Covered California vs Medi-Cal: Which One You Qualify For

California runs two different routes to health coverage for people without it through work. Which one you use is decided almost entirely by household income measured against the Federal Poverty Level, and you do not choose between them — the income figure does.

Medi-Cal: at or below 138% of the Federal Poverty Level

Medi-Cal is California’s Medicaid programme. For adults aged 19 to 64, eligibility is based on household Modified Adjusted Gross Income (MAGI) up to 138% of the Federal Poverty Level.

Children and pregnant individuals qualify at higher income levels than adults, so a household can have children on Medi-Cal while the adults are in a Covered California plan. The Department of Health Care Services publishes the eligibility chart with the current figures.

There is no asset or resource test for MAGI Medi-Cal. Savings and property do not disqualify you; income does the work.

Covered California: above that line

Covered California is the state’s insurance marketplace. Above the Medi-Cal threshold you buy a private plan through it — Bronze, Silver, Gold or Platinum — with federal and state financial help scaled to income. The lower your income within the eligible range, the larger the subsidy.

One application decides both

You do not apply to them separately and hope. A single application is assessed against both programmes and routes you to whichever you qualify for. Medi-Cal applications are processed by county human services or social services agencies, so the office handling your case is a county office even though the programme is statewide.

When your income changes mid-year

This is the most common source of trouble. Both programmes are income-tested during the year, not just at enrolment, and a change can move you across the line in either direction. Report income changes when they happen: it can shift you between programmes, and for Covered California it adjusts your subsidy. Subsidies that turn out to have been too large are reconciled on your federal tax return, which is where an unreported raise becomes a bill.

Where to start

Because one application covers both, start at Covered California or your county human services agency; either route reaches the same determination.

Federal Poverty Level figures are updated annually, so the dollar amount at 138% changes every year. Check the current chart from the source above.