If you qualify for both Medicare and Medi-Cal, the two programs work together to cover nearly all of your healthcare costs, often leaving you with little or nothing to pay out of pocket. Medicare acts as your primary insurance and pays first, then Medi-Cal steps in to cover remaining costs like copays, deductibles, and services Medicare doesn’t offer. California refers to people enrolled in both programs as “dual eligibles,” and roughly 1.5 million Californians fall into this category.
Which Program Pays First
Medicare always pays first when you have both programs. This is called “coordination of benefits,” and it prevents duplicate payments while ensuring the total paid never exceeds 100% of the claim. When you visit a doctor, go to the hospital, or fill a prescription, your provider bills Medicare first. Medicare pays its share, and then Medi-Cal picks up some or all of what’s left, depending on the service.
For dual-eligible beneficiaries, providers cannot “balance bill” you for the difference between what Medicare pays and what the provider charges. Medi-Cal covers that gap. In practice, this means most doctor visits, hospital stays, and lab tests cost you nothing.
What Medi-Cal Covers That Medicare Doesn’t
Medicare has notable gaps. It does not cover most dental care, routine eye exams for glasses, hearing aids, hearing exams for fitting them, or long-term custodial care. These are significant expenses, especially for older adults.
Medi-Cal fills many of these gaps. It covers comprehensive dental services (including cleanings, fillings, and dentures), vision care, hearing aids, and long-term care services like nursing home stays and in-home supportive services. For dual eligibles, this combination creates a benefit package that’s more comprehensive than either program alone. You get Medicare’s broad hospital and physician coverage plus Medi-Cal’s additional services and cost protections.
How Medi-Cal Helps Pay Medicare Costs
One of the biggest financial benefits of dual eligibility is that Medi-Cal can pay your Medicare premiums, deductibles, and copays. How much it covers depends on your income level, through what California calls Medicare Savings Programs.
The Qualified Medicare Beneficiary (QMB) program offers the most help. If your monthly income is at or below $1,305 as an individual (or $1,763 for a couple), Medi-Cal pays your Medicare Part A and Part B premiums, plus all deductibles and copayments. This effectively eliminates your out-of-pocket Medicare costs entirely.
If your income is slightly higher, the Specified Low-Income Beneficiary (SLMB) program covers your Part B premium for individuals earning up to $1,566 per month. The Qualifying Individual (QI) program does the same for individuals earning up to $1,762 per month, though QI participants cannot also receive full Medi-Cal coverage. These are 2025 figures, and the state applies certain income deductions during the eligibility process, so you may still qualify even if your income is slightly above these thresholds.
California also participates in a “buy-in” agreement with the federal government, automatically paying Medicare Part B premiums for eligible Medi-Cal members. If you qualify, this happens without you needing to submit a separate payment each month.
Prescription Drug Coverage for Dual Eligibles
Prescription drugs are covered through Medicare Part D, not Medi-Cal. But if you have full Medi-Cal coverage, you automatically qualify for a federal program called “Extra Help” that dramatically reduces your Part D costs. You don’t need to apply separately; enrollment is automatic.
With Extra Help, you pay no monthly premium for your Part D plan and no annual deductible. Your copays for prescriptions drop to no more than $5.10 for generics and $12.65 for brand-name drugs (2026 amounts). If you’re also in the QMB program, your copays are even lower: no more than $4.90 per covered drug.
If you don’t already have a Part D plan when you become eligible for Extra Help, Medicare will automatically enroll you in one. And starting in 2025, dual eligibles can switch their drug plan once per month rather than waiting for an annual enrollment period, giving you more flexibility if your plan isn’t covering the medications you need.
Medi-Cal Eligibility Without Asset Limits
A major change took effect on January 1, 2024: California eliminated asset limits for Medi-Cal eligibility. Bank accounts, cash savings, a second vehicle, and home equity are no longer counted when determining whether you qualify. Applications and renewal forms no longer ask for asset information. This means you can have savings and still qualify for or keep your Medi-Cal coverage, which was a significant barrier for many older adults who previously had to spend down their assets to remain eligible.
The one exception involves long-term care services. If you transferred assets for less than fair market value within the past 30 months, you may still need to provide asset verification when applying for nursing home or similar institutional care.
Integrated Plans That Combine Both Programs
Managing two separate insurance programs can be confusing, which is why California has been pushing dual eligibles toward integrated plans that combine Medicare and Medi-Cal under one roof. These are called Dual Eligible Special Needs Plans (D-SNPs), and in California they go by the name “Medi-Medi Plans.”
A Medi-Medi plan is a type of Medicare Advantage plan designed specifically for people with both programs. Instead of dealing with separate cards, separate networks, and separate customer service lines, you get a single plan that coordinates all your Medicare and Medi-Cal benefits together. These plans provide care coordination, integrated paperwork, and a single point of contact for questions.
California’s CalAIM initiative has been accelerating this integration. Starting in 2025, new enrollment in D-SNPs is limited to plans that are affiliated with a Medi-Cal managed care plan in your county. The goal is to ensure that the same organization manages both sides of your coverage, reducing the confusion and fragmented care that dual eligibles have historically experienced. Enrollment in these plans is voluntary, but the state is actively encouraging it.
How to Get Both Programs
You don’t apply for Medicare and Medi-Cal through the same process. Medicare eligibility is based on age (65 and older) or disability, and enrollment is handled through the Social Security Administration. Medi-Cal eligibility is based on income and is managed by your county’s social services office or through Covered California.
If you already have Medicare and your income is low enough, you can apply for Medi-Cal through your county. Once approved, the coordination between the two programs happens largely behind the scenes. Your Medicare Part B premium gets paid automatically if you qualify, Extra Help kicks in for prescriptions, and your providers bill Medicare first and Medi-Cal second without you needing to manage the process yourself. If you’re interested in a Medi-Medi integrated plan, you can search for available D-SNPs in your county through Medicare’s plan finder tool or by calling the state’s Health Insurance Counseling and Advocacy Program (HICAP) for free, unbiased help.