What is the difference between Medi-Cal and Medicare?

Medicare is federal health insurance based on age or disability: people 65 and older qualify regardless of income. It pays for hospital care, doctors, drugs, hospice and short skilled-nursing rehab, but not long-term care. Medi-Cal is California's Medicaid program, based on income and, for seniors, savings. It covers medical care with little or no cost to the member, and it is the program that pays for long-term nursing home care, In-Home Supportive Services, and the care portion of assisted living through the Assisted Living Waiver.

Can you have both Medi-Cal and Medicare?

Yes. People with both are called dual eligible, or Medi-Medi. Medicare pays first for most medical services and prescription drugs. Medi-Cal can pay the Medicare Part A and Part B premiums through the Buy-In program, can cover Medicare deductibles and coinsurance through a Medicare Savings Program, and pays for long-term services Medicare does not cover, such as nursing home care and IHSS. In 2026, dual eligible members in 41 California counties can also choose a Medi-Medi Plan that combines both into one plan.

Does Medicare or Medi-Cal pay for a nursing home?

Medicare pays only for short-term skilled nursing after a qualifying hospital stay of at least three days in a row as an inpatient: up to 100 days per benefit period, with $0 for days 1 to 20 and $217 a day for days 21 to 100 in 2026, and only while your parent needs daily skilled care. Medicare does not pay for a long-term stay. Medi-Cal does, for members who meet the income and asset rules. For comparison, DHCS uses $14,440 as the 2026 statewide average private pay rate for nursing facility services.

Does Medicare or Medi-Cal pay for assisted living?

Medicare does not pay for assisted living at all, neither the room nor the daily care. Medi-Cal pays only through the Assisted Living Waiver, which covers the care portion for members who need a nursing-facility level of care, have no Share of Cost, and live in a participating facility in one of 15 California counties. ALW never pays room and board, and enrollment is capped with a statewide waitlist. Our Medi-Cal vs Medicare for assisted living comparison goes deeper on that one question.

What is the Medi-Cal asset limit in 2026, and is it changing?

Through June 30, 2027, the limit for seniors and other non-MAGI Medi-Cal programs is $130,000 for one person plus $65,000 for each additional household member, which makes $195,000 for a couple. The home you live in, one vehicle and household items do not count. DHCS says that starting July 1, 2027, the limit drops to $21,000 for one person and $31,000 for two, plus $1,550 for each additional household member. New applicants report assets when they apply; current members are reviewed at renewal.

What does Medicare cost in 2026?

Most people pay no premium for Part A. The Part A hospital deductible is $1,736 per benefit period. The standard Part B premium is $202.90 a month, or more at higher incomes, and the Part B deductible is $283 a year, after which you usually pay 20% of the Medicare-approved amount. Medicare Advantage and Part D drug plan costs vary by plan. If your parent has limited income and savings, Medi-Cal may pay the premiums and cost sharing.

How long does a Medi-Cal application take?

DHCS says the county can take up to 45 days to decide a Medi-Cal application, or up to 90 days if the application is based on disability. The decision arrives as a letter called a Notice of Action. If you do not hear back within that time, or you disagree with the decision, you can ask for a State Fair Hearing. If your parent has unpaid medical bills, ask the county for retroactive Medi-Cal, which may cover bills from the three months before the application date, so apply as soon as care costs start.

Who can help us sort out Medicare and Medi-Cal for free?

HICAP, the Health Insurance Counseling and Advocacy Program run through the California Department of Aging, gives free, confidential one-on-one counseling on Medicare, Medi-Cal and long-term care insurance. Call 1-800-434-0222 to reach the HICAP office for your county. For a Medi-Cal application itself, your county Medi-Cal office is the place to start, and our Medi-Cal application help page walks through what to gather first.

Medi-Cal vs Medicare: what each pays in 2026

The answer in two sentences.

Medicare pays for medical care, short rehab stays and hospice for nearly every Californian 65 and older, but it does not pay for long-term care in a nursing home, in assisted living or at home. Medi-Cal is the program that does pay for long-term care, for people whose income and savings are under its limits, and many seniors end up needing both.

Medi-Cal vs Medicare, side by side.

Who runs it

Medicare: The federal government, through the Centers for Medicare & Medicaid Services.

Medi-Cal: California's Department of Health Care Services. Your county Medi-Cal office handles applications and renewals.

Who qualifies

Medicare: People 65 and older who meet citizenship or residency rules, and some younger people with a disability, End-Stage Renal Disease or ALS. No income test.

Medi-Cal: Based on income and, for seniors, assets. Seniors with income up to 138% of the federal poverty level qualify with no Share of Cost. Higher income can still qualify with a Share of Cost.

Income line (current DHCS chart)

Medicare: None.

Medi-Cal: DHCS lists 138% of the poverty level as $21,597 a year for one person (about $1,800 a month) and $29,187 for two.

Asset (savings) limit

Medicare: None.

Medi-Cal: $130,000 for one person, plus $65,000 for each additional household member, through June 30, 2027. From July 1, 2027: $21,000 for one person and $31,000 for two. Home and one vehicle do not count.

