Understanding the Differences Between Medi-Cal, Medicaid, and Medicare

While Medi-Cal, Medicaid, and Medicare all provide healthcare coverage, they serve different populations and have distinct eligibility requirements. This guide breaks down their differences, who qualifies, and how they work—including options for dual eligibility for those who qualify for both Medicare and Medi-Cal.

1. Medicaid

What It Is:

Medicaid is a joint federal and state program that provides free or low-cost health coverage to low-income individuals and families. Each state administers its own Medicaid program within federal guidelines, so coverage and eligibility can vary.

Who Qualifies?

• Low-income adults

• Children

• Pregnant women

• Elderly individuals

• People with disabilities

• Generally, individuals with incomes at or below 138% of the Federal Poverty Level (FPL) qualify.

  • (In 2024, this is about $20,783/year for an individual or $43,056/year for a family of four.)

What Does Medicaid Cover?

• Doctor and hospital visits

• Lab tests, X-rays, and screenings

• Mental health services

• Vision & dental (varies by state)

• Prescription drugs (varies by state)

• Long-term care, including nursing homes

• Transportation to medical appointments

How to Apply for Medicaid?

• Apply through your state’s Medicaid office or Healthcare.gov.

• Eligibility depends on income, household size, disability status, and state rules.

2. Medi-Cal (California’s Medicaid Program)

What It Is:

Medi-Cal is California's version of Medicaid, offering similar coverage for low-income residents. It follows federal Medicaid guidelines but includes additional benefits specific to California.

Who Qualifies?

• Low-income California residents (adults, children, pregnant women, and seniors)

• Adults earning up to 138% of the FPL

• Individuals with certain disabilities and medical conditions

  
  

What Does Medi-Cal Cover?

• Everything covered by Medicaid, plus:

  • Prescription drugs

  • Vision & dental care

  • Mental health & substance abuse treatment

  • Long-term care & in-home support services

  • Transportation for medical visits

    
    

How to Apply for Medi-Cal?

• Apply through Covered California (California’s health insurance marketplace).

• Automatically eligible if receiving Supplemental Security Income (SSI).

3. Medicare

What It Is:

Medicare is a federal health insurance program primarily for seniors (65+) and certain younger individuals with disabilities.

Who Qualifies?

• People 65 and older who worked and paid Medicare taxes for at least 10 years.

• People under 65 with certain disabilities (receiving SSDI for at least 24 months).

• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease).

What Does Medicare Cover?

Medicare has four parts, each covering different aspects of healthcare:

• Part A (Hospital Insurance) – Covers hospital stays, skilled nursing facilities, hospice, and some home health care.

  • Cost: Free for most, up to $506/month if not eligible for premium-free coverage.

• Part B (Medical Insurance) – Covers doctor visits, outpatient care, preventive services, and medical equipment.

  • Cost: Monthly premium of $174.70 in 2024 + 20% coinsurance after meeting deductible.

• Part C (Medicare Advantage) – Private insurance plans that bundle Parts A & B (and often Part D, plus extras like dental & vision).

  • Cost: Varies by plan but often has lower out-of-pocket costs than Original Medicare.

• Part D (Prescription Drug Coverage) – Covers medications.

  • Cost: Varies by plan and income level.

How to Apply for Medicare?

• Automatically enrolled at age 65 if receiving Social Security benefits.

• If not, apply through Social Security (ssa.gov/medicare) starting 3 months before turning 65.

• Disabled individuals under 65 must apply through Social Security.

4. Dual Eligibility (Medicare + Medicaid/Medi-Cal)

Some individuals qualify for both Medicare and Medicaid (or Medi-Cal in California).

Who Qualifies for Dual Eligibility?

• Low-income seniors (65+) already on Medicare.

• Disabled individuals under 65 on Medicare with limited income.

How Dual Eligibility Works:

• Medicaid/Medi-Cal helps cover Medicare costs, including:

  • Part B premiums

  • Copays & deductibles

  • Long-term care (nursing home, in-home care)

• Dual-eligible individuals may qualify for Medicare Savings Programs (MSPs) for additional financial assistance.

• Some may enroll in Special Needs Plans (SNPs), which are Medicare Advantage plans designed for dual-eligible individuals.

5. Cost Comparison: Medicare vs. Medicaid vs. Medi-Cal

Program	Premiums	Copays/Deductibles	Who Pays?
Medicare Part A	Free (if paid Medicare taxes for 10+ years)	Deductible ($1,632 per benefit period in 2024)	Individual or Medicaid if eligible
Medicare Part B	$174.70/month (2024)	20% coinsurance after $240 deductible	Individual or Medicaid if eligible
Medicare Part C (Advantage)	Varies (often lower than Original Medicare)	Varies by plan	Private insurer
Medicare Part D	Varies by plan	Copays & coinsurance	Private insurer
Medicaid (varies by state)	Usually $0	Minimal or no copays	Government-funded
Medi-Cal (California)	$0 for most	Small copays for some services	Government-funded

Key Takeaways

✅ Medicare = Federal program for seniors (65+) & disabled individuals. Covers hospital, medical, and drug costs but has premiums/copays.

✅ Medicaid = State & federal program for low-income individuals. Covers most healthcare costs with little to no out-of-pocket expenses.

✅ Medi-Cal = California’s Medicaid program. Same as Medicaid but specific to California.

✅ Dual Eligibility = Some people qualify for both Medicare and Medicaid, which can cover additional costs like premiums and long-term care.

If you're unsure which program you qualify for, visit Healthcare.gov, SSA.gov, or your state Medicaid office for personalized guidance.