Understanding the Differences between Medi-Cal and Medicare with a San Jose Elder Law Attorney

Medi-Cal and Medicare consist of very different components and are designed for different purposes. Being eligible for one program does not automatically make you eligible for the other. You must meet separate eligibility requirements for each program. However, if you qualify for both, Medi-Cal will pay for most Medicare part A and B premiums, deductibles and co-payments.

Medicare is an insurance program. Medicare was designed to assist with the high medical costs of older citizens who face financial difficulties given their reduced earning power. It serves people primarily over the age of 65, whatever their income, as well as younger people with disabilities. However, eligibility for Medicare is not tied into individual need. It is an entitlement program. You or your spouse are entitled to Medicare because you paid for it through payroll taxes. Medical bills are paid by trust funds that those covered have paid into. Patients pay part of costs through deductibles for hospital and additional costs. Sometimes, small monthly premiums are required for non-hospital coverage. Medicare is a federally run program.

Medi-Cal is an assistance program run by the state of California for low-income, financially troubled people. This is often referred to as a patient pay responsibility. Medicaid is a federal program administered through the states, and the rules vary from state to state. In California, the Medicaid program is called Medi-Cal. It’s set up by the government and administered by each state. Medical bills are paid by federal, state, and local tax funds. Patients usually pay no part of costs for medical expenses, although, sometimes a co-payment is required. The program varies from state to state. In California it is known as Medi-Cal. There are multiple programs within Medi-Cal, such as Supplementary Security Income (SSI), Aged and Disabled Federal Poverty Level (A&D FPL), Medi-Cal with a Share of Cost (SOC) and California Working Disabled (CWD).

There are many types of documents needed to validate income, assets and expenses. Understanding the eligibility requirements, benefit packages and application process is imperative to choosing the plan that will best suit you and your family.

Jim Ward is an experienced Elder Law Attorney who can help guide you through the process. Give Jim a call to today for a free consultation, 1-800-JIM-WARD.