The main difference between Covered California and Medi-Cal comes down to income. Medi-Cal is California’s version of Medicaid and provides free or very low-cost coverage to people with limited income. Covered California is the state’s marketplace for buying private insurance, usually with federal subsidies that lower the premium. If your household earns less than roughly 138 percent of the federal poverty level, you’ll land in Medi-Cal; above that line, you shop on Covered California. Both programs use the same application, and the system routes you to whichever one fits.
The Income Line That Sorts You Into One or the Other
For most adults between 19 and 64, Medi-Cal eligibility tops out at 138 percent of the federal poverty level. In 2026, that works out to about $22,025 a year for a single person.1Covered California. Program Eligibility by Federal Poverty Level for 2026 Earn more than that and you’re directed to Covered California, where households between 138 and 400 percent of the poverty level can receive premium tax credits that bring private coverage down to something affordable.
Children and pregnant people have higher cutoffs. Kids under 19 can qualify for Medi-Cal with household incomes up to 266 percent of the federal poverty level, and pregnant individuals qualify up to 213 percent.2Covered California. Program Eligibility by Federal Poverty Level for 20253Department of Health Care Services. Program Descriptions by FPL Enclosure 3 Pregnant people with income between 213 and 322 percent of the poverty level may qualify for the Medi-Cal Access Program, a separate option with a small monthly premium.
For working-age adults, Medi-Cal uses Modified Adjusted Gross Income rules, which means no asset or property test. Your savings account, car, and home don’t count against you.4DHCS. Medi-Cal Help Center This trips a lot of people up: they assume they’ll be disqualified because they own a car. Assets only matter for certain non-MAGI categories, like some seniors and people with disabilities who qualify through different pathways.
Immigration status is another dividing line. Starting in January 2024, California expanded full-scope Medi-Cal to all income-eligible adults regardless of immigration status, so undocumented residents who meet the income rules can get the same Medi-Cal benefits as citizens. Covered California requires applicants to be U.S. citizens or lawfully present immigrants. People with DACA status can’t enroll through Covered California but may qualify for Medi-Cal.5CMS. Health Coverage Options for Immigrants Both programs require California residency.
What You’ll Actually Pay
Medi-Cal is free for almost everyone enrolled. No monthly premium, no deductible, no copays for standard services. The one exception is Medi-Cal for Families, which charges $13 per child per month for families with children aged 1 through 18 whose household income is between 160 and 266 percent of the federal poverty level. No family pays more than $39 a month no matter how many kids are enrolled, and the premium disappears entirely once family income drops below 160 percent.6DHCS. Senate Bill 75 Full Scope Medi-Cal Coverage for All Children Frequently Asked Questions
Covered California plans come with monthly premiums that vary by plan, age, location, and household size. Federal advance premium tax credits go straight to your insurer each month and reduce what you owe. For 2026, the subsidy structure caps how much of your income goes to premiums based on your earnings:
- 138–150 percent of FPL: premiums capped at 0 percent of income
- 150–200 percent of FPL: roughly 3 to 7 percent of income
- 200–250 percent of FPL: roughly 7 to 8.5 percent of income
- 250–300 percent of FPL: roughly 8.5 to 10 percent of income
- 300–400 percent of FPL: 9.96 percent of income
For 2026, premium tax credits are not available to households earning above 400 percent of the federal poverty level. The enhanced subsidies that temporarily removed that income ceiling expired at the end of 2025, bringing back the “subsidy cliff.”1Covered California. Program Eligibility by Federal Poverty Level for 2026 If your income sits just over the line, you pay full price for marketplace coverage. Estimating your annual income carefully before you enroll matters more now than it has in years.
There’s one more cost benefit that only applies to Covered California. If your income is between 100 and 250 percent of the federal poverty level and you pick a Silver-tier plan, you also get cost-sharing reductions that lower your deductibles, copays, and out-of-pocket maximums. A standard Silver plan might carry an annual out-of-pocket maximum around $10,600, but with the reductions, that figure can drop to $3,500 or less at the lower end of the income range.7Covered California. Covered California to Launch State-Enhanced Cost-Sharing Reduction Program It only works with Silver, so picking Gold or Bronze when you qualify leaves money on the table.
What’s Covered
Both programs must cover the same essential health benefits required by the Affordable Care Act: doctor visits, hospital stays, prescriptions, lab work, mental health, preventive care, and maternity care. The real difference is at the edges.
