Dual Eligibility: Medicare and Medi-Cal in California 2026

Who Qualifies for Dual Eligibility in California

Dual eligibility means you meet the requirements to have both Medicare and Medi-Cal simultaneously. Millions of Californians with limited income and assets qualify for this critical benefit that covers costs that Medicare leaves uncovered.

To qualify in California, you must meet ALL these requirements:

Financial Limits

Additionally, your income and assets must be within the limits set by the State of California. These limits are reviewed annually and may vary based on your family situation.

Important note: California is one of the few states that allows people with higher incomes to qualify for Medi-Cal under the Medicare Savings Program (MSP). This means that even if you don't qualify for full Medi-Cal, you might qualify for help with Medicare premiums and cost-sharing.

2026 Income and Asset Limits

To qualify for Medi-Cal in California as a dual-eligible person, your gross monthly income must be within these limits:

Asset Limits (resources): California allows you to have up to $2,000 in non-excluded resources if single, or $3,000 if a couple. Excluded resources (don't count) include your home, one vehicle, personal items, and certain savings.

How Income is Calculated

Income includes: wages and salaries, self-employment income, Social Security benefits, pensions, rental income, interest and dividends, unemployment benefits, child support, and capital gains.

Income exclusions: Supplemental Security Income (SSI) does not count, veteran compensation benefits, certain part-time work income for minors, and certain state/local assistance income.

How Dual Eligibility Works in Practice

Dual eligibility is a situation where you have two insurers working together to cover your healthcare costs. Understanding how they coordinate is essential to maximizing your benefits.

The Primary and Secondary Insurance System

Medicare is your primary insurer. This means Medicare is the first to pay for covered services. Medicare determines the amount it will pay based on its approved rates.

Medi-Cal is your secondary insurer. After Medicare pays its share, Medi-Cal "fills the gaps" by paying:

• Your Medicare deductible (currently $1,600 for Part A)
• Your Medicare coinsurance (typically 20 percent)
• Your Medicare copayments
• Your Part D deductible (prescription drugs)
• Your Part D coinsurance

Services That Medicare Only Covers

Medicare covers basic medical services such as: hospitalization, doctor visits, lab services, x-rays, surgery, rehabilitation after hospitalization, ambulance services, and preventive care.

Services That Medi-Cal Adds

Medi-Cal provides additional benefits that Medicare does not cover:

• Long-term care (nursing home, home care)
• Vision services (eye exams, glasses, eye surgery)
• Dental services (cleanings, extractions, dentures)
• Hearing services (hearing aids, evaluations)
• Medical transportation services
• Mental health and substance abuse treatment services
• Some medications not covered by Medicare Part D

Main Benefits of Dual Eligibility

Being eligible for Medicare and Medi-Cal simultaneously offers incredible benefits that can save thousands of dollars each year in healthcare costs.

1. Zero Copayments for Essential Services

With both programs coordinating, many dual-eligible people pay no copayments for services such as doctor visits, lab services, x-rays, and preventive care. Medi-Cal covers what Medicare leaves uncovered.

2. Complete Prescription Drug Coverage

Medicare Part D provides prescription drug coverage, but it has a coverage "gap" known as the "donut hole." Medi-Cal helps cover that out-of-pocket cost. Additionally, Medi-Cal can cover drugs that Medicare does not approve.

3. Long-Term Care Benefits

Medicare covers only the first 100 days of nursing home care after hospitalization. Medi-Cal is the primary program that covers long-term care after that. This is critical for many older adults who need institutional care.

4. Coverage for Services Medicare Does Not Cover

Medicare does not cover dental, vision, hearing, or elective mental health services. Medi-Cal covers ALL of these services, eliminating important coverage gaps.

5. D-SNP Plan Benefits

If you enroll in a D-SNP (Dual Special Needs Plan), you get additional benefits designed specifically for dual-eligible people, such as transportation services, wellness programs, and enhanced care coordination.

6. Protection Against Catastrophic Expenses

Without dual eligibility, a serious medical event (hospitalization, major surgery) could lead to thousands of dollars in out-of-pocket expenses. With both programs, your out-of-pocket costs are limited.

D-SNP Plans (Dual Special Needs Plans) in California

D-SNP plans are Medicare Advantage plans specially designed for people who qualify for dual eligibility. They are coordinated products that integrate Medicare and Medi-Cal, offering a more seamless care experience.

What is a D-SNP Plan

A D-SNP (Dual Special Needs Plan) is a type of Medicare Advantage (Part C) that combines

• Coverage for Medicare Parts A, B, and D (hospital, doctor, drugs)
• Coordinated Medi-Cal coverage
• Special additional benefits

Advantages of D-SNP Plans

Integrated coordination: One plan coordinates both insurances, eliminating confusion.

Reduced or zero copayments: Many D-SNPs offer zero copayments for basic services.

Special additional benefits: Services not covered by Medicare such as transportation, audiobooks, home meal delivery services, and wellness programs.

Better care coordination: D-SNP plans typically offer better case management and coordination between providers.

Access to specialized networks: Provider networks trained in treating people with multiple chronic conditions.

