Defining Medicare vs. Medi-Cal
Then it comes to health insurance, you’ve likely heard of Medicare and Medi-Cal. But what are the differences? And which do you qualify for? Read on to better understand these coverages.
Medicare: Federal Health Insurance Program
Medicare is a nationwide program for individuals 65 and older as well as for younger individuals who receive disability benefits or have end-stage renal disease (ESRD).
The Medicare program consists of four parts:
- Part A (Hospital Insurance) – Coverage for hospital visits, nursing, and hospice care.
- Part B (Medical Insurance) – Coverage for outpatient care, preventive services, and doctor visits.
- Part C (Medicare Advantage) – Alternative coverage to traditional Medicare, including additional benefits such as vision or dental care. If you sign up for Part C, you move into a managed care program where your coverage for parts A, B and even D is coordinated by one health plan and you must stay in their network.
- Part D (Prescription Drug Coverage) – Coverage for prescription drugs.
Medicare is funded through payroll taxes, general revenue, and premiums. Enrollment is managed on a federal level through the Social Security Administration. Beneficiaries typically pay premiums for Part B or other out-of-pocket costs like deductibles or coinsurance.
Medi-Cal: California's Medicaid Program
Medi-Cal is California's Medicaid program. This program is state administered and is for low-income California residents. Funded by both the state and federal government, Medi-Cal provides free and low-cost healthcare to eligible participants, including:
- Low-income seniors
- Low-income families
- Persons with disabilities
- Pregnant individuals
Medi-Cal provides coverage to residents for a wide range of services such as doctor visits, hospital stays, long-term care (skilled nursing facilities), mental health, home care (IHSS) and dental services. Medi-Cal specifically focuses on income-based eligibility and provides comprehensive care with minimal costs for beneficiaries. You can apply or learn more through the California Department of Health Care Services (DHCS).
Dual Eligibility
For some Californians, it’s possible to qualify for both programs. These individuals, known as "dual eligibles" or "Medi-Medi," are able to benefit from the combined advantages of both programs. To learn more about dual eligibility, visit DHCS's resources on integrated care.
Medicare and Medi-Cal with CEI
If you have Medi-Cal or dual eligibility and qualify for PACE based on your health status, CEI’s PACE program is available to you at no cost. If you have Medicare alone, you will have a co-pay. You’ll receive comprehensive medical, eye, and ear care, transportation, nutritious meals, rehabilitation services, and access to social activities. To learn more about CEI and the services we offer, call us at (844) 319-1150.