Hospital and doctor visits

Medicare: Covered. 2026: Part A deductible $1,736 per benefit period; Part B premium $202.90 a month and $283 deductible, then usually 20% of the approved amount.

Medi-Cal: Covered. Managed care members pay no copays. In fee-for-service, copays are at most $1 a visit or prescription, $5 for a non-emergency ER visit.

Short-term skilled nursing (rehab)

Medicare: Up to 100 days per benefit period after a 3-day inpatient hospital stay. 2026: days 1 to 20 cost $0; days 21 to 100 cost $217 a day; after day 100 you pay all costs.

Medi-Cal: Medi-Cal covers nursing facility care for members who qualify. For people with both, a Medicare Savings Program can pay Medicare's coinsurance.

Long-term nursing home care

Medicare: Not covered. Medicare does not pay for long-term or custodial care.

Medi-Cal: Covered for members who meet the income and asset rules. A Share of Cost may apply.

Assisted living

Medicare: Not covered, for the residence or the daily care.

Medi-Cal: Only through the Assisted Living Waiver: the care portion, at participating facilities, in 15 counties, with a waitlist. Never room and board.

Help at home with daily living

Medicare: Not covered. Medicare covers skilled home health at $0 when its rules are met, but not personal care on its own.

Medi-Cal: In-Home Supportive Services (IHSS) pays for personal care, meals, cleaning, laundry and protective supervision, and a relative can be the paid caregiver.

Hospice

Medicare: Covered at $0, with up to a $5 copay per drug for symptom control. Can be delivered at home, in assisted living or in a nursing home. Room and board not covered.

Medi-Cal: For people with both, Medicare pays first for medical care, including hospice.

How to apply

Medicare: Automatic for many people already getting Social Security before 65. Others sign up through Social Security.

Medi-Cal: Through your county Medi-Cal office or Covered California. Decisions take up to 45 days, or up to 90 days when based on disability.

	Medicare	Medi-Cal
Who runs it	The federal government, through the Centers for Medicare & Medicaid Services.	California's Department of Health Care Services. Your county Medi-Cal office handles applications and renewals.
Who qualifies	People 65 and older who meet citizenship or residency rules, and some younger people with a disability, End-Stage Renal Disease or ALS. No income test.	Based on income and, for seniors, assets. Seniors with income up to 138% of the federal poverty level qualify with no Share of Cost. Higher income can still qualify with a Share of Cost.
Income line (current DHCS chart)	None.	DHCS lists 138% of the poverty level as $21,597 a year for one person (about $1,800 a month) and $29,187 for two.
Asset (savings) limit	None.	$130,000 for one person, plus $65,000 for each additional household member, through June 30, 2027. From July 1, 2027: $21,000 for one person and $31,000 for two. Home and one vehicle do not count.
Hospital and doctor visits	Covered. 2026: Part A deductible $1,736 per benefit period; Part B premium $202.90 a month and $283 deductible, then usually 20% of the approved amount.	Covered. Managed care members pay no copays. In fee-for-service, copays are at most $1 a visit or prescription, $5 for a non-emergency ER visit.
Short-term skilled nursing (rehab)	Up to 100 days per benefit period after a 3-day inpatient hospital stay. 2026: days 1 to 20 cost $0; days 21 to 100 cost $217 a day; after day 100 you pay all costs.	Medi-Cal covers nursing facility care for members who qualify. For people with both, a Medicare Savings Program can pay Medicare's coinsurance.
Long-term nursing home care	Not covered. Medicare does not pay for long-term or custodial care.	Covered for members who meet the income and asset rules. A Share of Cost may apply.
Assisted living	Not covered, for the residence or the daily care.	Only through the Assisted Living Waiver: the care portion, at participating facilities, in 15 counties, with a waitlist. Never room and board.
Help at home with daily living	Not covered. Medicare covers skilled home health at $0 when its rules are met, but not personal care on its own.	In-Home Supportive Services (IHSS) pays for personal care, meals, cleaning, laundry and protective supervision, and a relative can be the paid caregiver.
Hospice	Covered at $0, with up to a $5 copay per drug for symptom control. Can be delivered at home, in assisted living or in a nursing home. Room and board not covered.	For people with both, Medicare pays first for medical care, including hospice.
How to apply	Automatic for many people already getting Social Security before 65. Others sign up through Social Security.	Through your county Medi-Cal office or Covered California. Decisions take up to 45 days, or up to 90 days when based on disability.

Dollar figures are 2026 amounts from Medicare.gov and the California Department of Health Care Services. Medicare amounts can change each year.

What Medicare covers, and where it stops.

Part A (hospital). Inpatient hospital care, hospice, skilled home health, and short-term skilled nursing facility care after a qualifying hospital stay. Most people pay no Part A premium. In 2026 the deductible is $1,736 per benefit period.
Part B (medical). Doctor visits, outpatient care, preventive care and medical equipment. In 2026 the standard premium is $202.90 a month and the deductible is $283, then you usually pay 20% of the Medicare-approved amount.
Part D (drugs). Prescription drug coverage through private plans. Premiums vary by plan.
Medicare Advantage (Part C). A private plan that replaces Original Medicare for most purposes. You keep paying the Part B premium. Costs and extras vary by plan.

