If you are 65 or older and have limited income, you may qualify for two health programs at the same time: Medicare and Medi-Cal. In California, hundreds of thousands of people receive benefits from both programs. These individuals are known as "dual-eligible," and they have access to a combination of coverage that can reduce their health costs to practically zero.
However, navigating two programs at once can be confusing. This guide explains how Medicare and Medi-Cal work together, what each one covers, and how to make sure you are taking advantage of every benefit available to you.
What Is Dual Eligibility?
A "dual-eligible" person is someone who qualifies for both Medicare and Medi-Cal (California's Medicaid program). This most commonly happens with adults age 65 and older who have limited income and resources. It can also apply to people under 65 with certain disabilities who qualify for Medicare and also meet Medi-Cal's income requirements.
When you have both programs, Medicare serves as your primary insurance. That means Medicare pays first for covered services. Medi-Cal acts as your secondary insurance, covering what Medicare does not pay: copays, deductibles, premiums, and some additional services that Medicare does not include.
What Does Medicare Cover vs. What Does Medi-Cal Cover?
What Medicare covers
Medicare is a federal program that covers essential health services. Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B covers doctor visits, outpatient services, durable medical equipment, and preventive services such as vaccines and screenings. Part D covers prescription drugs.
What Medi-Cal adds
Medi-Cal fills the gaps that Medicare leaves. In California, Medi-Cal can cover comprehensive dental services (including cleanings, extractions, crowns, and dentures), vision services (eye exams and glasses), hearing aids, non-emergency medical transportation, long-term care in a nursing facility, broader mental health services, and In-Home Supportive Services (IHSS) for people who need help with daily activities.
For many older Hispanic adults in California, IHSS services are particularly valuable. This program allows a family member or caregiver to receive payment for helping with tasks like bathing, dressing, cooking, and grocery shopping.
Medicare Savings Programs (MSP): How Medi-Cal Pays Your Costs
If you qualify for Medi-Cal, you are likely also eligible for a Medicare Savings Program (MSP). These programs have Medi-Cal pay some or all of your Medicare costs.
QMB (Qualified Medicare Beneficiary)
The most complete level of help. If you qualify for QMB, Medi-Cal pays your Part B premium, your Part A premium (if applicable), all Medicare deductibles, and all copays and coinsurance. Additionally, health care providers cannot charge you anything extra for Medicare-covered services.
SLMB (Specified Low-Income Medicare Beneficiary)
If your income is slightly above the QMB limit but still low, the SLMB program pays your monthly Part B premium.
QI (Qualifying Individual)
Similar to SLMB, the QI program pays your Part B premium. Income limits are slightly higher than SLMB. This benefit is assigned on a first-come, first-served basis, so it is important to apply early each year.
QDWI (Qualified Disabled and Working Individuals)
For people with disabilities who work and lost their premium-free Medicare Part A, QDWI pays the Part A premium.
D-SNP Plans: One Card for Both Programs
If you have Medicare and Medi-Cal, one of the best options is to enroll in a D-SNP (Dual-Eligible Special Needs Plan). These are Medicare Advantage plans designed specifically for dual-eligible individuals.
A D-SNP plan coordinates your Medicare and Medi-Cal benefits under one card. Instead of navigating two programs separately, you have one plan that manages everything. D-SNP plans in California frequently include additional benefits beyond what Original Medicare offers.
Many D-SNP plans in California offer a monthly allowance for purchasing healthy foods at participating stores (generally between $50 and $200 per month), free transportation to medical appointments and the pharmacy, dental coverage with cleanings, exams and treatments, vision exams and glasses at no cost, hearing aids, exercise and wellness programs, and a personal care coordinator who helps you manage your appointments and medications.
How to Know If You Qualify for Dual Eligibility
To qualify as dual-eligible in California, you need to meet the requirements of both programs. For Medicare, you generally must be 65 or older (or have a qualifying disability). For Medi-Cal, your income and resources must fall below certain limits that vary by household size and the county where you live.
In 2026, Medi-Cal's income limits in California are generous compared to other states. Many people who assume they earn "too much" to qualify are surprised to find out they are eligible. If you receive Supplemental Security Income (SSI), you automatically qualify for Medi-Cal in California.
You can apply for Medi-Cal through your county social services office, online through Covered California, or with the help of a licensed agent who can guide you through the process at no cost.
Common Mistakes Dual-Eligible Beneficiaries Make
Not enrolling in a D-SNP plan
Many dual-eligible people stay on Original Medicare without realizing that a D-SNP plan could give them significant additional benefits at no extra cost. If you have both programs, it is worth comparing the D-SNP plans available in your county.
Not using Medi-Cal benefits
Some beneficiaries do not know that Medi-Cal covers dental, vision, and hearing services. Others are unaware of the IHSS program. If you have Medi-Cal, make sure you understand everything it covers.
Assuming you will lose Medi-Cal when you turn 65
Many people fear that when they turn 65 and receive Medicare, they will lose Medi-Cal. This is not automatic. If you continue to meet the income requirements, you can keep both programs.
For an English-language guide on how to avoid penalties when enrolling in Medicare, visit our enrollment penalties guide on Medicare California.
Frequently Asked Questions
Can I have Medi-Cal and Medicare at the same time?
Yes. Many people in California qualify for both programs. Medicare is your primary insurance and Medi-Cal acts as secondary insurance, covering copays, deductibles, and premiums.
What is a D-SNP plan and how does it benefit me?
It is a Medicare Advantage plan for dual-eligible individuals. It coordinates your Medicare and Medi-Cal benefits under one card and frequently includes additional benefits like transportation, vision, dental, and a grocery allowance.
Does Medi-Cal pay my Medicare premium?
If you qualify for a Medicare Savings Program (QMB, SLMB, QI, or QDWI), Medi-Cal can pay your Part B premium. The QMB program also covers deductibles and copays.
Will I lose Medi-Cal if I enroll in Medicare?
Not necessarily. If you meet Medi-Cal's income and resource requirements, you can keep both programs and benefit from the combined coverage.
Have Medicare and Medi-Cal? Make the Most of Your Benefits
Our licensed agents speak Spanish and English and can help you find the D-SNP plan that best fits your needs. The consultation is completely free.
Talk to an Agent TodayDo Not Leave Benefits on the Table
If you have Medicare and Medi-Cal in California, you have access to a network of benefits that can cover virtually all of your health care costs. From medical services and medications to dental care, vision, transportation, and in-home support, the combination of these two programs offers complete protection. The first step is confirming your eligibility and exploring the D-SNP plans available in your area.
Contact us today for a free review of your benefits.
Share this with someone you love. If you know someone who has Medicare and might qualify for Medi-Cal, this information could save them hundreds of dollars each month.