Medicare Vs. Medi-Cal

Medi-Cal is the official name of California's Medicaid program, which provides medically needy Californians with health insurance coverage. In comparison, Medicare health is administered and funded through the federal government's Medicare program and is available to eligible citizens in every jurisdiction. California's Medi-Cal health insurance is only available to Californians.

Medicaid Is State Specific

• Medicaid's rules vary by state but Medicare's eligibility rules do not vary by state. The federal government uses one set of federal guidelines to determine eligibility. Each state may enact its own rules regarding Medicaid coverage.

Medicare Health Insurance

• Only senior citizens 65 and older, people with certain long-term disabilities and individuals with renal failure are eligible to receive Medicare services. Medicare typically provides benefits to those who have earned enough government credits through their employment history and Medicare tax contributions. Spouses of eligible individuals can also apply for Medicare benefits. Medicare benefits for hospital stays are usually provided at no cost to eligible recipients. However, additional coverage for doctor's visits, medical supplies and prescription drug coverage are optional medical coverage offered to eligible applicants at a reduced cost.

Medi-Cal Coverage in California

• Medicaid health insurance provides necessary health insurance coverage to low-income individuals based upon need. Most states offer Medicaid coverage to low-income individuals that are permanently and severely disabled, blind and senior citizens who have not earned enough work credits to qualify for Medicare coverage. Some states may offer Medicaid coverage to groups of other low-income individuals. California offers its Medicaid program known as Medi-Cal to other groups of needy individuals.

Medi-Cal Coverage

• Medi-Cal provides health insurance coverage to low-income individuals with disabilities and senior citizens. However, California's Medi-Cal insurance offers benefits to non-disabled individuals, including foster care families, low-income individuals with diseases that are not debilitating, pregnant women and children. California residents receiving Social Security Income benefits or assistance through the California state government are eligible to receive Medi-Cal benefits. In addition, blind or disabled individuals, individuals younger than 21 years of age, senior citizens 65 or older and pregnant women qualify for coverage. California also provides Medi-Cal to eligible patients who are in an intermediate skilled nursing home or full-time nursing home, parents or caretakers of those younger than 21 and refugees from other countries. Medicare does not cover these groups of individuals unless they have enough work credits to qualify for coverage and are 65 or older or suffer either permanent blindness or permanent and serious illness. The Medi-Cal program is more widely available than Medicare.

Dual Eligibility

• Californians who meet the eligibility criterion for Medi-Cal and Medicare are "dual beneficiaries" or "dual eligibles." Medi-Cal pays costs that are medically necessary and may provide more comprehensive coverage than Medicare for some medical costs. For instance, Medicare does not cover prescription drug costs unless recipients purchase Medicare Part D. Medi-Cal, on the other hand, offers some prescription drug coverage. For dual eligibles, Medicare is the primary provider and Medi-Cal provides payments for any additional costs not covered through the recipient's Medicare health insurance.