How to navigate Medicare and Medi-Cal in California

Two programs with nearly the same name, different rules, and deadlines that cost you money if you miss them. Here's what each one covers, who qualifies, when to sign up, and how they work together.

Last reviewed October 15, 2026. 2026 figures. General information, not legal or financial advice.

Medicare Open Enrollment is Oct 15 – Dec 7. It's the time to switch Medicare Advantage or drug plans for next year. HICAP can compare plans with you for free: 1-800-434-0222.

At a glance

Medicare vs. Medi-Cal

	Medicare	Medi-Cal
Who it's for	People 65+, and some younger people with disabilities	Californians with limited income (and, for 65+, limited assets)
Based on	Age or disability and work history	Income and assets
Run by	The federal government	California (DHCS) with federal funding
Sign up through	Social Security	BenefitsCal or your county social services office
Costs you	Monthly premiums, deductibles and 20% coinsurance	Usually nothing; some people have a monthly share of cost
Long-term care	No (only short skilled-nursing stays)	Yes: nursing homes, IHSS at home, and the Assisted Living Waiver
Can you have both?	Yes. Medicare pays first.	Yes. Medi-Cal pays what Medicare doesn't, including premiums.

Medicare

The four parts of Medicare, and what they cost in 2026

Part A: Hospital insurance

Hospital stays, short skilled-nursing stays after a hospital stay, hospice, some home health.

$0 premium for most people (40 work quarters). $1,736 deductible per benefit period in 2026.

Part B: Medical insurance

Doctor visits, outpatient care, tests, durable medical equipment, preventive care.

$202.90/month standard premium and $283 deductible in 2026, then usually 20% coinsurance.

Part C: Medicare Advantage

A private plan that replaces Original Medicare (A + B), usually with drug coverage and extras.

You still pay the Part B premium. Plan premiums, copays and networks vary; there's a yearly out-of-pocket cap.

Part D: Prescription drugs

Drug coverage from a private plan, alone or inside a Medicare Advantage plan.

Premiums vary. 2026 deductible can be up to $615; out-of-pocket drug costs are capped at $2,100 a year.

Path 1: Original Medicare

Part A+Part B+Medigap+Part D

See any doctor or hospital that takes Medicare. A Medigap policy covers most of the 20% and deductibles. Higher monthly premiums, fewer surprise bills.

Path 2: Medicare Advantage

Part C plan (includes A, B and usually D)

One private plan with a network, copays and a yearly out-of-pocket cap. Often a lower premium, but you're limited to the plan's doctors.

Deadlines

When you can sign up or switch

1
Initial Enrollment Period Around your 65th birthday
7 months: the 3 months before your birthday month, that month, and the 3 months after. Sign up early so coverage starts on time.
2
Annual Open Enrollment Oct 15 – Dec 7
Switch between Original Medicare and Medicare Advantage, or change drug plans. Changes start Jan 1.
3
General Enrollment + Medicare Advantage Open Enrollment Jan 1 – Mar 31
Missed your first window? Sign up for Part A/B now (coverage starts the next month, penalties may apply). Advantage members get one plan switch.
4
Medigap birthday rule Your birthday (California)
For 60 days starting on your birthday, you can switch to a Medigap policy with the same or fewer benefits without health questions.
5
Special Enrollment Period When job coverage ends
If you or your spouse still work and have job-based coverage, you have 8 months after it ends to sign up for Part B without a penalty. COBRA and retiree plans don't count.
6
If you have Medi-Cal or Extra Help Any month
You can change your Medicare plan once a month.

Late penalties last for life

Part B: +10% for every full year you could have had it and didn't. Part D: +1% of the national base premium ($38.99 in 2026) for every month without drug coverage after a 63-day gap. Having Extra Help removes the Part D penalty.

Medi-Cal

Who qualifies for Medi-Cal as a senior

Income limit, 1 person$1,836/mo138% of poverty level, 2026

Income limit, couple$2,490/moHigher income? Ask about share of cost

Asset limit, 1 person$130,000+$65,000 per extra household member

Scheduled July 1, 2027$21,000$31,000 for a couple, per the 2026-27 state budget

Doesn't count toward assets

Your home
One car
Household and personal items
Retirement accounts paying regular income (the payments count as income)

How to apply

Apply online at benefitscal.com, by mail, by phone, or at your county social services office.
Have ready: ID, proof of income (Social Security, pension), recent bank statements, and information about property and other assets.
If your income is over the limit, ask about Medi-Cal with a share of cost: you pay part of your medical bills each month and Medi-Cal pays the rest.
Need long-term care? Say so on the application. Nursing home and in-home care have their own rules, including a 30-month look-back on gifts.

