Covered California vs. Medi-Cal: Income, Eligibility and Coverage

Covered California and Medi-Cal both help Californians get health coverage, but they are different programs with different eligibility rules, costs and enrollment requirements.

One of the biggest differences is income. Many lower-income Californians qualify for Medi-Cal, while people above the applicable Medi-Cal income limits may qualify for private health insurance through Covered California, potentially with financial assistance.

Quick answer: Medi-Cal provides free or low-cost health coverage to eligible Californians and, for many adults ages 19 through 64, the income limit is generally 138% of the Federal Poverty Level. Covered California is the state's health insurance marketplace, where eligible consumers can purchase private health plans and may qualify for financial help based on household income and other factors.

For a broader overview of private plans available through the marketplace, costs, financial help and enrollment, see our complete guide to Covered California health insurance.

What Is the Difference Between Covered California and Medi-Cal?

Covered California is California's health insurance marketplace. It allows eligible individuals and families to compare and enroll in private health insurance plans offered by participating insurance companies.

Medi-Cal is California's Medicaid program. It provides free or low-cost health coverage to eligible California residents based on income and other eligibility rules.

A simple way to think about the difference is:

• Covered California: Private health insurance purchased through California's marketplace, with financial assistance available to eligible consumers.
• Medi-Cal: Public health coverage for eligible Californians, generally with little or no premium for many members.

Covered California vs. Medi-Cal Income Limits

Income is one of the primary factors used to determine whether someone qualifies for Medi-Cal or a Covered California plan with financial assistance.

For many adults ages 19 through 64, Medi-Cal eligibility extends to household income at or below approximately 138% of the Federal Poverty Level, provided the person meets the other applicable eligibility requirements.

Different Medi-Cal income limits can apply to children, pregnant individuals and other eligibility groups, so 138% FPL should not be treated as a universal Medi-Cal limit for everyone.

If you want to compare specific income amounts by household size, see our 2027 Covered California income limits guide.

Can I Choose Covered California Instead of Medi-Cal?

If you qualify for full-scope Medi-Cal, you generally cannot receive Covered California premium assistance for the same period because eligibility for qualifying Medi-Cal coverage can make you ineligible for Marketplace financial assistance.

You may be able to purchase certain coverage without financial assistance, but paying full price for private coverage when Medi-Cal is available can be significantly more expensive.

Your eligibility determination is based on the information provided on your application and the rules that apply to your circumstances.

Can One Family Have Both Medi-Cal and Covered California?

Yes. Members of the same household can qualify for different health coverage programs.

This is sometimes called a mixed-program family.

For example, children have different Medi-Cal income eligibility limits than many adults. A household may therefore have children enrolled in Medi-Cal while one or both parents enroll in a Covered California health plan.

This does not necessarily mean there is an error with the application. Eligibility is determined for each household member based on the rules that apply to that person.

How Does Covered California Determine Income?

Covered California generally considers your household's expected annual income and household size when determining eligibility for health coverage and financial assistance.

The calculation generally uses Modified Adjusted Gross Income, commonly called MAGI.

Different sources of income can be treated differently. Wages, net self-employment income, Social Security benefits, unemployment benefits and investment income are examples of income that may need to be reported.

For a detailed explanation, see what counts as income for Covered California.

What Happens if My Income Is Too High for Medi-Cal?

If your household income rises above the applicable Medi-Cal eligibility limit, you may become eligible for health insurance through Covered California.

Depending on your income and other eligibility factors, you may also qualify for financial assistance that reduces your monthly premium or other health care costs.

For 2027, California also provides state premium assistance to eligible Covered California consumers with household incomes up to 200% of the Federal Poverty Level.

Learn more about Covered California subsidies and financial help.

What Happens if My Income Drops While I Have Covered California?

If your income decreases during the year, update your Covered California account.

A lower income may increase the financial assistance available for your Covered California plan. If your income falls within an applicable Medi-Cal eligibility range, you or another member of your household may instead become eligible for Medi-Cal.

