What is Medicaid, Medi-Cal, Covered California, Anthem

By Xah Lee. Date: .

what is Medicaid

  • Medicaid is a joint federal and state government-funded healthcare program designed to provide health coverage to individuals and families with very low incomes or disabilities.
  • It is administered by states according to federal requirements, which allows for variation in eligibility criteria and benefits across different states.
  • The program covers a broad range of medical services, including hospital stays, doctor visits, long-term care services like nursing home and home-based care, and preventive health measures.
  • Medicaid is the largest source of funding for medical and health-related services for low-income individuals in the United States, covering millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

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What's the difference between Medicaid and medi-cal

  • Medicaid is a federal and state program that provides health coverage to low-income individuals and families across the United States, with each state operating its own version of the program.
  • Medi-Cal is California’s specific Medicaid program, meaning it is the state’s implementation of the federal Medicaid initiative.

what's the relationship of medical, covered california, anthem. very confusing.

what's the relationship of medical, covered california, anthem. very confusing.

Understanding Medi-Cal, Covered California, and AnthemThese three terms relate to health insurance in California, and the confusion often stems from how eligibility, coverage, and providers overlap. I'll break it down step by step, starting with what each is, then their connections.

1. Medi-Cal

  • This is California's Medicaid program, providing free or very low-cost health coverage to eligible low-income individuals, families, seniors, and people with disabilities.
  • It's funded by federal and state dollars and covers essentials like doctor visits, hospital care, prescriptions, mental health services, and more—with little to no copays for most people.
  • Managed through county-based plans, often by private insurers like Anthem.

2. Covered California

  • This is California's official health insurance marketplace under the Affordable Care Act (ACA), where residents can shop for and buy private health insurance plans.
  • It's for people who don't qualify for full Medi-Cal but need affordable coverage—subsidies (tax credits) lower premiums based on income.
  • Plans cover the same "essential health benefits" as Medi-Cal (e.g., preventive care, maternity services, emergency care).

3. Anthem (Anthem Blue Cross)

  • Anthem is a major private health insurance company operating in California.
  • It doesn't "own" Medi-Cal or Covered California but partners with the state to offer plans in both programs.

Key Relationships and How They Connect

Medi-Cal and Covered California: They're linked through a single application process—you apply once via CoveredCalifornia.com, and the system checks eligibility for both.

  • If your income is very low (typically under ~138% of the federal poverty level), you qualify for Medi-Cal.
  • If it's higher (up to 400% of poverty level or more with subsidies), you get options through Covered California.
  • Both programs ensure comprehensive coverage without denials for pre-existing conditions, but Medi-Cal is more "hands-off" (fewer costs), while Covered California involves choosing and paying for private plans.

Anthem's Role in Both:

  • With Medi-Cal: Anthem provides managed care plans in 17 specific counties (e.g., Los Angeles, Fresno, Sacramento, Kern). These include full benefits like primary care, specialists, vision/dental for kids, therapy, and care coordination—all with $0 copays for covered services. In some areas (like LA County), Anthem contracts with local plans like L.A. Care to deliver these services.
  • With Covered California: Anthem offers a range of private plans you can select during open enrollment, featuring guaranteed coverage for pre-existing conditions, no annual/lifetime benefit caps, and medically necessary treatments. You can use tools on CoveredCalifornia.com to compare networks and check if your doctors are in-network.

Overall Flow for Users: Based on income, you might land in Medi-Cal (with Anthem as a possible provider) or Covered California (where Anthem is one of several plan options). Anthem bridges the two by operating in both, making it easier to switch or maintain continuity if your situation changes.

If you're trying to enroll or check eligibility, start at CoveredCalifornia.com—it's the one-stop shop. For Anthem-specific questions, call them at (833) 933-0806. Let me know more details about your situation for tailored advice!