As a family caregiver in Southern California, you play a key role in supporting your loved ones. When navigating healthcare options, you may have realized that you aren’t sure what the difference is between Medi-Cal and Medicare. These two programs can provide valuable assistance, but knowing which one applies to your situation is incredibly important. So let's explore the nuances of Medi-Cal and Medicare, empowering you to make informed decisions in your caregiving journey.
Overview: What is Medi-Cal?
Medi-Cal is a California state-run program that offers medical coverage that is based on income. To determine eligibility, you'll need to meet specific income requirements and go through an application process. Once enrolled, Medi-Cal covers a wide range of services, including things like:
Doctor visits
Hospital stays
Prescription medications
And more.
Medi-Cal has many long-term care benefits that can assist family caregivers through coverage of services like Community Based Adult Services Day Programs, PACE programs, In Home Supportive Services, the CalAIM initiative and many other options. It's truly an essential lifeline for individuals and families facing financial hardships in California. Further, Medi-Cal has recently become more accessible to many families through significant changes to eligibility criteria so it can be worth exploring even if you’ve been denied in the past.
Overview: What is Medicare?
Medicare, on the other hand, is a federal (i.e., nationwide) health insurance program primarily designed for individuals aged 65 and older. However, it also covers certain younger individuals with disabilities.
Medicare consists of several similar coverages split between two parts: Medicare Part A and Medicare Part B, (which is part of why the two get confused so easily) including things like:
Hospital stays
Medical services (like doctor visits)
Medicare Advantage, which offers additional coverage options through private insurance companies
Prescription medications
And more.
Specifically, think of Medicare Part A as hospital insurance, and Medicare Part B as your more standard medical insurance.
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Part B covers certain doctor services, outpatient care, medical supplies, and preventive services.
(Source)
Medi-Cal vs. Medicare: Key Differences:
Understanding whether you need to contact Medi-Cal or Medicare for coverage will help you save a lot of time and confusion. Eligibility criteria, income limits, and covered services vary between the two programs.
So let’s explore some of the key differences:
Eligibility
Medi-Cal primarily serves low-income individuals and families, while Medicare is geared toward older adults and people with disabilities.
In some cases, you may be eligible for dual coverage, where you receive both Medi-Cal and Medicare benefits. It’s important to review the eligibility criteria to understand where each program would or would not apply to your situation for the best coverage. Let’s dive into that next.
How to Apply: Medi-Cal vs. Medicare
Another key difference is how you apply.
Medi-Cal
There are a few ways to apply for Medi-Cal that include:
Via post. You can apply through the mail by printing the Medi-Cal Single Streamlined Application in your native language (not all are available, but several are) and mailing it:
Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725
Or mail it to your local county office.
In person. You can apply in person at your local County Social Services Office.
Online. You can also apply for coverage through the Covered California Website.
Medicare
Medicare, on the other hand, may automatically enroll you. Here’s how that process works:
When you apply for either retirement or disability benefits from Social Security (or the Railroad Retirement Board, if applicable), that application also serves as your application for Medicare. That means that once you have been approved for Social Security benefits, you’ll automatically get Part A coverage (without having to pay a premium for it) as soon as you’re eligible for Medicare. (Source) You’ll also auto-enroll in Part B (unless you live in Puerto Rico or outside the U.S.), but you can opt out of it because you pay a monthly premium for it.
Accessing and Maximizing Benefits
As we touched on, you may be eligible for dual coverage, where you receive both Medi-Cal and Medicare benefits. Navigating both Medi-Cal and Medicare can seem daunting, but various resources are available to guide you through the process.
If you’d like personalized help, try resources like:
Your local healthcare offices
Community organizations like us
And online resources
Maximizing benefits involves understanding the specific services covered and learning about any potential out-of-pocket costs or co-payments. Take advantage of available resources to ensure your loved one(s) receive the comprehensive care and financial coverage they deserve.
Closing Thoughts: Medicare vs. Medi-Cal
We hope you have a clearer understanding about the differences between Medi-Cal and Medicare as a family caregiver in Southern California. By grasping the nuances of each program, you can ensure that your loved one(s) receives the healthcare coverage they deserve.
Take advantage of available resources, seek support from caregiver organizations, and remember to care for yourself along the way. As you continue your caregiving journey, know that you are not alone. The California Caregiver Resource Center of Orange County is here to provide assistance and guidance. Together, we can navigate the healthcare landscape and provide the best possible care for our loved ones.
Further Reading Spotlight: California Department on Aging
For aging adults, California is one of the best places to be in the country. Orange County, California has a wealth of resources and support available for older adults, family caregivers, and their families. From healthcare options to social services and financial resources, there are a number of programs ready to help you get the support you need.