Under-65 Medi-Cal recipients with specific, severe conditions may be eligible for Medicare, even if they have not yet reached age 65. The two primary, specific conditions often cited are:
Medicare eligibility primarily hinges on age (65+) or specific medical conditions like disabilities, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease), alongside being a U.S. citizen or permanent resident for at least 5 continuous years, often tied to work history (paying Medicare taxes). You can qualify automatically if receiving Social Security disability/retirement, or sign up for premium-free Part A if you or a spouse worked enough.
Part A provides inpatient. Most inpatient care is covered under Medicare Part A (hospital insurance). /hospital coverage. Part B provides outpatient. Most outpatient care is covered under Medicare Part B (medical insurance). /medical coverage.
Medicare eligibility generally requires you to be a U.S. citizen or legal resident, age 65+, or under 65 with a qualifying disability (like SSDI for 24 months, ALS, or ESRD), or have a qualifying spouse/parent's work history, with enrollment usually happening around age 65 or when starting disability benefits, often automatically if receiving Social Security. Requirements vary by Part (A, B, C, D) and coverage type, but core criteria involve age, residency, and work credits for premium-free benefits.
Who is eligible for Medicare?
Dual eligible members are people enrolled in both Medicare and Medi-Cal. Under CalAIM, Medi-Medi Plans offer integrated care for dually eligible members.
Medicare is a federal health insurance for seniors (65+) or those with disabilities, while Medi-Cal is California's Medicaid program for low-income individuals and families, covering people of any age. The key difference is funding (federal vs. state-run), eligibility (age/disability vs. income), and benefits; some people are "dual-eligible," receiving Medicare first and Medi-Cal for costs like premiums and extra services, acting as secondary payer.
Medicare is a federal health insurance program for people age 65 or older. People younger than age 65 with certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease), may also be eligible for Medicare.
If you have both Medicare and Medi-Cal, how you receive your benefits depends on what coverage option you choose for your Medicare. For Medicare benefits, you may choose fee-for-service Original Medicare in all counties, or a Medicare Advantage (MA) plan, if available in your county.
Medicare is our country's federal health insurance program for people age 65 and older, some younger people with disabilities, and people of any age with end-stage renal disease (ESRD). The rules for Medicare eligibility are the same for everyone.
Some of the items and services Medicare doesn't cover include:
The Medi-Cal "3-month rule" refers to retroactive coverage, allowing you to request payment for Medi-Cal covered services received up to three months before the month you applied, provided you were eligible during that time and your provider accepted Medi-Cal. You must request this retroactive coverage, often by submitting a specific form like the MC 210A, and claims for reimbursement for paid bills must generally be submitted within one year of the service date or 90 days after approval, whichever is longer.
eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information. » I was not eligible in the past.
To qualify for both Medicare and Medicaid (be "dually eligible"), you must meet eligibility for Medicare (usually age 65+, disability, or certain conditions like ESRD/ALS) and also meet your state's low-income and asset limits for Medicaid, often through Medicare Savings Programs (MSPs) that help pay costs, or by receiving full Medicaid benefits, which coordinates with Medicare to cover services like nursing home care.
The three core requirements for Medicare eligibility generally center on age (65+ or younger with specific conditions like disability/ESRD/ALS), U.S. citizenship/legal residency (5+ years), and sufficient work history (10 years for premium-free Part A), though some (like ESRD/ALS) bypass age, and individuals must also qualify for Social Security or Railroad Retirement benefits to get premium-free coverage, notes Medicare School.
If your income is too high for Medi-Cal, you may qualify to purchase health insurance through Covered California. Covered California offers “premium assistance.” It helps lower the cost of health care for individuals and families who enroll in a Covered California health plan and meet income rules.
Medicare eligibility primarily hinges on age (65+) or specific medical conditions like disabilities, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease), alongside being a U.S. citizen or permanent resident for at least 5 continuous years, often tied to work history (paying Medicare taxes). You can qualify automatically if receiving Social Security disability/retirement, or sign up for premium-free Part A if you or a spouse worked enough.
You generally qualify for Medicare if you're 65+, a U.S. citizen/permanent resident, and meet work (10 years/40 quarters) or Social Security/Railroad Retirement Board (RRB) benefit criteria, or you may qualify younger if you have a qualifying disability, ALS, or End-Stage Renal Disease (ESRD). Many people get premium-free Part A automatically if they're already receiving Social Security, while others must sign up, often during a 7-month window around their 65th birthday.