Help paying for Medicare

Programs that pay your Medicare costs

Many people qualify for these even if they don't qualify for full Medi-Cal.

Medicare Savings Program	Monthly income limit (single / couple)	What it pays
QMB	$1,330 / $1,804	Part A and B premiums, deductibles and copays
SLMB	$1,596 / $2,165	Part B premium
QI	$1,796 / $2,436	Part B premium (can't also have Medi-Cal)

The same asset limit as Medi-Cal applies ($130,000 for one person in 2026). Apply through BenefitsCal or your county. Extra Help lowers Part D drug costs: 2026 limits are $23,940/year income and $18,090 in resources for one person. Apply at ssa.gov/extrahelp. People with Medi-Cal or a Medicare Savings Program get Extra Help automatically.

Medi-Medi

If you have both Medicare and Medi-Cal

1. Medicare pays firstDoctor, hospital and drug claims go to Medicare

2. Medi-Cal pays nextYour Part B premium, deductibles and copays

3. Medi-Cal-only benefitsLong-term care, IHSS, ALW and other services Medicare doesn't cover

In 41 counties you can join a Medi-Medi Plan that puts both programs under one plan and one care team; call Health Care Options at 1-800-430-4263. With Medi-Cal you can also change Medicare plans once a month. If you need long-term care, see how Medicare, Medi-Cal, ALW and senior housing fit together.

Checklist

Turning 65 in California

1
Three months before your 65th birthday, decide whether you need Part B now or have qualifying job coverage.
2
Sign up at ssa.gov or call Social Security (1-800-772-1213). If you already get Social Security, you're enrolled in Parts A and B automatically.
3
Choose Original Medicare + a Medigap policy + a Part D plan, or a Medicare Advantage plan. Compare plans at medicare.gov or with HICAP.
4
If your income is limited, apply for a Medicare Savings Program and Extra Help at the same time.
5
If you have a Covered California plan, cancel it once Medicare starts (you generally can't keep premium help).

Common questions

Medicare & Medi-Cal FAQ

What's the difference between Medicare and Medi-Cal?

Medicare is federal health insurance for people 65+ and some people with disabilities, based on age and work history. Medi-Cal is California's Medicaid program, based on income and assets. Medi-Cal covers long-term care that Medicare doesn't, and you can have both.

Can I have Medicare and Medi-Cal at the same time?

Yes. People with both are often called “Medi-Medi.” Medicare pays first, and Medi-Cal pays Medicare premiums and most of what Medicare doesn't cover. In 41 California counties you can join a Medi-Medi Plan that combines both.

What is the Medi-Cal income limit for seniors in 2026?

For the main senior and disabled program, income up to 138% of the federal poverty level: $1,836 a month for one person or $2,490 for a couple. People above that may qualify with a share of cost.

What is the Medi-Cal asset limit in 2026?

$130,000 for one person plus $65,000 for each additional household member. Your home, one car, household items and some retirement accounts don't count. Under the 2026-27 state budget the limit is scheduled to drop sharply on July 1, 2027.

What happens if I sign up for Medicare late?

Part B costs 10% more for each full year you could have had it but didn't, for as long as you have Part B. Part D adds 1% of the base premium for each month without drug coverage. Job-based coverage through you or your spouse can protect you.

Will Medi-Cal take my house after I die?

California limits estate recovery to probate estates for people who died on or after January 1, 2017, and only for certain care received at 55 or older. Homes passed through a living trust or joint ownership generally aren't in the probate estate. Talk to an elder-law attorney about your situation.

Who can help me for free?

HICAP gives free, unbiased Medicare counseling at 1-800-434-0222. For Medi-Cal, call the Member Help Line at 1-800-541-5555 or your county office.

Free help, no sales pitch

HICAP · 1-800-434-0222: Free, unbiased Medicare counseling
Medicare · 1-800-633-4227: Plans, claims, enrollment
Social Security · 1-800-772-1213: Sign up for Medicare, Extra Help
Medi-Cal Member Help Line · 1-800-541-5555: Medi-Cal questions
Health Care Options · 1-800-430-4263: Choosing a Medi-Cal or Medi-Medi plan
CA Dept. of Insurance · 1-800-927-4357: Medigap rights and complaints

Who pays for senior care Assisted living that accepts Medi-Cal

Sources