Major D-SNP Providers in California 2026

How to Enroll in a D-SNP Plan

You can enroll in a D-SNP plan during open enrollment periods:

• Initial Enrollment Period: When you turn 65 (3 months before, during, 3 months after)
• Annual Enrollment Period (AEP): October 15 to December 7 each year
• Special Enrollment Period (SEP): If you have coverage changes or move

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or by visiting a local Medicare assistance office.

Medicare Savings Programs (MSP) in California

If your income is too high for full Medi-Cal but still low, you may qualify for a Medicare Savings Program (MSP). These programs pay your Medicare premiums and cost-sharing.

The Four MSP Programs

Extra Help / Low Income Subsidy (LIS)

Extra Help is a federal program that helps with Medicare Part D prescription drug costs if you have limited income and assets. You can receive up to 75 percent savings on medications.

Income limits for Extra Help: Up to 150 percent of federal poverty level (approximately $1,050/month for one person).

Benefits: Reduced or zero Part D premiums, no deductibles or very low deductibles, significantly reduced copayments.

How to Apply for Medi-Cal in California

If you think you qualify for Medi-Cal, the application process is free and relatively simple. There are several ways to do it.

Option 1: Online Application (Recommended)

Website: https://dhcs.ca.gov/ or https://benefitscal.org/

Advantages: Fast, available 24/7, can track your application online, receive email confirmation.

What you need: Your Social Security number, family members' Social Security numbers, income information, list of assets, residential address.

Option 2: By Phone

Number: 1-866-352-7222 (MEDI-CAL)

Hours: Monday to Friday, 8 AM to 5 PM (Pacific time)

Multilingual availability: Translation services available

Option 3: In Person

Visit your county Medi-Cal office. You can find the location at https://dhcs.ca.gov/. Bring all required documents.

Documents You Will Need

Have the following documents ready to speed up your application:

What to Expect After Applying

Processing time: California typically processes applications within 45 days. In urgent cases, you may get temporary coverage while your application is being processed.

Interview: Medi-Cal may contact you for an interview to verify your information. It can be by phone, video, or in person.

Decision notice: You will receive a letter telling you if you were approved or denied. If denied, you can appeal.

If approved: You will receive your Medi-Cal case number and Medi-Cal card within 10 days.

Renewing Your Medi-Cal

After obtaining Medi-Cal, you must renew your coverage each year. Medi-Cal will send you a renewal notice 30 days before your coverage expires. You can renew online, by mail, or by phone.

Frequently Asked Questions About Dual Eligibility

Q: If I have dual eligibility, can I choose my own doctor?

A: It depends on your plan. If you have Original Medicare with Medi-Cal, you can see any provider who accepts Medicare (most do). If you have a D-SNP plan, you must use their in-network providers, but plans typically have broad networks.

Q: What happens if I move within California?

A: You can keep your Medi-Cal coverage. However, if your D-SNP plan does not serve your new area, you may be entitled to switch plans. Contact Medi-Cal immediately about any address change.

Q: Will dual eligibility affect my Social Security?

A: No. Your Social Security benefits are received the same way. However, the money you receive is considered "income" to determine if you qualify for Medi-Cal, but it normally doesn't reduce your benefits.

Q: What if my income changes?

A: You must report income changes to Medi-Cal within 10 days. If your income rises too high, you may lose Medi-Cal eligibility but could qualify for MSP programs. If it falls, you may get more benefits.

Q: Can I have both Medigap supplemental and Medi-Cal?

A: No. If you have Medi-Cal, you should not have a Medigap plan. Medi-Cal plays the role of Medigap by paying costs that Medicare leaves uncovered. Having both can cause benefit coordination problems.

Q: How does Medi-Cal work with prescription drugs?

A: You must have Medicare Part D for prescription drug coverage. Medi-Cal provides assistance with Part D copayments and deductibles. If Medi-Cal covers a drug that Part D does not, Medi-Cal covers it as a Medi-Cal medication.

Q: If I enroll in a D-SNP plan, do I have to change doctors?

A: It depends. If your current doctor participates in the D-SNP plan, you can continue seeing them. If not, you would need to switch to an in-network provider. Verify before enrolling.

Q: What is the first thing I should do if I think I qualify?

A: First: check your eligibility using BenefitsCal.org. If it looks like you qualify, submit your application. Don't wait. While it's being processed, you could be eligible for retroactive coverage.

Q: Are there enrollment costs for Medi-Cal?

A: No. Applying for and getting Medi-Cal is completely free. Be suspicious of anyone who charges you for help applying.

Q: If my application is denied, can I appeal?

A: Yes. You have the right to a "fair hearing." The denial letter will explain how to appeal. You must do so within 90 days of the letter's date.

Your Next Step: Apply Today

If you think you might qualify for dual eligibility for Medicare and Medi-Cal, the time to act is now. Thousands of Californians qualify but never apply because they don't know they're eligible.

Important Contact Information

• Medi-Cal: 1-866-352-7222 | https://dhcs.ca.gov
• Medicare: 1-800-MEDICARE (1-800-633-4227)
• Social Security: 1-800-772-1213
• BenefitsCal (check eligibility): https://benefitscal.org

Important note: This information is for educational purposes only. Consult with a certified benefits professional or community assistance service for personalized advice about your specific situation.

See Also on Our Site

Learn more about Medicare benefits:

• What is Medicare: Complete Guide
• Best Medicare Plans in California 2026

Spanish version of this page: Medicare y Medi-Cal: Doble Elegibilidad en California