Why It Matters

Millions of people get health care through Medicare, Medicaid (Medi-Cal in California), or both. These programs work together in important ways, especially to help older adults with low incomes live in their communities as they age. It’s important for older adults and their families to understand the basics of these programs to make sure they get the most out of them.

Medicare is the main health insurance program for older adults, but it doesn’t always cover everything they need. Medi-Cal is critical for older adults with low incomes because it covers many services that Medicare doesn’t cover. It also makes Medicare more affordable by covering what people must pay to have Medicare.

Key Differences Between Medicare and Medi-Cal

 

Medicare

Medi-Cal

What is it?

Federal health insurance for people ages 65+ and some younger people with disabilities.

California’s Medicaid program provides health insurance for people of all ages with limited incomes.

Who can financially qualify?

People can qualify regardless of income.

People with limited incomes and assets (cash, bank accounts).

What does it cover?

Doctor visits, hospital care, prescriptions, some help at home, short stays in nursing homes, and other medical services.

Doctor visits, hospital care, prescriptions, in-home help, transportation, supports to remain living at home, nursing home care, vision, and dental.

What does it not cover?

Dental care, hearing aids, substance use treatment, and long-term care are usually not covered.

Services that are not medically needed.

How much does it cost?

Monthly premium and other costs. Medicare does not pay for everything.

Care is fully covered for most people.

Who Financially Qualifies for Medi-Cal?

In 2026, older adults and people with disabilities with incomes at or below $1,836 and with $130,000 in assets (cash, bank accounts, and more) qualify for Medi-Cal. One home and one car does not count. The income limit changes every April. See this page for more information: https://www.dhcs.ca.gov/Medi-Cal/

Why Do Some People Have Both Medicare and Medi-Cal?

People who have both Medicare and Medi-Cal are called dually eligible individuals. They have Medicare because of their age or disability and Medi-Cal because they have limited incomes. Medicare pays first, and Medi-Cal pays second and covers costs Medicare does not. The costs of care for approved services are fully covered for people with both Medicare and Medi-Cal.

How Does Medi-Cal Help People with Medicare?

Medi-Cal pays for many things Medicare does not, like help for people to stay in their homes as they get older, called “home and community-based services.” Medi-Cal is one of the only options for people who need long-term care either at home or in a nursing facility because the costs of such care are unaffordable for almost everyone.

Here is why Medi-Cal is so important:

  • Pays for long-term care in nursing facilities (also called nursing homes)
  • Pays for home-based help for things like bathing, dressing, and cooking. California’s biggest home-based help program is In-Home Supportive Services (IHSS).
  • Medi-Cal health plans also pay for home-based help through what is called “CalAIM.” These are services can help with food, housing, and support for people who want to leave a nursing facility and return to their community, or prevent people from having to be in a nursing facility in the first place.
  • Covers dental, vision, hearing, substance use treatment, and transportation to medical services – services Medicare does not usually cover.
  • Medi-Cal pays for Medicare premiums and other out-of-pocket costs like co-pays and co-insurance, and deductibles.

Important Information About Recent Federal Changes

A new federal law passed in 2025 that will affect Medi-Cal.

What the law does:

  • Cuts Medicaid funding. Under the law, California will get less federal money for Medi-Cal. If California cannot make up the funding loss, the state may have to make cuts to Medi-Cal benefits. Programs like IHSS and other home and community-based services programs are usually first to be cut because they are optional for the state to cover. Dental, vision, and hearing are also usually cut.
  • Adds new requirements. New rules require some people on Medi-Cal to work, volunteer, or go to school to keep Medi-Cal. These work rules do not apply to people age 65 or older and anyone with Medicare.
    • Medi-Cal enrollees who take care of a family member or friend are excused from the new rules, but may need to show that they are caregivers. They should contact an advocate if they need help meeting the new rules or showing they are excused.
    • These new work rules and other changes start January 2027.
  • Immigrant Changes. Many older immigrants who are not green card holders may see changes to their Medi-Cal coverage. There are a few changes to Medi-Cal for some immigrants but these changes do not apply to everyone. Changes are specific to immigration status and age. Check the resource section to contact an advocate for more specific information.

If older adults age 65 or older or anyone with Medicare gets a notice about having to prove they are working, they should contact an advocate right away - these rules do not apply to them. Older immigrants who receive a notice about their health coverage changing should also contact an advocate immediately. See below for where to find help.

What Can Advocates and Older Adults Do?

To learn more about what is happening with Medi-Cal and get involved:

  • Tell your story about why Medi-Cal matters to older adults. Telling your story helps people understand why Medi-Cal is so important and why cutting benefits or making it harder to qualify will hurt people.
  • Join local or state advocacy groups and public meetings. Some ideas are to join public meetings or member committees set up by local Medi-Cal health plans.
  • Connect with advocacy groups and coalitions. Search online for groups that represent the interests of certain groups, like people with disabilities.

For one-on-one help with Medicare and Medi-Cal coverage, older adults can contact these organizations:

 

 


www.justiceinaging.org