Many people are confused about the differences between Medicare and Medi-Cal. While these programs may sound similar, they are in fact two distinct and different programs.
Medicare is an entitlement program that is funded by the federal government. It does not depend on one’s assets or income. Benefits are earned by virtue of payments made into this program over one’s working lifetime. When one retires from the workforce at age 65 or so, or earlier due to a disability, Medicare coverage begins. Medicare coverage is often not complete coverage and many services require co-payments. Many seniors supplement their basic coverage by joining Medicare HMOs or purchasing supplemental insurance commonly called Medi-Gap coverage.
There are several parts to Medicare. Part A covers hospital bills, Part B covers doctor visits and other outpatient services, while Part D covers prescriptions.
Medi-Cal is different from Medicare in several important ways. It is a needs-based program, funded by the federal and California state government. It is known as Medicaid in other states. To qualify, one must typically meet both asset and income requirements.
Medi-Cal is a program that many seniors rely on to help with the payment of the costs of nursing home care. Currently in California, the average cost of nursing home care is over $8,500 per month. Unlike Medicare that pays, if at all, for only a limited number of days in a nursing home for rehabilitative care (up to a maximum of 100 days), Medi-Cal can pay for custodial care for someone in a skilled nursing facility for an unlimited time period.
Since there are strict eligibility requirements to qualify for Medi-Cal benefits, for many persons needing this care, it is important to work with an experienced and qualified elder law attorney to prevent an unnecessary denial of benefits.