comprehensive preventative and restorative dental benefits to both children and adults. You can find a Medi-Cal dentist on the ​ Medi-Cal Dental Provider Referral List, or by calling 1-800-322-6384.

What is Medicaid vs Medi-Cal?

Actually, the good news is – there is no difference between the two. Medi-Cal health insurance is merely California's Medicaid program, which is paid for with federal and state tax revenues.

Does Medi-Cal cover prescriptions?

Medi-Cal will cover most prescriptions. In order to be covered, first, the prescription has to allow you to stay healthy or treat a medical problem. ... If your doctor is prescribing a medication that is not on the pre-approved list, your doctor will need to provide an explanation why that specific drug is needed.

Can You Get Covered California if you are over 65?

Anyone who completes a Covered California application is automatically screened to see if they qualify for Medi-Cal. A Medicare beneficiary whose income is low or who meets other requirements may qualify if they are over age 65, blind or have other disabilities.

Is Medi-Cal HMO or PPO?

Medi-Cal is health insurance for people with low incomes. Some counties have Medi-Cal Managed Care, in which the State contracts with HMO plans to provide health care services to Medi-Cal members.

Do I have to choose a plan for Medi-Cal?

Most people who have Medi-Cal must enroll in a medical plan. You or a member of your family must choose a medical plan if: You get CalWorks benefits (cash aid, food stamps)

Does Kaiser ER accept Medi-Cal?

Individuals who qualify for Medi-Cal will have no or low monthly premiums, no copays, and no out-of-pocket costs for most covered services. ... All of our available doctors accept Kaiser Permanente members with Medi-Cal coverage.

What disqualifies Medi-Cal?

If a person has more than the limit for a whole month, Medi-Cal benefits will be discontinued. A person's home, furnishings, personal items, and one motor vehicle are not counted. A single person is allowed to keep $2,000 in property/assets, more if they are married and/or have a family.

What is needed for Medi-Cal?

You can also get Medi-Cal if you are:
  • 65 or older.
  • Blind.
  • Disabled.
  • Under 21.
  • Pregnant.
  • In a skilled nursing or intermediate care home.
  • On refugee status for a limited time, depending how long you have been in the United States.
  • A parent or caretaker relative of an age eligible child.

What happens if my income increases while on Medi-Cal?

(See Updated Medi-Cal Estate Recovery Rules.) ... Just because your income increased, doesn't mean you were ineligible for Medi-Cal. It is permissible to have both Medi-Cal and commercial private health insurance plan like an individual and family plan. This applies to adults as well as children.