Medi-Cal vs Covered California: Eligibility, Costs and How to Apply
If you live in San Diego County and need health insurance you buy yourself, you will almost certainly end up at one of two doors. Medi-Cal vs Covered California is the choice most people face, and the line between them is mostly about income. Get the line wrong and you can pay hundreds of dollars a month you didn’t need to, or owe money back at tax time.
This guide explains who qualifies for each program, what each one really costs, how the rules shifted in 2026 and what changes in 2027 and beyond. It also covers San Diego’s own plans, phone numbers and offices, and walks through the application step by step. Figures are based on publicly available information as of September 21, 2026, and eligibility rules, rates and deadlines can change.
Quick Answer
Medi-Cal is California’s free or very low-cost Medicaid program for adults earning up to 138% of the federal poverty level, which is roughly $22,000 a year for one person in 2026, and for children in families earning up to 266%. Covered California is the state marketplace where people above the Medi-Cal line buy private plans, with federal tax credits for incomes up to 400% of poverty and extra state help for the lowest earners. Both use the same application, so you don’t have to guess which one to apply for. Medi-Cal enrollment is open year-round. Covered California’s open enrollment for 2027 coverage runs from November 1, 2026 to January 31, 2027.
Medi-Cal vs Covered California: The Short Version
The two programs are run by different agencies and work in different ways. Medi-Cal is administered by the California Department of Health Care Services (DHCS) and handled locally by the county. Covered California is the state’s Affordable Care Act marketplace. It sells plans from private insurers such as Kaiser Permanente, Sharp Health Plan and Blue Shield.
The practical difference is who pays. Medi-Cal is public coverage, and most members pay no monthly premium. Covered California plans have a monthly premium, and a tax credit shrinks it. How much it shrinks depends on your income, your age and where you live.
Both programs use a single shared application. According to Covered California, the application screens every household member and routes each person to the right program. A family can end up split between the two, with the kids on Medi-Cal and the parents on a Covered California plan.
| Feature | Medi-Cal | Covered California |
|---|---|---|
| Who runs it | DHCS, through the County of San Diego | Covered California (state marketplace) with private insurers |
| Main income test (adults) | Up to 138% of the federal poverty level | Above 138%; federal tax credits up to 400% |
| Monthly premium | Usually $0 for most members | Varies; reduced by federal and state subsidies |
| When you can enroll | Year-round | Open enrollment (Nov. 1–Jan. 31) or after a qualifying life event |
| Deductibles and copays | Generally none or minimal today; some copays planned from Oct. 2028 | Depend on metal tier; lower in Enhanced Silver plans |
| Renewal | Annual now; every six months for many expansion adults from March 2027 | Annual, during open enrollment |
| Counts as coverage for California’s penalty | Yes (full-scope) | Yes |
Who Qualifies for Medi-Cal in 2026
For most adults aged 19 to 64, Medi-Cal eligibility comes down to one number: household income at or below 138% of the federal poverty level. Covered California’s Medi-Cal page lists the thresholds as 138% for adults and up to 266% for children. It also names other qualifying routes: being 65 or older, blind or disabled, pregnant, or already receiving CalFresh, SSI/SSP or CalWORKs.
Pregnancy has its own higher limits. According to Covered California’s 2026 eligibility chart, Medi-Cal for pregnant people reaches 213% of the poverty level. The Medi-Cal Access Program covers pregnant people from 213% up to 322%.
The 2026 income limit: two official numbers, and why they differ
Here is where official sources don’t match, so it’s worth being precise.
The DHCS consumer page titled “Eligibility by Federal Poverty Level” lists an income limit of $21,597 for one person and $44,367 for a family of four. Covered California’s “Program Eligibility by Federal Poverty Level for 2026” chart, dated March 2026, shows $22,025 for one person and $45,540 for four. That chart cites a DHCS eligibility letter (ACWDL 26-01) as its source.
The gap comes from which year’s poverty guideline each page uses. The HHS poverty guideline for one person was $15,650 in 2025 and rose to $15,960 in 2026, according to the January 15, 2026 Federal Register notice. 138% of the older figure is about $21,597; 138% of the newer one is about $22,025.
Covered California’s chart says Medi-Cal uses current-year poverty figures, which points to the higher numbers as the operative 2026 limits. The DHCS consumer page appears not to have caught up. Either way, the county makes the final call. If your income sits between the two figures, apply anyway and let the county decide.
Assets: mostly irrelevant for working-age adults
Most adults under 65 qualify on income alone. The asset test that returned on January 1, 2026 applies to specific groups. According to DHCS, those are people 65 or older, people with disabilities, nursing home residents, and certain families whose income is too high to qualify under the federal tax-based rules.
