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California · Medi-Cal · Covered California · 2026 income lines

Medi-Cal vs Covered California: What Is the Difference, Which One Do You Qualify For, and What Happens When Your Income Changes?

Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published October 16, 2026

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Richard 'Dick' Tracy, Your Insurance Detective, independent health insurance broker in Buffalo NY, USA Benefits Group, 716-503-1113

Quick answer No, they are not the same program. Medi-Cal is California's Medicaid: $0 premium coverage for adults earning up to 138% of the federal poverty level, which in 2026 is $1,836 a month ($22,025 a year) for one person and $3,795 a month ($45,540 a year) for a family of four. Covered California is the state's insurance marketplace, where you buy a private plan and the government pays part of the premium if your income lands between 100% and 400% of poverty. One application sorts you into one or the other, and crossing the line in either direction changes your program, sometimes mid-year. That is the part that costs self-employed people money. I'll explain both, and where I fit. I educate, you decide.

I'm Dick Tracy, a health insurance broker licensed in California (NPN 20414610), one of 25 states, working with 80+ carriers from Buffalo, New York, by phone or Zoom. No gag clause on me: you get the tips, the tricks, and the traps. The trap here is that the line between these programs is drawn in income, and a self-employed income moves every month.

$1,836
a month: the 2026 Medi-Cal line
for one adult (138% of poverty)
$63,840
a year: where the federal credit stops
for one person on 2027 coverage (400%)
90 days
to pick a Covered California plan
after Medi-Cal ends

Sources: Covered California FPL chart (DHCS ACWDL 26-01 values); Covered California M2C fact sheet.

Is Medi-Cal the same as Covered California?

No. They share a front door and nothing else. Medi-Cal is California's Medicaid, run by the Department of Health Care Services (DHCS) with your county: no premium, sign up any month. Covered California is the state's marketplace: you buy a private plan, and between 100% and 400% of the federal poverty level a federal tax credit pays part of the premium, with a state subsidy at lower incomes. Enrollment is limited to open enrollment or a qualifying life event (Covered California, the difference; eligibility chart).

One application sorts your household by size and income, and a household can land in both: Covered California's own example is a family at 250% of poverty, children on Medi-Cal (they qualify up to 266%), parents on a Covered California plan with help (same source). That shared door is also how a yellow renewal envelope can move you from one program to the other.

Medi-Cal vs Covered California income limits 2026

Medi-Cal uses the current year's poverty level; Covered California uses the previous year's table, so the 2027 plans you shop this fall are priced on the 2026 level (Covered California FPL chart). Households of one to four are below; the full one-to-eight chart is on my Covered California income limits 2026 page.

HouseholdMedi-Cal, adults 19 to 64 (138%), monthlyAdults, yearlyChildren under 19 (266%), yearlyPregnant (213%), yearlyCovered California credit, 2027 coverage (100% to 400%)
1$1,836$22,025$42,454$33,995$15,960 to $63,840
2$2,490$29,864$57,563$46,094$21,640 to $86,560
3$3,143$37,702$72,672$58,192$27,320 to $109,280
4$3,795$45,540$87,780$70,290$33,000 to $132,000

Source: Covered California, Program Eligibility by Federal Poverty Level, Medi-Cal values from DHCS ACWDL 26-01. The enhanced credits that erased the 400% cliff expired December 31, 2025 and were not extended for 2027 (2027 rates release).

California adds a state subsidy: $300 million for 2027, up to 200% of poverty ($31,920 for one, $66,000 for four), and nearly 200,000 people can get a $0 premium Silver plan with it (2027 rates release). Your share of the benchmark Silver premium runs from 0% at 138% to 150% of poverty to 10.22% at 300% to 400% (FPL chart, page 2). Over 400%, you pay all of it.

What is the difference in cost and coverage?

Price is the obvious difference; the ones that bite later are further down the table.

Medi-CalCovered California
Monthly premium$0 for nearly everyone. $30 a month from July 1, 2027 for members 19 through 59 without satisfactory immigration status.Varies by age, region, plan, and income, less the credit and state subsidy; a $1 a month California Premium Credit also comes off for every member.
CopaysNone published for 2026. From October 1, 2028, federal law requires copays on most services for expansion adults above 100% of poverty, up to $35 each and capped at 5% of income; primary care and mental health stay exempt.Set by metal tier and income.
Network and plan choiceDepends on your county. Medi-Cal picks for you after 30 days.19 pricing regions; the carriers and the HMO, EPO, or PPO choice change at the region line, and 13 of 19 regions have exactly one individual PPO (my California PPO page).
Dental and visionIncluded. Adult dental capped at $1,800 a year, with exceptions.Separate dental plan and premium. Vision not standard.
How income is countedCurrent monthly income; self-employment after IRS-allowed expenses.Expected income for the year, reconciled on your tax return.
When you can enrollAny time of year.November 1 to January 31, or a life event. Losing Medi-Cal gives you 90 days.
RenewalYearly; every six months for expansion adults from 2027.Yearly; 2027 renewals began October 1, 2026.

