What is the difference between Medicare and Medi-cal?
Understanding the distinction between Medicare vs. Medi-Cal is critical, as both are essential government-run programs providing healthcare coverage to various segments of the American population. The primary difference between these two programs lies in their objectives, eligibility criteria, and types of benefits offered.
What Is Medicare?
Medicare is a federal program designed to provide health insurance primarily to individuals 65 years of age or older or younger people with specific disabilities. Medicare coverage can include preventative care, inpatient medical costs, prescription drug costs, and more.
What is Medi-Cal?
Medi-Cal is California's state-run Medicaid coverage program, designed to offer healthcare coverage to low-income residents. Established in 1966, Medi-Cal's primary goal is to provide essential healthcare services to individuals and families with limited income and resources. Unlike Medicare, which is funded entirely by the federal government, Medi-Cal receives both federal and state funding.
What's Covered Under Each Program?
Medicare - Medicare coverage depends on the type or part of Medicare you are using. Each part may cover different medications or procedures than another.
Part A (Hospital Insurance) - Part A covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home healthcare services, including:
- Inpatient care in a hospital
- Skilled nursing facilities (SNF) care
- Hospice care
- Home healthcare
- Inpatient care in a religious nonmedical healthcare institution (RNHCI)
Part B (Medical Insurance) - Part B covers certain physician services, outpatient care, medical supplies, and preventive services, including:
- Physician services (not routine physicals)
- Outpatient medical and surgical services
- Lab tests
- X-rays and diagnostic imaging
- Vaccinations
- Ambulance services
- Physical, occupational, and speech therapy
- Durable medical equipment (DME) like wheelchairs and walkers
Part C (Medicare Advantage Plans) - These plans cover all the same services as Medicare Parts A and B and may also offer additional benefits such as dental, hearing, and vision care.
Part D (Prescription Drug Coverage) - Part D is a voluntary prescription drug coverage program that helps cover prescription medication costs.
Medi-Cal - This program provides a wide range of healthcare services, including:
- Physician visits
- Specialist care
- Emergency and urgent care
- Pregnancy-related services
- Home healthcare
- Prescription medications
- Rehabilitative services
- Behavioral health services
- Dental care
- Transportation to and from medical appointments
- Long-term care
Certain Medi-Cal beneficiaries may also be eligible to enroll in a Medi-Cal managed care plan. These plans typically offer a network of healthcare providers and services to choose from.
Am I eligible for Medicare or Medi-Cal?
Understanding eligibility requirements for government-sponsored healthcare programs is essential when determining what options are available.
Medicare - In order to be eligible for Medicare, you need to be 65 years or older. Younger people can qualify for Medicare if they have specific disabilities such as ALS or end stage renal disease.
Medi-Cal - You may be eligible for comprehensive health services through Medi-Cal if you meet the low-income threshold. If you do not meet the income requirements, you may still qualify if you are:
- 65 or older
- Blind
- Disabled
- Under 21
- Pregnant
- In a nursing home or care facility
- A refugee
- A parent or guardian of an eligible child
- Have been screened for breast or cervical cancer
Otherwise, you may be eligible if you are enrolled in certain programs, including:
- CalFresh
- SSI/SSP
- CalWorks (AFDC)
- Refugee Assistance
- Foster Care or Adoption Assistance Program
Can You be Enrolled in Both Medi-Cal and Medicare?
Yes, individuals can be enrolled in both Medi-Cal and Medicare.
Those who qualify for both programs can take advantage of the benefits and services each provides, helping to maximize their healthcare coverage. These individuals are referred to as "dual eligibles" or "Medi-Medis."
When enrolled in both Medicare and Medi-Cal, Medicare serves as the primary payer, which means that it will cover expenses first. Afterward, Medi-Cal steps in as a secondary payer, covering additional costs that Medicare does not.
FAQS
Are Medi-Cal and Medicare the same?
No, Medi-Cal is health coverage offered by the state of California, and Medicare is a national health coverage program. The primary difference between these two programs lies in their objectives, eligibility criteria, and types of benefits offered.
Can you have both Medi-Cal and Medicare?
Yes, individuals can be enrolled in both Medi-Cal and Medicare. These individuals are referred to as "dual eligibles" or "Medi-Medis."