Medicare is the federal health insurance program that provides broad-based coverage for inpatient care, outpatient treatment, doctors’ visits, preventive care and medical testing. Medicare is limited to seniors age 65 and older and disabled individuals. People from any state can qualify for the program.
Medi-Cal is California’s Medicaid health care program. It is a joint state-federal health insurance program for low-income residents. Eligible low-income U.S. residents of any age can access Medi-Cal benefits, although they must be residents of California.
How Medicare Works
Original Medicare is the government-run health insurance program. It’s comprised of Part A and Part B. Medicare Part A pays most of the cost of inpatient hospital care for individuals enrolled in the program, while Part B helps pay the cost for emergency room visits that don’t result in hospital admission, outpatient care in medical offices and allied health services.
There are other optional Medicare programs. Medicare Part D provides prescription drug coverage, which helps beneficiaries cover the cost of their medications. Medicare Advantage or Medicare Part C plans are available as an alternative to Original Medicare. These plans are administered by individual private health insurance companies that meet Medicare’s guidelines. All authorized Part C plans must provide the benefits of Parts A and B, and most include extra benefits, such as vision and dental coverage. Many Part C plans also include prescription drug coverage.
How Medi-Cal Works
Medi-Cal is California’s Medicaid program. Medicaid is partly funded by the federal government and partly by the state. In California, Medi-Cal provides unified health insurance benefits that cover all necessary medical expenses up to the program’s limits.
California residents who need low- or no-cost health coverage can sign up for Medi-Cal online or through an intake worker at their county’s Office of Human Services. Once approved, benefits may be retroactively applied to medical expenses incurred over the prior few months. Medi-Cal benefits include some services that aren’t covered by Medicare, such as non-emergency transportation to and from medical appointments.
Eligibility and Benefits for Each Program
Participation in both Medicare and Medi-Cal is limited to U.S. citizens and permanent legal residents. Medi-Cal beneficiaries must be residents of California and may be of any age, while Medicare is open to all eligible U.S. residents aged 65 and over. Individuals receiving Social Security or Railroad Retirement Board disability benefits and those with certain chronic medical conditions qualify for Medicare coverage before age 65. Medi-Cal participation requires verification of income and assets. Individuals whose income is higher than the no-cost threshold but lower than the program cutoff may qualify for share-of-cost coverage.
People who meet the eligibility requirements for Medicare and Medi-Cal may qualify for both programs. These “dual-eligible” beneficiaries can use both programs to cover the cost of their medical care. In these cases, Medi-Cal benefits act as a Medicare supplement that reduces or eliminates beneficiaries’ Medicare deductibles and other point-of-service costs. Medi-Cal benefits can’t be used to reduce or pay monthly Medicare premiums.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
