Medicare and Medi-Cal Together: Dual Eligibility in Riverside County

Some of my neighbors in Hemet, Lake Elsinore, Menifee and across Southwest Riverside County qualify for both Medicare and Medi-Cal. People call this being “dual eligible” or “Medi-Medi.” It can make health care much more affordable, but the rules changed in California in 2026, and there are more changes on the calendar. Here’s a plain-language overview of how the two programs work together.

What dual eligibility means

Medicare is the federal health program for people 65 and older and some younger people with disabilities. Medi-Cal is California’s Medicaid program for people with limited income and resources. If you qualify for both, Medicare generally pays first for covered services, and Medi-Cal can help with costs Medicare doesn’t cover, depending on the level of Medi-Cal you qualify for.

Some people get full-scope Medi-Cal. Others qualify only for a Medicare Savings Program, which helps with Medicare premiums and sometimes cost-sharing. Both are run through Medi-Cal and administered locally by your county, Riverside County for most of our area or San Diego County for Fallbrook.

Medicare Savings Programs: help with premiums

California’s Medicare Savings Programs (MSPs) can pay your Part B premium, which is $202.90 a month in 2026 for most people. Some levels also pay Part A premiums, deductibles and coinsurance. The California Department of Health Care Services (DHCS) lists three main programs (DHCS: Medicare Savings Programs):

• Qualified Medicare Beneficiary (QMB): helps pay Part A and Part B premiums, deductibles and copayments.
• Specified Low-Income Medicare Beneficiary (SLMB): helps pay the Part B premium.
• Qualifying Individual (QI): helps pay the Part B premium for people who don’t otherwise receive Medi-Cal.

DHCS also notes that starting January 1, 2025, California became a Medicare Part A Buy-In state. Eligible full-scope Medi-Cal members with Part B who qualify for QMB are enrolled in Part A by the state, which covers the Part A premium (DHCS). Income limits are updated each year, so check the current DHCS figures or ask me to help you look them up.

The 2026 asset limit change

This is the big change. For a couple of years, California didn’t count assets for many Medi-Cal programs that serve older adults. Starting January 1, 2026, Medi-Cal counts assets again for these programs, including Medicare Savings Programs and long-term care (DHCS: Medi-Cal changes). According to DHCS:

• Through June 30, 2027, the asset limit is $130,000 for one person, plus $65,000 for each additional household member (up to 10 people) (DHCS Asset Limit FAQ).
• Starting July 1, 2027, DHCS lists a lower limit: $21,000 for one person, $31,000 for two people, and $1,550 for each additional person (up to 10) (DHCS Asset Limit FAQ).
• DHCS says assets that count include bank accounts, cash, and more than one house or vehicle. Assets that don’t count include the home you live in, one vehicle, household items, and some savings like retirement accounts.

If you already have Medi-Cal, DHCS says your assets are reviewed when you renew. Open your renewal packet as soon as it arrives and return it on time. Missing a renewal is one of the most common ways people lose help they still qualify for.

Extra Help with prescription costs

Extra Help, the Part D Low-Income Subsidy, lowers drug plan premiums, deductibles and copays. Medicare.gov explains that people with full Medi-Cal (Medicaid), and people in a Medicare Savings Program, generally qualify for Extra Help automatically (Medicare.gov: Help with drug costs). Others can apply through Social Security (SSA: Extra Help).

Your coverage choices as a dual-eligible

Dual-eligible people have the same basic Medicare choices as everyone else, plus some extra options and enrollment opportunities:

• Original Medicare with Medi-Cal, plus a Part D plan.
• Medicare Advantage plans designed for dual-eligible people, often called Dual Special Needs Plans (D-SNPs), which coordinate Medicare and Medi-Cal benefits. Which ones are available depends on your county and ZIP code.
• Additional enrollment opportunities beyond the October 15 – December 7 Annual Enrollment Period. Federal rules give dual-eligible people and Extra Help recipients certain Special Enrollment Periods, so ask what applies to you.

When I review options with someone who has Medi-Cal, the main things we check are whether their doctors and pharmacy work with both programs, how the plan coordinates Medi-Cal benefits, and whether any change could affect their Medi-Cal.

Steps if you think you might qualify

• Gather your income information and a rough list of your assets, using the DHCS categories above.
• Apply for Medi-Cal or an MSP through your county or online through California’s application portal.
• Watch for mail from your county and respond quickly.
• Once approved, review your Medicare coverage, since your options and enrollment windows may change.

If you’re just turning 65, start with Turning 65 in Temecula or Murrieta: Your Medicare Checklist. For current Part B and Part D figures, see Medicare 2026 in Temecula & Murrieta. For free, unbiased help with Medi-Cal and Medicare, you can also contact HICAP at 1-800-434-0222 (California Department of Aging).

If you’re dual eligible or think you might be, I’m glad to walk through your Medicare options. Call 760-297-0366 or request a free Medicare review.

Frequently Asked Questions

Questions about your own situation? Call me at 760-297-0366 or request a free Medicare review. I’m Cesar Ramirez with Temeku Insurance, CA License #0M47591, serving Temecula, Murrieta, Menifee, Sun City, Wildomar, Lake Elsinore, Hemet and Fallbrook.