Medi-Cal covers adult dental through the Denti-Cal program, including exams, cleanings, fillings, root canals on front teeth, and dentures.8Covered California. Medi-Cal Benefits Dental It also covers vision: a routine eye exam and one pair of eyeglasses every 24 months, with more frequent visits allowed if medically necessary.9DHCS. Medi-Cal Vision Benefits All of that is included at no cost. Covered California plans typically don’t include adult dental or vision in the base plan. You’d buy a separate dental plan through the marketplace or pay extra for a plan that bundles it.
Doctors and Plan Choice
Covered California lets you pick from private carriers like Kaiser Permanente, Anthem Blue Cross, and others. Plans sit in four metal tiers that describe how costs are split between you and the insurer:
- Bronze: insurer covers about 60 percent of costs; lowest premiums, highest out-of-pocket risk
- Silver: roughly 70 percent coverage; the only tier eligible for cost-sharing reductions
- Gold: roughly 80 percent coverage; higher premiums, lower costs when you use care
- Platinum: roughly 90 percent coverage; highest premiums, lowest out-of-pocket costs
Which carriers and plans you can pick depends on your county. Private marketplace plans generally offer broader provider networks, giving you more flexibility to see specialists or use specific hospitals.10Covered California. Coverage Levels The Metal Tiers
Medi-Cal runs through managed care plans assigned by county. Most counties offer two managed care plans, and you can pick between them when you enroll. If you don’t choose, the state assigns one. These networks are more localized than private insurance networks, and switching doctors can require changing your managed care plan.11DHCS. Medi-Cal Overview The trade-off is straightforward: Medi-Cal’s narrower networks come with zero cost, while Covered California’s broader networks come with premiums and cost-sharing.
When You Can Sign Up
Medi-Cal accepts applications year-round. If you qualify, you can sign up any day of the year and get coverage without waiting for a window.12HealthCare.gov. When Can You Get Health Insurance
Covered California has an annual open enrollment period from November 1 through January 31.13Covered California. Dates and Deadlines Miss that window and you can only enroll through a special enrollment period triggered by a qualifying life event such as losing other coverage, getting married, having a baby, moving, or gaining lawful immigration status. Otherwise you’re locked out until the next open enrollment. People transitioning off Medi-Cal because their income rose too high do get a special enrollment period, so there shouldn’t be a gap.
One Application for Both
You don’t have to figure out which program you qualify for before you start. Go to coveredca.com, enter your household and income details, and the system determines your eligibility automatically. If your income puts you in Medi-Cal territory, the application is forwarded to your county’s social services office for processing. If you qualify for a marketplace plan, you select a carrier and tier on the site.
You can also apply by phone at (800) 300-1506, by paper application mailed to the state, or in person at your county social services office. Certified enrollment counselors and insurance agents help with the application at no charge. Brokers who assist with Covered California plans are paid by the carriers, not by you.
What Happens If Your Income Changes
Your program eligibility can shift mid-year, and you’re required to report income changes. Medi-Cal enrollees must report to their county office within 10 days. Covered California enrollees have 30 days to update their account.14Covered California. How to Update Your Account Skipping this step causes real trouble on the Covered California side, because your subsidy is pegged to projected income.
If your income drops below 138 percent of the poverty level during the year, you may become eligible for Medi-Cal and can transition without waiting for open enrollment. If it rises above the Medi-Cal threshold, you get a special enrollment period to pick a marketplace plan. The transition doesn’t happen on its own. You have to report the change and act on the new eligibility determination.
Medi-Cal enrollees have no tax obligations tied to their coverage. Covered California enrollees who received advance premium tax credits do. By early February, Covered California sends Form 1095-A showing how much was paid to your insurer during the year. You use that to complete IRS Form 8962 and attach it to your federal return. Form 8962 reconciles what you received in advance against what you were actually entitled to based on your real income.15IRS. Updates to Questions and Answers About the Premium Tax Credit Earn less than you projected and you get the extra credit back as part of your refund. Earn more and you owe money.
For the 2026 tax year, there is no cap on how much excess credit you have to repay. In earlier years, repayment limits softened the hit for people whose income estimates were off. Those limits are gone starting with tax year 2026. If you received $3,000 more in advance credits than you were entitled to, you owe back all $3,000.15IRS. Updates to Questions and Answers About the Premium Tax Credit That makes accurate income reporting throughout the year far more important than it used to be. Pick up freelance work or get a raise, and update your Covered California account before tax season does the sorting for you.