For those groups, DHCS says the limit through June 30, 2027 is $130,000 for one person, plus $65,000 for each additional household member. On July 1, 2027 it drops sharply, to $21,000 for one person and $31,000 for two. Your home, one vehicle, household items and some retirement savings don’t count toward the limit.
Immigration status and Medi-Cal
This is the area with the most change. According to DHCS, since January 1, 2026, adults 19 and older without satisfactory immigration status can no longer newly enroll in full-scope Medi-Cal. People who already had it can keep it if they renew on time. If their coverage ends, they have three months to re-enroll.
Children through age 18 and pregnant people (during pregnancy and for a year afterward) can still get full-scope coverage regardless of status. So can former foster youth under 26 who were in care on their 18th birthday. Everyone who meets the income rules can still get emergency Medi-Cal.
DHCS’s immigrant eligibility FAQ also says that, as of June 2025, Medi-Cal is not considered in a public charge determination. The one exception is long-term institutional care for people entering the U.S. or applying for a green card. Families with immigration questions can ask a qualified immigration attorney or one of the nonprofits listed by the California Department of Social Services.
Who Qualifies for Covered California and Financial Help
Anyone who lives in California and is a citizen or has satisfactory immigration status can buy a Covered California plan, whatever their income. Whether you get help paying for it is a separate question. Covered California says DACA recipients cannot enroll, and people over 65 usually don’t qualify, though there are exceptions.
Financial help comes in three layers.
- Federal premium tax credit. Available from 100% to 400% of the poverty level. It’s calculated so you pay a set percentage of your income toward the benchmark plan, which is the second-lowest-cost Silver plan where you live.
- California State Subsidy. For 2026 it covers households from 100% to 165% of the poverty level. The state expanded it to 200% for 2027.
- Enhanced Silver plans. Silver 94, Silver 87 and Silver 73 cut deductibles, copays and out-of-pocket maximums for incomes up to 250% of the poverty level.
The 400% cliff is back
The enhanced federal tax credits that ran from 2021 through 2025 expired on December 31, 2025. Covered California’s 2026 chart now states plainly that people above 400% of the poverty level get no federal tax credit. For 2026 coverage, that line was $62,600 for one person and $128,600 for a family of four.
For a household just over the line, the swing can be large. The same plan can cost the full sticker price instead of a capped share of income. Many people in this situation look at whether a retirement account contribution or HSA deposit could bring their modified adjusted gross income back under 400%. A tax professional can tell you whether that applies to you.
Covered California uses last year’s poverty numbers
One detail trips people up. Covered California’s chart explains that the marketplace uses the prior year’s poverty guideline, while Medi-Cal uses the current year’s. That’s why the 2026 Covered California columns are built on $15,650 per person, not $15,960. For 2027 coverage, the marketplace moves to the 2026 guideline. 200% becomes $31,920 for one person, matching the figure in Covered California’s July 2026 rate announcement.
Income Limits Side by Side for 2026
The table below pulls the most-used thresholds from Covered California’s March 2026 program chart. The Medi-Cal columns use current-year (2026) poverty figures. The Covered California columns use the 2025 figures the marketplace applies to 2026 coverage.
| Household size | Medi-Cal adults (138%) | Medi-Cal kids (266%) | State subsidy ceiling (165%) | Silver 94 ceiling (150%) | Silver 87 ceiling (200%) | Federal tax credit ceiling (400%) |
|---|---|---|---|---|---|---|
| 1 | $22,025 | $42,454 | $25,823 | $23,475 | $31,300 | $62,600 |
| 2 | $29,864 | $57,563 | $34,898 | $31,725 | $42,300 | $84,600 |
| 3 | $37,702 | $72,672 | $43,973 | $39,975 | $53,300 | $106,600 |
| 4 | $45,540 | $87,780 | $53,048 | $48,225 | $64,300 | $128,600 |
Source: Covered California, Program Eligibility by Federal Poverty Level for 2026 (3/2026). The DHCS consumer page shows a lower adult Medi-Cal figure ($21,597 for one person); see the explanation above.
Income here means modified adjusted gross income (MAGI) for your tax household, estimated for the coverage year. It isn’t your take-home pay, and it isn’t last year’s tax return, although many people start from line 11 of their Form 1040.
What Each Program Costs
Medi-Cal costs
For most members, Medi-Cal has no monthly premium and very little cost at the point of care. Covered California describes it as free or low-cost coverage. The DHCS “Medi-Cal Changes” page shows copayments for certain adults don’t begin until October 1, 2028.
