Medicare vs. Medi-Cal in California

Medicare vs. Medi-Cal: The Basics

Feature	Medicare	Medi-Cal (Medicaid)
Type	Federal program	State program (California)
Eligibility	Age 65+, disability, or ESRD	Low-income residents of any age
Based on	Age or disability status	Income and resources
Funding	Federal payroll taxes, premiums	Federal and state funds
Premiums	Part B: $202.90/mo; Part A: usually $0	Usually $0
Provider choice	Any Medicare-accepting provider	Medi-Cal managed care network
Prescription drugs	Part D plans	Medi-Cal Rx
Long-term care	Very limited	Covers nursing home and IHSS

Dual Eligibility: Having Both Programs

More than 1.5 million Californians qualify for both Medicare and Medi-Cal. If you’re “dual eligible,” you get the best of both programs:

Medicare covers hospital stays, doctor visits, and medical equipment
Medi-Cal covers what Medicare doesn’t: long-term care, dental, vision, transportation, and In-Home Supportive Services (IHSS)
Medi-Cal may pay your Medicare premiums, deductibles, and copays
You automatically qualify for Extra Help with Part D costs

Dual-Eligible Special Needs Plans (D-SNPs)

If you qualify for both Medicare and Medi-Cal, you may benefit from a D-SNP — a special Medicare Advantage plan designed specifically for dual-eligible beneficiaries. These plans coordinate benefits from both programs and often include extra benefits.

Check for D-SNPs in your county →

How to Know If You Qualify for Medi-Cal

In California, Medi-Cal eligibility is based primarily on income. Generally, individuals with income up to 138% of the Federal Poverty Level qualify. For 2026, that’s approximately:

Individual: ~$20,783/year
Couple: ~$28,208/year

Seniors 65+ can qualify for Medi-Cal through the Aged & Disabled program with different income limits.

Cal MediConnect and Coordination

California has programs to help coordinate Medicare and Medi-Cal benefits, making it easier for dual-eligible beneficiaries to navigate both systems. Talk to a HICAP counselor or a licensed agent to understand your options.

What is the difference between Medicare and Medi-Cal?

Medicare is a federal program based on age (65+) or disability. Medi-Cal is California's Medicaid program based on income. Medicare covers medical care; Medi-Cal covers long-term care, dental, vision, and more.

Can I have both Medicare and Medi-Cal?

Yes. Over 1.5 million Californians are dual eligible. Medi-Cal can pay your Medicare premiums and cost-sharing, and covers benefits Medicare doesn't, like long-term care and dental.

What is a D-SNP plan?

A Dual-Eligible Special Needs Plan is a Medicare Advantage plan designed for people who have both Medicare and Medi-Cal. It coordinates benefits from both programs in one plan.

How do I apply for Medi-Cal?

You can apply through Covered California at CoveredCA.com, at your county social services office, or by calling 1-800-541-5555.