Skip to main content

What’s The Difference Between Medi-Cal and Medicaid Insurance?

Smiling Hispanic man shaking doctors hand in hospital and illustrating what is the difference between MediCal and Medicaid.

Shopping for health insurance to obtain coverage by a certain date can be intimidating and overwhelming at the same time. For those individuals who can least afford coverage, it can be even more confusing as they try to figure out the difference between Medi-Cal and Medicaid insurance.

Actually, the good news is – there is no difference between the two. Medi-Cal health insurance is merely California’s Medicaid program, which is paid for with federal and state tax revenues. It’s the easiest way for low-income California residents, who meet certain requirements, to enroll in a health insurance plan for themselves and their families, despite limited financial means. If your income is within the Medi-Cal limits for your family size, you’ll be eligible to receive Medi-Cal coverage at no cost or low-cost to you.

What is Medi-Cal? California’s Medicaid Program

Medi-Cal is a California government program that helps people with low incomes get the health care they need. It’s like a safety net for your health. If you don’t have a lot of money and you live in California, Medi-Cal can step in to cover your medical expenses. It’s there to make sure you can see a doctor when you’re sick, get medicine when you need it, and even get regular checkups to keep you healthy. Medi-Cal is like a helping hand with your health, making sure that everyone, no matter how much money they have. 

Who’s Eligible for Medi-Cal?

Medi-Cal is California’s government-funded health care program. Its main goal is to help low-income people and their families get health coverage. To see if you can get Medi-Cal, they look at a few things:

Money: They check how much money you and your family make. If you make less than a certain amount, you may qualify. The rules can vary depending on the number of people in your family and your age. The rules have also changed a little because of the Affordable Care Act. So, even if you don’t have children, you may qualify if you don’t make a lot of money.

Living in California: You have to live in California to get Medi-Cal. You do not always have to be a U.S. citizen or have a green card. Some immigrants who do not have papers in order can get Medi-Cal, but it may only cover certain things, such as emergencies and pregnancy.

Citizenship or immigration: Having U.S. citizenship or a green card is not always necessary, but it may affect the type of Medi-Cal you can get.

Age and number of family members: Age and number of family members can affect whether you get Medi-Cal. Children may have different money rules than adults.

Pregnancy: If you are pregnant and do not have a lot of money, you may be able to get Medi-Cal while you are pregnant and even after you have your baby.

Disability: If you have a disability, no matter how old you are, you may be able to get Medi-Cal if your income and savings are within certain limits.

What is Medicaid? A Nationwide Program  

Medicaid is a program that helps people in the United States who may not have enough money to pay for their medical expenses. It is like a safety net for those who need it. Medicaid covers doctor visits, hospital stays, medications and other important health services. It’s a bit like health insurance, but provided by the government. To qualify for Medicaid, you usually have to have a low income, but the rules can vary from state to state. 

Who’s Eligible for Medicaid?

In the United States, access to Medicaid, a program that helps people with low incomes pay for their healthcare, depends on some rules set by the federal government and others set by each state. Therefore, the requirements for Medicaid eligibility may be a little different depending on where you live. But here are some general things that usually determine whether you can get Medicaid:

How much money you make: Medicaid is primarily for individuals and families who don’t make a lot of money. Things like your family size and how much money you make are considered in deciding if you qualify. The exact amount of money you can earn and still qualify can vary from state to state. Therefore, it is best to check with your state Medicaid office or website to find out what the rules are where you live.

How many people live in your home: If there are more people living in your home, such as a spouse or children, it can sometimes be easier to qualify for Medicaid. This is because the entire family’s situation is taken into account.

Where you are from: To get Medicaid, you usually have to be a U.S. citizen or someone with permission to live in the U.S., such as a permanent resident or a refugee.

Your age: Some Medicaid programs are exclusive to certain age groups, such as children, pregnant women or seniors.

Your health status: In some states, even if you earn more money than the usual limit, you may be able to get Medicaid if you have a serious health problem. 

What is covered by Medi-Cal?

Medi-Cal is more or less like any of the other health plans you can purchase on the Covered California exchange; in that Medi-Cal insurance contains the same 10 comprehensive services known as “essential health benefits” as designated by the Affordable Care Act to include:

  • Outpatient (ambulatory) services (Doctor visits)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Programs such as physical and occupational therapy (known as rehabilitative and habilitative services) and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Children’s services, including immunization, oral and vision care.

While an immigrant who meets all other eligibility requirements, but doesn’t possess a satisfactory immigration status is not eligible for full scope Medi-Cal, he or she may still be entitled to receive emergency, pregnancy-related services, and state-funded long-term care, when needed.

For those with lawful residency, keep in mind there are income limits to qualify for no-cost Medi-Cal health insurance. Eligibility is based on your family’s net monthly income after allowances for child care and working expenses. In other words, your income minus these expenses must be at or below the limit specified for the size of your family.

Medical Dental and Vision Coverage

In addition to standard health coverage as required under the Affordable Care Act, Medi-Cal also offers dental and vision plans for qualifying adults and children. Orthodontic care may or may not be covered by the dental plan, depending on the degree of the corrective procedure needed to repair the malocclusion. To learn more about dental benefits and eligibility, you can contact your nearest Freeway Insurance agent or visit Denti-Cal.

Application and Enrollment Processes

Vision benefits are also available for those with full-scope Medi-Cal benefits. All Medi-Cal members are eligible for a routine eye exam once every 24 months, at which time they can check the health of their eyes as well as test to see if an eyeglass prescription may be needed.

Unlike open enrollment for private health plans through Covered California, which runs from November 1 through January 31 – enrollment for Medi-Cal is open year-round.

Simplify the Process of Searching for Health Coverage with Freeway Insurance

Freeway Insurance, the premier healthcare insurance broker, has partnered with Covered California, along with some of the nation’s most trusted carriers to help provide their customers with the best health quotes and make obtaining low-cost or no-cost health insurance as easy as possible. Plus – Freeway’s services are absolutely 100% free.

Why not get started today and choose from the different types of health insurance to find the one that’s right for you? Freeway Insurance can offer you an assortment of affordable health plans. Call (800) 777-5620 to speak with an agent to get a free health insurance quote or you can get your free health insurance quote online!

Ready to Get a Quick Quote?