Two groups will see new costs. From July 1, 2027, adults aged 19 to 59 without satisfactory immigration status who keep full-scope coverage will owe a $30 monthly premium, according to DHCS. From October 2028, working-age adults earning more than $15,560 a year may owe copays for some services, such as specialist visits. Annual copays are capped at 5% of household income. Clinics, emergency care, checkups, pregnancy care, children’s care and mental health services are exempt.
Covered California costs
With Covered California, you pay your share of the premium each month, plus deductibles and copays when you use care. How big your share is depends on your income.
Covered California’s 2026 chart lists the percentage of household income you’re expected to pay for the benchmark Silver plan:
| Household income (% of poverty level) | Share of income toward benchmark Silver plan (2026) |
|---|---|
| 138%–150% | 0% (state subsidy fills the gap) |
| Above 150%–165% | 3.19%–3.91% |
| Above 165% to under 200% | 4.91%–6.60% |
| 200% to under 250% | 6.60%–8.44% |
| 250% to under 300% | 8.44%–9.96% |
| 300%–400% | 9.96% |
| Above 400% | No federal tax credit |
The tax credit is fixed in dollars once it’s calculated. If you pick a plan cheaper than the benchmark, you pay less, and a Bronze plan can sometimes drop close to $0. If you pick a pricier plan, such as a PPO, you pay the whole difference.
Why rate increases hit subsidized and unsubsidized people differently
Covered California announced a preliminary statewide average increase of 9.9% for 2027. San Diego County, Rating Region 19, is well above that at 13.1%, one of the highest in the state. That’s the sticker price, though. Because the tax credit is tied to the benchmark plan, subsidized enrollees are partly shielded. Covered California projects that 60% of enrollees will see no increase in their monthly premium in 2027.
People above 400% of the poverty level get no credit, so they feel the full 13.1%.
Worked Examples: Two San Diego Households
These examples use Covered California’s preliminary 2026 regional rate sheet for San Diego County. That sheet was prepared in September 2025, priced a single 40-year-old in one ZIP code, and was subject to regulatory review. Final rates and plan availability vary by ZIP code, so treat these as illustrations, not quotes. Covered California’s Shop and Compare tool gives exact numbers for your address.
Example 1: A 40-year-old freelancer in Chula Vista earning $30,000
Maria is 40, single, and does freelance bookkeeping. She expects to earn $30,000 in 2026. That’s above the Medi-Cal adult limit of $22,025, so Medi-Cal is out.
For Covered California, her income is about 192% of the 2025 poverty guideline ($30,000 ÷ $15,650). At that level, the expected contribution works out to roughly 6.2% of income, or about $1,860 a year, which is around $155 a month.
On the rate sheet, the cheapest Silver plans for a 40-year-old in San Diego were Sharp’s Premier HMO at $475 and Molina’s HMO at $490. The Sharp plan isn’t offered in every ZIP code. Taking the $490 plan as the benchmark, her tax credit is about $335 a month, and here’s what she might pay:
- Sharp Premier Silver (if available in her ZIP): about $140 a month
- Molina Silver: about $155 a month
- Kaiser Silver: about $195 a month
- Blue Shield Silver PPO: about $508 a month
- Kaiser Bronze: about $97 a month
Because she falls between 150% and 200% of the poverty level, a Silver plan would automatically be the Silver 87 version, with much lower deductibles and copays than standard Silver. That’s why many people in her income band look closely at Silver before choosing Bronze on price alone.
One caution for freelancers: if Maria’s income comes in at $45,000 instead of $30,000, she’ll owe back the extra tax credit when she files. From the 2026 tax year there’s no cap on that repayment (see the common mistakes section below).
Example 2: A family of four in El Cajon earning $58,000
The Nguyens are two 40-year-old parents with kids aged 8 and 12. Their household income is $58,000.
The children qualify for Medi-Cal, because the limit for kids in a family of four is $87,780. The parents don’t, because the adult limit for four people is $45,540. This is the classic split household.
The parents go to Covered California, and the whole family of four still counts for the poverty calculation. $58,000 is about 180% of the 2025 guideline for four ($32,150). The expected contribution is about 5.7% of income, roughly $273 a month for the parents’ benchmark coverage.
Using two 40-year-old Molina Silver rates ($490 each, $980 total) as the benchmark, the tax credit is about $707 a month. Estimated costs for the parents:
- Two Sharp Premier Silver plans (if available): about $243 a month
- Two Molina Silver plans: about $273 a month
- Two Kaiser Silver plans: about $353 a month
- Two Kaiser Bronze plans: about $157 a month
The kids’ Medi-Cal costs nothing in premiums. Like Maria, the parents would land in Silver 87 because they are between 150% and 200% of the poverty level.
