Individuals with Medicare

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

If individuals are enrolled in Medicare, they cannot apply for coverage through Covered California because they are already covered. Medicare is considered minimum essential coverage (MEC) under the Affordable Care Act (ACA). Covered California does not offer Medicare Advantage Plans or any Medicare supplemental plans, such as Medicare Part D.

If Covered California enrollees become eligible for, or enroll in, Medicare, it may affect their eligibility for financial assistance. They must report their eligibility for or enrollment in Medicare to Covered California within 30 days. They should contact Covered California for more information about how their Medicare eligibility/enrollment impacts their Covered California health plan. Covered California does not automatically terminate health plan coverage for Medicare enrollees.

Covered California and Medicare Supplemental Plans

Covered California does not sell Medicare Advantage plans (such as Medicare HMOs and PPOs), Medicare Part D prescription drug plans, or Medigap policies. These plans will be available as they were before.

Consumers can enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare website or by signing up directly with the company that offers the plan. To learn more about the different coverage options under Medicare, including the Medicare Advantage plans, Part D drug plans, and Medigap supplemental policies available in a particular area, and how to enroll, consumers can visit Medicare Plan Finder, call (800) Medicare, or work with a licensed insurance agent.

Covered California, Medicare, and Tax Credits

Generally, someone who is eligible for Medicare — even if they do not enroll in it — cannot receive tax credits to help them pay for a Covered California health plan. Additionally, if a consumer chooses to enroll in a Covered California health plan instead of Medicare and then enroll in Medicare later, they may have to pay a late enrollment penalty.

Medicare Part A has a premium; however, if someone qualifies for Medicare but has to pay a premium for Part A and does not enroll in Medicare Part A, they may be eligible for a Covered California health plan. Depending on a consumer’s income, they may be eligible for premium assistance and cost-sharing subsidies for the Covered California health plan. However, if consumers choose to enroll in a Covered California health plan instead of Medicare and then enroll in Medicare later, their premium for Part A, and possibly Part B, could increase by 10% due to paying a late enrollment penalty.

Covered California, Medicare, and Medi-Cal

If consumers are enrolled in Medicare, they cannot purchase a Covered California health plan. Purchasing a Covered California health plan would give consumers the same health benefits they are already receiving on Medicare.

However, consumers may still be eligible for Medi-Cal, depending on their income and assets, and should still apply through Covered California. The Covered California application automatically checks to see if consumers qualify for Medi-Cal. A Medicare beneficiary whose income is low or who meets other requirements may qualify for Medi-Cal if they are over age 65, blind, or have disabilities.

Medicare and Medi-Cal

If consumers qualify for both Medicare and Medi-Cal, Medi-Cal will help pay for Medicare premiums and cost-sharing requirements. Medi-Cal may cover additional benefits, such as dental services, nursing home care, and personal care services. Medi-Cal may also provide extra financial assistance to help with the cost of Medicare Part D prescription drug coverage.

Covered California, Medi-Cal, and Disabilities

An individual who has a permanent disability, but is not yet eligible for Medicare due to the two-year waiting period for people receiving SSDI payments, may purchase health coverage through Covered California. Depending on income and if otherwise eligible, the individual may get help paying for a health plan through Covered California or get low- or no-cost Medi-Cal. An individual could be eligible for Medi-Cal either through the adult program or through other Medi-Cal programs, such as those based on age, disability or blindness.

SSDI recipients who apply for and receive premium assistance and/or cost-sharing subsidies for a health plan through Covered California, will lose eligibility for the premium assistance and/or cost-sharing subsidies when they become eligible for Medicare. At that point, they will be able to drop their health plan through Covered California and enroll in Medicare. Similarly, if SSDI recipients enroll in Medi-Cal during the waiting period, they will lose eligibility for Medi-Cal when they become eligible for Medicare. Medi-Cal will automatically reevaluate their circumstances to see if they are eligible for another Medi-Cal program at that time.

Medicare Options and Enrollment

Consumers can review and compare their Medicare options on the Medicare website, call 1-800-MEDICARE, or work with a licensed insurance agent. For questions about changing your address, Medicare Part A or Part B, or a lost Medicare card, a consumer may call the Social Security Administration at (800) 772-1213. Consumers can also contact the Health Insurance Counseling & Advocacy Program (HICAP) for free, individual counseling on Medicare coverage questions, rights, and health care options. Call (800) 434-0222 to schedule an appointment at a HICAP office near their home.

For even more information about Covered California and Medicare, see our Medicare Fact Sheet.

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