Sources: M2C fact sheet ($0); DHCS Budget Act Highlights ($30); DHCS to CSAC, December 2025 (copays); 2026 rates deck ($1, PPO); Medi-Cal basics; NHeLP guide ($1,800); 42 CFR 435.603; DHCS c15-06; what counts as income; enrollment windows; DHCS H.R. 1 deck; 2027 rates release.

62% of California physicians were accepting new Medi-Cal patients, versus 79% accepting new privately insured patients (2015 data, the latest statewide survey I could find). That gap never shows up on the application. Source: California Health Care Foundation and UCSF, Physician Participation in Medi-Cal (2017 report, 2015 data).

One honest line, and I will say it on the call too: if your income is under the Medi-Cal line, Medi-Cal is almost certainly your best deal. The county enrolls you, not me, but I will tell you it is the right door.

What happens if you make too much for Medi-Cal?

The question that brings most self-employed Californians here. In order:

What the envelope does not say: the plan picked for you is whichever Silver costs least in your pricing region, not the one with your doctors in it, and whether your region even has a PPO is on my California PPO page. The credit rests on an estimate of your income for the whole year, and if the year finishes higher, "you may have to pay some or all of it back when you file your federal taxes" (Covered California, income changes). If your income went up because the business is working, a subsidy priced on a guess is the worst fit you can have; my route for that is in the last section.

What happens if your income drops?

Report a drop to Covered California within 30 days (Covered California, income changes). Medi-Cal looks at current monthly income, not last year's return (42 CFR 435.603(h)), so one bad quarter can qualify you in any month. Once you are Medi-Cal eligible, the federal credit and state subsidy stop going forward, because a Medi-Cal eligible person cannot receive either (Covered California, state premium subsidy explainer).

The fear is the clawback: "I took the credit for six months, now I qualify for Medi-Cal, do I owe it back?" Under 26 CFR 1.36B-2(c)(2)(v), if the marketplace determined you were not Medi-Cal eligible when you enrolled, the credits for that period stand, unless you gave information "with intentional or reckless disregard for the facts." What you can owe is different: if your actual income came in higher than your estimate, you may repay some or all of the federal credit; the state subsidy is reconciled on your California return with repayment caps (state subsidy explainer). In the first round of 2023 renewals, fewer than 3% of the people dropped had income over the limit; most of the rest were missing paperwork, with 90 days to fix it (CalMatters, July 2023).

What changed for Medi-Cal in 2026 and 2027?

The ones that touch your own eligibility:

Up to 2 million Medi-Cal members may lose coverage under the federal changes, by DHCS's January 2026 estimate; the work rule alone up to 233,000 by June 2027 and 1.4 million by June 2028. Self-employed and under the line? Keep monthly income records: $580 a month in earnings satisfies the rule. Source: DHCS, Enacted H.R. 1 presentation to the Assembly Health Committee, January 2026.

Which one should a self-employed Californian plan around?

Your income decides the first answer; your health and how much your income moves decide the second. These are the doors.

Income clearly under the Medi-Cal line, and likely to stay there

Medi-Cal, and I will tell you so on the call. $0 premium, dental and vision included, nothing to reconcile. Keep monthly books for the 2027 work rule and open every yellow envelope.

Between 138% and 400% of poverty, income fairly steady

Covered California with the credit, eyes open. Under 200% of poverty the state subsidy stacks on top of the federal credit. The trade-offs: a regional, mostly HMO or EPO network, an income estimate you must get right, repayment if you guess low, and the 400% cliff. Run the California subsidy calculator, then bring me the number and we check your doctors first.

Over the line, or an income that swings

A pre-established ERISA group plan. This is what I do for people in your spot. Under ERISA, the 1974 federal benefits law, group plans already exist, and a solo owner or a small business's people can be merged into one: group rates, a true nationwide PPO network of the PHCS and MultiPlan type, a policy you own. No employees required, and one simple compliance step I walk you through. Priced on group rates, not a guess at your income, so no credit to repay, no cliff, no program hop when a good month hits. The ERISA cheat code, and all four California doors in order.