What changes for these households in 2027
For 2027 coverage, the state subsidy reaches 200% of the poverty level ($31,920 for one person and $66,000 for a family of four, according to Covered California). Maria and the Nguyens would both fall inside it if their incomes stay the same. On top of that, Covered California says nearly 200,000 Californians will be able to choose from two Silver plans with a $0 premium.
San Diego and California Specifics
Where San Diegans apply for Medi-Cal
The County of San Diego Health and Human Services Agency (HHSA) handles Medi-Cal locally. According to the county’s “How to Apply for Medi-Cal” page, there are four routes:
- Online through BenefitsCal, or through Covered California’s shared application
- By mail to County of San Diego HHSA, Applications, P.O. Box 939044, San Diego, CA 92193-9005
- In person at any HHSA Family Resource Center
- By phone by calling the Access Customer Service Call Center at 1-866-262-9881, or 2-1-1, to request an application
The county’s Access FAQ says live agents answer Monday through Friday, 7 a.m. to 5 p.m. If you apply for Medi-Cal through Covered California and qualify, coverage starts on the first day of the following month, according to Covered California.
Medi-Cal health plans in San Diego County
New Medi-Cal members in San Diego County generally pick a managed care plan. A San Diego County Medi-Cal plan poster published through Optum San Diego (last updated September 2024) lists four:
- Blue Shield of California Promise Health Plan
- Community Health Group
- Kaiser Permanente
- Molina Healthcare of California
The poster notes that if you don’t choose, Medi-Cal will choose for you. For current options, the state’s Health Care Options line is 1-800-430-4263.
Don’t assume a big-name hospital system takes every Medi-Cal plan. UC San Diego Health’s own accepted-plans page, for instance, lists several Medi-Cal plans as specialty-referral only, with no primary care access. Check your preferred doctor before choosing.
From January 1, 2027, DHCS says undocumented members and some other immigrant groups will move from health plans to fee-for-service Medi-Cal. That means using any provider that accepts straight Medi-Cal. It changes how they get care, not whether they’re covered.
Covered California insurers in San Diego County
Covered California’s preliminary 2026 rate sheet for San Diego County (Region 19) lists plans from:
- Anthem Blue Cross (HMO)
- Blue Shield of California (PPO and HMO)
- Health Net (PPO and HMO)
- Kaiser Permanente
- Molina Healthcare
- Sharp Health Plan, including two HMO networks
Some of those plans aren’t sold in every ZIP code, which matters in a county that runs from Oceanside to Jacumba.
For 2027, Covered California reports Region 19 had 136,310 enrollees as of March 2026. The region faces a preliminary average rate increase of 13.1%. Carrier-by-carrier statewide averages for 2027 include:
- Kaiser Permanente: 6.7%
- Sharp Health Plan: 12.3%
- Blue Shield: 12.5%
- Anthem Blue Cross: 13.0%
- Health Net: 13.2%
- Molina Healthcare: 16.9%
Covered California estimates San Diego enrollees who switch to the lowest-cost plan in their current metal tier would see an average change of 2.8% instead.
California’s own coverage mandate
California kept an individual mandate after the federal penalty went to zero. According to the Franchise Tax Board, the penalty for having no coverage in 2025 is the greater of:
- a flat $950 per adult and $475 per child, or
- 2.5% of household income above the state filing threshold.
Full-scope Medi-Cal and Covered California plans both count as coverage. The FTB also lists exemptions, including income below the filing threshold and enrollment in restricted-scope Medi-Cal.
You’ll see other penalty figures online, such as $750, $800 or $900 per adult. Those numbers are mostly accurate for earlier tax years, because the amount is adjusted for inflation each year. The FTB’s penalty estimator is the reliable place to check the current year.
A note for military families and cross-border households
Active-duty military families generally have TRICARE, which is a separate system not covered here. Households that split time between San Diego and Baja California should know that both programs require California residency. Covered California’s rules also say you apply where you live.
How to Apply, Step by Step
1. Estimate your income for the coverage year
Both programs want your expected income for the period you need coverage, not last year’s. Medi-Cal looks at current monthly income. Covered California looks at the full calendar year. Include wages, self-employment profit and unemployment, and count everyone in your tax household.
2. Gather documents
Covered California’s “Start Your Enrollment” page lists what you’ll need:
- Social Security numbers for applicants who have them
- Federal tax information
- Immigration documents for non-citizens
- Employer and income details
In mixed-status families, only the people applying need to provide Social Security numbers or immigration information.
