Medicare and Medicaid: Unlocking the Mystery

Medicare and Medi-Cal have long been a mystery to many consumers. In fact, it can baffle and confuse even some of the smartest citizens. Like me, you might have thought, “I don’t need to worry about this right now.” However, it is never too early to gain a little understanding and awareness that just might help you help an aging loved one or yourself down the road. As the saying goes, “Time flies.”, and you will be there sooner than you think. Let’s break it down and learn some of the differences and basics of Medicare and Medi-Cal to unlock the mystery.



Medicare is a health insurance program provided through the federal government. To receive Medicare, a person must be 65 years old or older or have a severe disability. For a disabled person under the age of 65 to be eligible for Medicare, they must have received Social Security Disability Insurance (SSDI) for two years. To be eligible for Medicare, a person must have Social Security retirement benefits or Social Security disability benefits. Because Medicare is run and administered by the federal government, it is uniform from state to state. If a person meets Medicare eligibility requirements, they can receive Medicare no matter their income or assets. Costs for Medicare are based on the recipient’s work history. This means that costs are determined by the amount of time a person paid Medicare taxes. These costs, like all insurance, include premiums, copays, and prescriptions.


Medicare can be confusing because there are four parts. The commercials talk about Parts A, B, C, D. What does it all really mean? Parts A, B, and D can be somewhat simplified. Part A is hospital insurance, Part B is medical insurance, and Part D is prescription drug coverage. Parts A and B are covered in Original Medicare offered by the government.


Part C is often called the Medicare Advantage Plan. This is a private health plan. The Medicare Advantage Plan or Medicare Part C plan are required to include the same coverage as Original Medicare, but usually also include Part D as well.


It is important to do your homework on these plans to find what works best and is most cost effective for you.



Medicaid is a health care assistance program of the federal government. It is administered by the individual states, and Medicaid is called Medi-Cal in California. Medi-Cal is for people who cannot afford to pay for care on their own. It is based on income and assets, and is available to people who belong to one of the eligible groups: Children, people with disabilities, people over age 65, pregnant women, and the parents of eligible children. Seniors who require nursing home care can qualify for Medi-Cal and only pay a share of their income for the nursing home. Medi-Cal then pays the rest.


Dual Eligibility

A person can be eligible for both Medicare and Medi-Cal, and can have both. The two programs work together to help the recipient best cover the expenses of health care. For example, Medicare costs include premiums, copays, and deductibles. Full Medi-Cal benefits can cover the costs of Medicare deductibles and cover the 20% of costs not covered by Medicare. Medi-Cal can also help with Medicare assistance and may cover costs of premiums for Part A and/or Part B.


Although Medi-Cal and Medicare can be quite confusing, it is important to know the basics.


We assist seniors and their families qualify for Medi-Cal with a number of different planning tools. If you would like to discuss Medi-Cal, please call us now.


If you have any questions about something you have read or would like additional information, please feel free to contact us.

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