An elderly female hand holds a mock United States government Medicare Health Insurance card.

Medi-Cal facts for Seniors

Medi-Cal Facts for People with Medicare

Medi-Cal is the California name for Medicaid. This is a federal and state-funded health coverage program for persons with low incomes and limited assets.

What is Medi-Cal?

Medi-Cal is a government program that pays for health and medical care for seniors 65 and over or disabled persons who have low incomes and limited resources. Medi-Cal pays for:

  • Health and medical services when you use a Medi-Cal doctor, provider, or facility
  • The Medicare Part B premium

What does Medi-Cal Cover?**

  • Adult day health services
  • Ambulance services
  • Dental care
  • Doctor visits
  • Home health care
  • Hospice care
  • Hospital and nursing home care
  • Medical equipment
  • Some categories of medicines and supplies are excluded by Medicare Part D plans, including incontinence supplies.
  • Prosthetic/orthopedic devices
  • X-ray and laboratory tests

**Note: Medi-Cal is the “payer of last resort.” Medicare is primary. If Medicare covers one of these services, Medi-Cal generally will not pay anything, although by law you cannot be billed for the balance.

How Many Resources You Can Have

No more than $2,000 countable resources if you are single or $3,000 for a married couple*. As of July 1, 2022, the asset limit will go up to $130,000 for an individual and $195,000 for a couple.

Countable resources include bank accounts, certificates of deposits, retirement accounts, stocks, and bonds. (IRAs and other tax-qualified retirement plans are not counted if monthly payments of principal and interest are being taken.)

How Much Income You Can Have

To be eligible for Medi-Cal with no share of cost, your monthly gross income in 2022 must not be more than $1,563 for an individual and not more than $2,163 for a married couple*.

*For married couples, when one spouse is in a nursing home, higher resource and income limits apply. Contact Medi-Cal for details.

  • Persons on SSI are automatically eligible for full Medi-Cal.
  • Persons who have income over the Medi-Cal limit may still be eligible for Medi-Cal with a share of cost.

What is a Share of Cost?

If your income is more than the Medi-Cal income limits, you can still qualify for Medi-Cal, but you will have a share of cost.

  • A share of cost is not an amount that you must pay every month. Share of cost is like a deductible; it is the share of your medical bills that you are liable for before Medi-Cal pays the rest of your expenses for that month.
  • If your medical expenses in a month do not exceed your share of cost amount, Medi-Cal will not pay any of your medical bills. Medi-Cal will pay medical bills that exceed your share of cost amount in a month.
  • To find your approximate share of cost, subtract $620 for an individual ($954 for a couple) from the amount of your monthly income along with any health insurance premiums you may be paying (including Part B premium). The result is your share of cost.
  • Resource limits for Medi-Cal with a share of cost are the same as those for regular Medi-Cal with no share of cost.
  • Medi-Cal will pay the Medicare Part B premium only for the months when share of cost is met.

Medi-Cal & Medicare Part D

If you are covered by Medi-Cal, you may be entitled to ‘Extra Help’, also known as the Low Income Subsidy (LIS), which helps pay for prescription costs in a Medicare Part D plan.

If you have full Medi-Cal (with no Share of Cost) you do not need to apply for Extra Help. You will be automatically enrolled for the highest level of Extra Help which includes:

  • No monthly premium in designated plans
  • No deductible
  • No coverage gap
  • Co-payments between $1.35-$4.00

If you are not in a Part D plan, you will be assigned to a plan. You have the right to change your Medicare drug plan or Medicare Advantage once per quarter if desired.

If you have Medi-Cal with a Share of Cost, you may qualify for Extra Help in one of two ways:

  1. Complete and return the Social Security application for Extra Help with prescription drug costs. Social Security will advise you if the application has been approved and what the benefits will be.
  2. If you meet your Share of Cost expenses in one month, you are entitled to receive Extra Help on prescription drug costs for the rest of the year. If the Share of Cost is met between July 1 and December 31, you will be considered eligible for Extra Help for the following year as well.

How Can You Apply for Medi-Cal Benefits?

Call the Santa Clara County Medi-Cal Center at (408) 758-3800 or (877) 962-3633. Ask for the Medi-Cal intake line and say that you want to start your Medi-Cal application over the telephone.

  • Have available your Social Security number and birth date.
  • If you are eligible for Medi-Cal, your benefits will start on the date you called. If you do not start the application process by telephone, your benefits will start on the date you return your application to the address indicated on the form.
  • When asked in the Medi-Cal application, if true, state you have medical expenses in order to start the application to start benefits up to three months before your application date.
You can also apply in person at:
  1. Application Assistance Center 1867 Senter Rd, San Jose, CA 95112
  2. North County Office 1330 W. Middlefield Rd, Mountain View, CA 94043
  3. South County Office 379 Tomkins Ct, Gilroy, CA 95020

HICAP can help you understand your options: HICAP counseling appointments.

This project was supported, in whole or in part, by grant numbers 2101CAMISH, 2101CAMIAA, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.

Support provided by the California Department of Aging.