Medicare vs. Medi-Cal - The Law Office of Anne Hydorn

Medicare vs. Medi-Cal – What’s the Difference?

Medicare and Medi-Cal have long been a mystery to many consumers. It can baffle and confuse even the smartest of us. Like me, you might have thought: “I don’t need to worry about this right now.” It’s never too early, however, to gain a little understanding and awareness that just might help you or an aging loved one down the road. As the saying goes – “time flies.” Here are some of the differences and basics of Medicare and Medi-Cal.

Medicare

Medicare is a federal health insurance program. Medicare is for people age 65 years old or older or under age 65 with a qualifying disability, or for those who have End-Stage Renal Disease (ESRD). Because the federal government runs and administers Medicare, it is uniform from state-to-state. Individuals who meet the Medicare eligibility requirements can receive Medicare regardless of how much income they have or assets they own. Costs for Medicare, like most health insurance plans, include premiums, copays, and deductibles.

Medicare can be confusing because there are four parts. We hear people talk about Parts A, B, C, and D. What does this all mean? Parts A, B, and D can be simplified as follows. Part A is hospital insurance, Part B is medical insurance, and Part D is prescription drug coverage. The federal government offers Original Medicare, which includes Parts A and B coverage. Individuals enrolled in Original Medicare can purchase Part D prescription drug coverage through a Medicare-approved drug plan.

Alternative to Original Medicare is Medicare Part C, which is a Medicare Advantage Plan. A Medicare Advantage Plan is a Medicare-approved private health plan that must follow the rules that Medicare establishes. A Medicare Advantage Plan or Medicare Part C plan is required to include the same coverage as Original Medicare, but usually includes Part D prescription drug coverage, as well.

It is important to do your homework to find what works best and what is most cost effective for you or your loved one.

Medicaid (called Medi-Cal in California)

Medicaid is a health care assistance program. Its guidelines come from the federal government, but each state oversees its own program. Each county within California administers Medicaid eligibility. In California, Medicaid is called Medi-Cal.

Medi-Cal is for people who cannot afford to pay for their care on their own. In other words, it is a need-based program. Medi-Cal eligibility is based on income and assets, and is available to people who belong to one of many different eligible groups. Some of the common eligible groups are low-income families, children, people with disabilities, people over age 65, pregnant women, and the parents of eligible children. Seniors who require nursing home care and who qualify for Medi-Cal only pay a share of their income for their nursing home care. Medi-Cal pays the rest.

Dual Eligibility

A person can be eligible for both Medicare and Medi-Cal and receive both types of benefits. The two programs work together to help the recipient best cover the expenses of health care. For example, Medicare costs include premiums, copays, and deductibles. Full Medi-Cal benefits can cover the costs of Medicare deductibles and co-payments. Medi-Cal may also cover Part A and/or Part B premium costs or other costs that Medicare does not cover.

Only Medi-Cal pays for long-term care in a nursing home, unlike Medicare that generally only covers short-term stays in a skilled nursing facility following a qualifying hospitalization. This particular difference is a common confusion.

Although Medicare and Medi-Cal can be quite confusing, it is important at a minimum to know the basics. When you or someone you love is eligible or in need of the benefits, there are organizations that can help, and your elder law attorney is also a valuable resource.

If you have any questions about something you have read or would like additional information, please contact me.