Covered California vs Medi-Cal: Which Do I Qualify For?

What's the Difference?

Covered California and Medi-Cal are both programs that help Californians get health insurance, but they serve different income levels and have different costs and benefits:

Side-by-Side Comparison

Here's a detailed comparison of Covered California and Medi-Cal to help you understand which program fits your situation:

2026 Income Limits: The 138% FPL Threshold

The dividing line between Medi-Cal and Covered California is 138% of the Federal Poverty Level (FPL). Here are the approximate income limits for 2026:

Key Differences You Need to Know

Cost Differences

Medi-Cal is completely free for most enrollees—no monthly premiums, no deductibles, and minimal copays ($0-$5). This makes it the most affordable option for low-income Californians.

Covered California requires monthly premiums, but most enrollees qualify for substantial subsidies. About 90% of Covered California enrollees pay $10 or less per month after subsidies. If you earn between 150-200% FPL, you may pay $0-$1 per month.

Plan Choice & Flexibility

Covered California offers extensive choice: You can choose from over 10 insurance carriers (Kaiser, Blue Shield, Anthem, Health Net, etc.) and dozens of plans across Bronze, Silver, Gold, and Platinum metal tiers. You can select HMO, PPO, or EPO network types based on your preferences.

Medi-Cal has limited choice: You're typically assigned to a Medi-Cal managed care plan based on your county. While you may have 2-3 plan options, the choices are more restricted than Covered California.

Provider Networks

Covered California plans typically have broader provider networks. Many plans include access to major medical centers, specialist networks, and out-of-network coverage (PPO plans). Premium plans often have more extensive provider access.

Medi-Cal networks are more limited. Not all doctors accept Medi-Cal, and you may face longer wait times for specialist appointments. However, Medi-Cal still provides comprehensive coverage—you just have fewer provider choices.

Enrollment Flexibility

Medi-Cal enrollment is year-round. You can apply and enroll any time of year if you meet the income requirements. There's no waiting for open enrollment.

Covered California has enrollment periods. You must enroll during open enrollment (November 1 - January 31) or qualify for a Special Enrollment Period due to a qualifying life event (job loss, marriage, birth, etc.).

Which Program is Right for You?

The program you qualify for is primarily determined by your income, but here are some scenarios to help you decide:

What Happens When Your Income Changes?

Your income can fluctuate throughout the year, which may affect your program eligibility. Here's what happens when your income changes:

Income Decreases (Moving from Covered CA to Medi-Cal)

If your income drops below 138% FPL while enrolled in Covered California, you become eligible for Medi-Cal. You should:

• Report the income change to Covered California immediately
• Covered California will automatically transfer your case to Medi-Cal
• Your Covered California coverage will end, and Medi-Cal coverage begins
• You won't have to pay back any subsidies you received from Covered California

Income Increases (Moving from Medi-Cal to Covered CA)

If your income rises above 138% FPL while on Medi-Cal, you'll lose Medi-Cal eligibility but become eligible for subsidized Covered California coverage. You should:

• Report the income change to Medi-Cal as soon as possible
• You'll receive a notice that you're losing Medi-Cal eligibility
• This triggers a Special Enrollment Period for Covered California
• You have 60 days to enroll in a Covered California plan
• Your new coverage will start the first of the following month