A serious diagnosis in the last five years

Guaranteed-issue coverage, for now. Covered California plans, and the same plans off the exchange, cannot ask health questions or charge more. Take Medi-Cal or the credit, whichever you qualify for, get well, and we revisit later.

What kind of tank should we build? Both programs are right for the right person, and I will say so. They fit worst for the owner earning $4,000 one month and $9,000 the next, because both sort you on a number that keeps changing.

Common questions about Medi-Cal and Covered California

Is Covered California the same as Medi-Cal?

No. Medi-Cal is California's Medicaid program, run by the Department of Health Care Services and the counties, with $0 premiums for most adults earning up to 138% of the federal poverty level. Covered California is the state's health insurance marketplace, where you buy a private plan and may get a federal premium tax credit between 100% and 400% of poverty. One application checks both, but they are separate programs with different networks and enrollment windows.

What is the income limit for Medi-Cal in 2026?

For adults 19 to 64, Medi-Cal in 2026 covers household income up to 138% of the federal poverty level: $1,836 a month ($22,025 a year) for one person, $2,490 a month ($29,864) for two, $3,143 a month ($37,702) for three, and $3,795 a month ($45,540) for four, per Covered California's eligibility chart (DHCS ACWDL 26-01). Children under 19 qualify up to 266% of poverty and pregnant individuals up to 213%. Medi-Cal counts current monthly income.

Can you have both Medi-Cal and Covered California?

Not the same person at the same time with financial help: under 26 U.S.C. 36B, someone eligible for Medi-Cal cannot receive the federal premium tax credit or California's state subsidy, per Covered California's state subsidy explainer. A household can be split, though. Covered California's own example is a family at 250% of poverty: the children get Medi-Cal, because children are covered up to 266%, while the parents get a Covered California plan with a credit.

What happens if I make too much money for Medi-Cal?

Your Medi-Cal ends and the county sends your information to Covered California, which under California law (SB 260) automatically enrolls you in the lowest-cost Silver plan available to you if your income qualifies you for financial help. Confirm that plan and pay the first premium by the end of the first month or it is canceled, per Covered California's Medi-Cal to Covered California fact sheet. You have 90 days from the last day of Medi-Cal to choose any plan instead. Report income changes to Medi-Cal within 10 days.

Do I have to pay back Covered California subsidies if I end up qualifying for Medi-Cal?

Usually not for the months you were already enrolled. Under 26 CFR 1.36B-2(c)(2)(v), if the marketplace determined you were not eligible for Medicaid when you enrolled, you are treated as not eligible for that coverage period, so the credits you received stand, unless you gave information with intentional or reckless disregard for the facts. The credit simply stops going forward. If your actual annual income came in higher than you estimated, though, you may owe some or all of the federal credit back.

Does Medi-Cal count self-employment income before or after expenses?

After expenses. DHCS guidance (letter c15-06) says self-employed applicants report net taxable income from self-employment, the amount after the expenses and deductions the IRS allows, and a loss can offset other income. Medi-Cal looks at current monthly income under 42 CFR 435.603(h); Santa Clara County's handbook, for one, verifies it with your prior-year return or three months of income and expense records averaged monthly. Covered California instead uses your expected income for the whole year.

Is Medi-Cal free?

For nearly everyone, yes. Monthly premiums are $0; Covered California's own fact sheet tells people leaving Medi-Cal that a marketplace plan "might be as low as $0 per month, just like with Medi-Cal." Two changes are coming: from July 1, 2027, members 19 through 59 without satisfactory immigration status pay a $30 monthly premium (DHCS FY 2025-26 Budget Act Highlights), and from October 1, 2028, federal law requires copays on most services for expansion adults above 100% of poverty, up to $35 each, with primary care and mental health exempt (DHCS presentation to county officials, December 2025).

Will I lose Medi-Cal because of the new work requirement?

Only if you are an expansion adult (19 to 64, covered because of income alone) and cannot show 80 hours a month of work, community service, a work program, or half-time school, or earnings of at least $580 a month, starting January 1, 2027, per DHCS's January 2026 presentation on federal H.R. 1. Self-employment earnings of $580 a month satisfy it. Parents of a child 13 or younger, pregnant members, people on SSI or Medicare, and the medically frail are exempt. Keep monthly income records.

Near the line, or bouncing across it? Let's figure out which program you are actually in, and whether you want to be.
Thirty minutes on the phone or Zoom, no fee, no hard sell. Bring your household size, your last few months of income, your county, and how you use care. I show you where you land on the 2026 lines, what the yellow envelope will do next, and the route I use when income swings. If Medi-Cal is your best deal, I will say so.
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