Covered California is neither Medicare nor Medicaid. It is California’s health insurance marketplace, created under the Affordable Care Act, where residents shop for private health plans and apply for help paying the premiums. The same application also checks whether you qualify for Medi-Cal, which is California’s version of Medicaid, and routes you there automatically if you do. Medicare is a separate federal program for people 65 and older and certain people with disabilities, and you cannot buy it through Covered California at all.
What Covered California Actually Is
Covered California does not provide insurance. It is a regulated storefront where you compare plans from private carriers like Blue Shield, Kaiser Permanente, and Health Net, and buy one directly from the insurer.1Covered California. What is Covered California? What makes the marketplace different from buying a plan straight from an insurer is the federal premium tax credit. If your household income qualifies, the credit lowers your monthly premium, and Covered California is the only place in the state you can get it. Buy the same plan outside the marketplace and you pay full price.2IRS. Eligibility for the Premium Tax Credit
That is the core of why Covered California is not Medicaid or Medicare. Medicaid and Medicare are government insurance programs: the government is the payer. Covered California is a shopping and subsidy platform for private insurance.
Where Medi-Cal Comes In
Medi-Cal is California’s Medicaid program, governed by Welfare and Institutions Code Section 14000 and related provisions.3California Legislative Information. California Welfare and Institutions Code 14000.01 It is free or very low-cost coverage for Californians with limited income, and it is a separate program with separate rules.
What links it to Covered California is the application. You do not apply to Medi-Cal separately. When you submit a Covered California application, the system compares your household income against Medi-Cal thresholds. If you qualify for Medi-Cal, you are referred there instead of being offered a subsidized private plan. Eligibility is generally set at 138% of the federal poverty level, which for 2026 works out to roughly $22,025 for one person, $29,863 for a household of two, $37,702 for three, and $45,540 for four.4U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States Below those figures and you are most likely headed to Medi-Cal; above them and you are shopping on the marketplace.
Once the marketplace identifies you as Medi-Cal eligible, your information is handed off to your local county social services office, which handles enrollment from there. Some counties ask you to choose a managed care health plan within 30 days or they assign one; others enroll you automatically.5California Department of Health Care Services. Medi-Cal Managed Care Health Plan Directory
One boundary worth knowing: starting January 1, 2026, adults who do not have satisfactory immigration status can no longer newly enroll in full-scope Medi-Cal.6California Department of Health Care Services. Medi-Cal Immigrant Eligibility FAQs If you are already enrolled, check with your county about whether your coverage continues.
Why Medicare Is a Separate Program Entirely
Medicare is federal health insurance for people 65 and older, younger people with certain disabilities, and those with end-stage renal disease or ALS.7HHS.gov. Who’s Eligible for Medicare? It is established under Title XVIII of the Social Security Act and run entirely by the federal government through the Centers for Medicare and Medicaid Services.8Social Security Administration. Compilation of the Social Security Laws – Title XVIII – Health Insurance for the Aged and Disabled California has nothing to do with running it.
Covered California does not sell Medicare Advantage plans, Medicare Part D drug plans, or Medigap supplemental policies. If you already have Medicare, you cannot buy a Covered California plan. Even if you are only eligible for Medicare but have not yet enrolled, you generally cannot receive premium tax credits through the marketplace.9Covered California. Medicare Factsheet For Medicare coverage you use Medicare.gov or an insurance broker who specializes in Medicare.
Turning 65 on a Covered California Plan
This is where people slip up. If you have a Covered California plan and you are approaching 65, end your marketplace coverage the day before your Medicare coverage begins. Once your Medicare Part A starts, you lose eligibility for premium tax credits on your marketplace plan, you owe full price for any overlap, and you may have to repay the tax credits you received during that overlap when you file your federal taxes.10CMS. Notice for Consumers Turning 65 Confirm your Medicare start date through your SSA.gov account or your Medicare welcome packet before you cancel anything.
Which Program Applies to You
A short way to sort it out:
- If you are 65 or older, or you qualify through disability, ESRD, or ALS, your program is Medicare. Do not start at Covered California.
- If you are under 65 and your household income is at or below roughly 138% of the federal poverty level, you will most likely qualify for Medi-Cal. The Covered California application is still the right place to start, because it routes you there automatically. You can also apply directly through your county social services office, and Medi-Cal enrollment is open year-round.
- If you are under 65 and your income is above the Medi-Cal threshold, Covered California is where you shop for a private plan and apply for premium tax credits. Open enrollment for 2026 coverage ran from November 1, 2025, through January 31, 2026. Outside that window you need a qualifying life event, such as losing other coverage, getting married, or having a baby, and you generally have 60 days from that event to enroll.11Covered California. Covered California’s Open Enrollment 202612HealthCare.gov. Getting Health Coverage Outside Open Enrollment
If you are not sure which bucket you fall into, start the Covered California application anyway. It will sort you between a subsidized marketplace plan and Medi-Cal based on the income and household information you enter, so you cannot land in the wrong one just by applying. The only program the application cannot help with is Medicare, which lives entirely on the federal side.
Free help is available if you want someone to walk through it with you. Covered California’s service line is (800) 300-1506, with assistance in multiple languages,13Covered California. Help With Your Application and Certified Enrollment Counselors offer in-person help across the state at no cost.14California’s Health Benefit Exchange. Certified Enrollment Counselors