Keeping your income information current can help make sure your eligibility determination reflects your current circumstances.

Does Medi-Cal Have Monthly Premiums?

Many Medi-Cal members receive coverage at little or no monthly premium. Costs depend on the specific Medi-Cal program and the member's circumstances.

Covered California plans are private insurance plans with monthly premiums. Eligible consumers may receive financial assistance that reduces the amount they pay each month.

When comparing the two programs, it is important to consider eligibility, premiums, provider networks and other coverage rules rather than comparing monthly premiums alone.

Do Covered California and Medi-Cal Have the Same Doctors?

No. Provider networks can differ between Covered California health plans and Medi-Cal managed care plans.

Even within Covered California, different insurance companies and individual plans can have different networks of doctors, hospitals and medical groups.

Medi-Cal plan options can also vary by county.

Before choosing a health plan, it is important to verify whether your preferred doctors, hospitals and other providers participate in the specific plan you are considering.

Can I Apply for Medi-Cal Through Covered California?

Yes. The Covered California application is designed to determine eligibility for health coverage programs, including Medi-Cal.

Based on the information entered on the application, household members may be determined eligible for Covered California, Medi-Cal or different programs within the same household.

Medi-Cal applications can also be submitted through other approved channels, including county offices.

When Can I Enroll?

Medi-Cal enrollment is available throughout the year for people who qualify.

Covered California generally has an annual Open Enrollment period. Outside Open Enrollment, you usually need a qualifying life event to enroll through a Special Enrollment Period.

Examples can include losing other health coverage, getting married, having a baby or moving to California.

See our guides to Covered California Open Enrollment and Covered California Special Enrollment.

What if I'm Self-Employed?

Self-employed Californians can qualify for either Medi-Cal or Covered California depending on their household income and other eligibility factors.

Self-employment income can be more difficult to estimate because Covered California generally considers net self-employment income rather than simply looking at total business revenue.

See our guide to Covered California for self-employed Californians for more information.

Important Medi-Cal Changes in 2027

Some Medi-Cal rules change beginning in 2027. For example, certain adults ages 19 through 64 covered through the Affordable Care Act expansion may be subject to new work or community engagement requirements unless an exemption applies.

There are numerous exemptions, and these requirements do not apply to everyone enrolled in Medi-Cal. Anyone affected should follow notices from Medi-Cal and the California Department of Health Care Services regarding their individual eligibility requirements.

Frequently Asked Questions

Is Covered California the same as Medi-Cal?

No. Covered California is California's health insurance marketplace for private health plans. Medi-Cal is California's Medicaid program for eligible residents.

What is the Medi-Cal income limit for adults?

For many adults ages 19 through 64, Medi-Cal eligibility extends through approximately 138% of the Federal Poverty Level. Different income limits and rules apply to children, pregnant individuals and certain other eligibility groups.

What happens if I make too much money for Medi-Cal?

You may qualify for a private health insurance plan through Covered California. Depending on your household income and other eligibility requirements, financial assistance may be available to reduce the cost.

Can my children have Medi-Cal while I have Covered California?

Yes. Children and adults can have different Medi-Cal income limits, so members of the same household may qualify for different programs.

Can I enroll in Medi-Cal anytime?

Yes. Unlike Covered California's standard Open Enrollment schedule, eligible individuals can apply for Medi-Cal throughout the year.

What should I do if my income changes?

Report the change so your eligibility can be reevaluated. A change in income can affect financial assistance and may cause someone to move between Covered California and Medi-Cal eligibility.

Need Help Understanding Your Health Coverage Options?

It can be confusing when family members qualify for different programs or when a change in income causes your eligibility to change.

California Benefits Insurance Center can help you understand your health insurance options and navigate the Covered California enrollment process.

Call 800-341-1165 or email health@californiainsurancecenter.com for assistance.

This article is for general informational purposes and does not guarantee eligibility for Covered California, Medi-Cal or financial assistance. Eligibility is determined by the applicable government program based on individual circumstances and current program rules.