Medicare.gov is direct about the limit: Medicare and most health insurance, including Medigap, do not pay for long-term care, including help with bathing, dressing and using the bathroom, whether it happens at home, in assisted living or in a nursing home. That is the single most expensive thing families get wrong.

What Medi-Cal pays for that Medicare does not.

Medi-Cal is the program that pays for ongoing care. DHCS describes it this way for people with both: you get most medical services and prescription drugs through Medicare, and Medi-Cal provides long-term services and supports such as nursing home care and home and community-based services.

Long-term nursing home care.Medi-Cal pays for a long nursing facility stay for members who meet the rules, after Medicare’s short-term benefit ends or instead of it. See long-term skilled nursing in California.
In-Home Supportive Services (IHSS). Pays for help at home: personal care, meals, cleaning, laundry, shopping, going with your parent to medical appointments, and protective supervision for people who cannot be left alone safely. A friend or relative can be the paid caregiver. See IHSS eligibility.
The Assisted Living Waiver (ALW). Pays the care portion at participating assisted living facilities in 15 counties, for members who need a nursing-facility level of care. It does not pay room and board, and there is a statewide waitlist. See the ALW guide.
PACE, MSSP and CalAIM supports. Other Medi-Cal routes to care at home or in the community, each with its own rules and service areas. See PACE, MSSP and CalAIM.

Medi-Cal income and asset rules for seniors in 2026.

Income. Most California seniors qualify through the Aged, Blind and Disabled Federal Poverty Level program, which has counted income up to 138% of the federal poverty level since December 2020. The DHCS chart puts that line at $21,597 a year for one person, about $1,800 a month, and $29,187 for two. Above that, your parent can still qualify with a Share of Cost: a monthly amount paid toward their own care before Medi-Cal pays, which resets each month. For someone in a nursing home, the facility bill usually meets it quickly. See how Share of Cost works.

Assets.California dropped the Medi-Cal asset test entirely on January 1, 2024, then brought it back on January 1, 2026. Through June 30, 2027, the limit is $130,000 for one person plus $65,000 for each additional household member, so $195,000 for a couple. Your parent’s home, one vehicle, household items and some retirement accounts do not count. DHCS has announced a lower limit starting July 1, 2027: $21,000 for one person and $31,000 for two, plus $1,550 for each additional household member. Assets are checked at application or at the member’s renewal. The full detail is on our asset limit page.

Gifts and transfers. For long-term nursing home Medi-Cal, the county looks back 30 months for assets given away for less than they were worth. Transfers made between January 1, 2024 and December 31, 2025, while there was no asset test, are not penalized. If one spouse needs nursing home care, spousal impoverishment rules protect the spouse at home. In 2026 the Community Spouse Resource Allowance, the savings the at-home spouse can keep, is $162,660, and the Minimum Monthly Maintenance Needs Allowance, the monthly income the at-home spouse is protected up to, is $4,067. See the Medi-Cal look-back period.

Dual eligible (Medi-Medi): what changes when your parent has both.

Many people 65 and older qualify for both programs. When they do, Medicare pays first for doctors, hospitals and drugs, and Medi-Cal fills in. Three things make the biggest difference to a monthly budget:

Premiums. Through the Medicare Premium Payment Buy-In Program, Medi-Cal can pay the Part A and Part B premiums. At $202.90 a month for Part B in 2026, that alone is more than $2,400 a year.
Deductibles and coinsurance. A Medicare Savings Program can pay Medicare deductibles, coinsurance and copays. DHCS says members eligible for an MSP do not pay Medicare coinsurance or deductibles.
Long-term care. Medi-Cal adds what Medicare leaves out: nursing home care, IHSS and, where available, the Assisted Living Waiver.

Dual eligible members can also choose a Medi-Medi Plan, a type of Medicare Advantage plan that combines Medicare and Medi-Cal benefits in one plan, with one network of providers. In 2026 these plans are available in 41 California counties. Your parent needs Medicare Parts A and B plus Medi-Cal to join, and can enroll by calling their Medi-Cal plan or Health Care Options at 1-800-430-4263. Enrollment is voluntary. More on dual eligible benefits in California.

If you are starting from zero.

Call HICAP.The Health Insurance Counseling and Advocacy Program gives free, confidential counseling on Medicare and Medi-Cal. Call 1-800-434-0222 to reach your county’s office.
Apply for Medi-Cal if income or savings might qualify. Apply through your county Medi-Cal office. A decision can take up to 45 days, or 90 days for a disability-based application. Our Medi-Cal application guide lists what to gather.
If a hospital stay started this, talk to the discharge planner now. Ask how long Medicare will cover rehab, what the plan is when it ends, and whether a Medi-Cal application should start while your parent is still in the facility.

For the narrower question of who pays for assisted living, see Medi-Cal vs Medicare for assisted living. For the full Medicare picture in California, see Medicare in California.

Medi-Cal vs Medicare: what each one pays for California seniors.