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

In California, the three M’s are known to citizens as Medicaid, Medicare, and Medi-Cal. You probably know that all three of these programs pay for various healthcare costs, but you might still be fuzzy on the distinctions between these three programs. This blog will lay out many of the key differences between Medi-Cal and Medicare to give you an idea of what you may be eligible for. 

What is Medicare?

The first distinction between Medicare and Medi-Cal is that Medicare is a federal program that acts as monthly health insurance. Once you reach the age of 65, you begin to receive this government benefit that you likely helped pay for through your payroll taxes over the years. Medicare generally covers expenses related to doctor’s visits, hospital stays, surgery, outpatient care, home health care (including hospice), and brief stays in skilled nursing facilities. 

There are supplemental Medicare plans you can pay into that will cover some medical costs that would otherwise be out-of-pocket. Recipients must pay for Medicare Part B, which can be taken out of Social Security benefits. In addition to seniors, some people with serious disabilities or end-stage renal failure that requires dialysis are eligible for Medicare benefits. 

What is Medi-Cal?

Medi-Cal is the state of California’s version of Medicaid for those with low assets or income (or both). Instead of being health coverage that you draw from after reaching a certain age after contributing to it for years, it is a benefit that reimburses healthcare facilities for costs incurred. Recipients sometimes have to pay a small monthly fee to access Medi-Cal benefits. 

Medi-Cal, unlike Medicare, is a means-tested government program. This means that you must meet certain financial qualifications to be eligible for Medi-Cal. The test for Medi-Cal coverage is a household income at 138 percent of the poverty line or less. 

Long-Term Care

One fairly well-known difference between Medicare and Medi-Cal is that Medicare will typically not pay for costs of staying in a long-term care facility that employs skilled nurses. For that coverage, you will have to enroll in Medi-Cal. Because of the cap on income and assets, it is well worthwhile to start planning for Medi-Cal so you are eligible when you need care in a long-term facility. 

ConclusionPaying for a nursing home or assisted living is difficult due to the exorbitant costs associated with living at one. One solution for this is to start planning for Medi-Cal by moving some assets around into trusts and other places. This can get complicated, especially if you want to do it legally. That’s why it’s essential to enlist the help of an experienced and qualified California elder law firm like MMZ Law. Give us a call at 909-256-6702 to discuss your options with us today.

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