3. Use one application
Apply once at CoveredCA.com, by phone at (800) 300-1506, with a free certified enroller, or through BenefitsCal. The system screens each person for Medi-Cal first. Anyone over the Medi-Cal limit is offered Covered California plans with whatever financial help they qualify for. Covered California estimates the online application takes about 30 minutes.
4. Get the timing right
Medi-Cal enrollment is year-round, according to Covered California. For Covered California plans, 2027 open enrollment runs from November 1, 2026 to January 31, 2027. Enroll by December 31 for coverage starting January 1. Current enrollees can renew or switch from October 1.
Outside open enrollment, you need a qualifying life event, usually within 60 days. Covered California’s special enrollment page lists losing Medi-Cal as its own event with a 90-day window.
5. Choose a plan and pay the first premium
For Covered California, coverage doesn’t start until the first premium is paid. For Medi-Cal, choose a managed care plan (or let one be assigned) and keep your Benefits Identification Card.
6. Report changes and renew
Covered California’s Medi-Cal page says household changes must be reported to the county within 10 days. Medi-Cal renews annually on your original sign-up date for now. Covered California renews each fall. Open every letter from the county or Covered California promptly, because missed renewals are one of the most common reasons people lose coverage.
The Big Changes: 2026 to 2028 Timeline
Federal law (H.R. 1) and California’s budget are reshaping both programs. Here are the key dates DHCS and Covered California have published, as of September 2026.
| Date | What changes | Who it affects |
|---|---|---|
| Jan. 1, 2026 | Enhanced federal tax credits ended; 400% cliff returned; state subsidy covers up to 165% FPL | Covered California enrollees |
| Jan. 1, 2026 | Full-scope Medi-Cal enrollment freeze for adults 19+ without satisfactory immigration status; asset limit ($130,000) returns | Immigrant adults; seniors and people with disabilities |
| Tax year 2026 | No cap on repaying excess advance tax credits | Covered California enrollees whose income rises |
| July 1, 2026 or July 1, 2027 | Adult dental limited to emergencies for members without satisfactory immigration status (DHCS pages list different dates) | Adults 19+ without SIS, not pregnant |
| Oct. 2026 | Federal reclassification of some statuses; affected adults get state-funded full-scope Medi-Cal until June 30, 2027 | Refugees, asylees, humanitarian parolees, some survivors |
| Nov. 1, 2026–Jan. 31, 2027 | Covered California open enrollment for 2027 | Everyone buying a marketplace plan |
| Jan. 1, 2027 | Medi-Cal work and community engagement rules; shorter retroactive coverage; fee-for-service transition | Expansion adults 19–64; certain immigrant groups |
| Jan. 1, 2027 | Marketplace financial help limited to green card holders, Cuban/Haitian entrants and COFA migrants; state subsidy expands to 200% FPL | Lawfully present immigrants; lower-income enrollees |
| Mar. 1, 2027 | Medi-Cal eligibility checks every six months | Expansion adults 19–64 |
| July 1, 2027 | $30 monthly premium; asset limit drops to $21,000 (one person) | Adults 19–59 without SIS; seniors and people with disabilities |
| 2028 | Income and eligibility must be verified before financial help is applied | Covered California enrollees |
| Oct. 1, 2028 | Copays for some services | Adults 19–64 earning over $15,560 |
About the dental date
DHCS’s own pages disagree on this. The Medi-Cal Immigrant Eligibility FAQ (last modified August 2026) still says dental benefits end July 1, 2026 for adults without satisfactory immigration status. The “Medi-Cal Changes” page, updated September 2, 2026, lists the change under July 1, 2027. The later page is more recent, but anyone affected should go by the notice they receive from the county or DHCS.
Medi-Cal work rules in brief
According to DHCS, starting January 1, 2027, many expansion adults aged 19 to 64 will need to show one of the following each month:
- earnings of at least $580
- at least 80 hours of work, job training, volunteering or community service
- half-time school enrollment
- a combination of these activities
There are broad exemptions, including:
- parents and caregivers of children 13 and under
- pregnant people
- people with disabilities or serious health conditions
- American Indians and Alaska Natives
- people on Medicare
The county will send a letter if the rules apply to you.
Common Mistakes That Cost People Money
Underestimating income on Covered California. Covered California’s Important Changes page says that from the 2026 tax year, people who receive too much financial help may have to repay the full excess, with no income-based cap. Gig workers, commission earners and seasonal tourism workers in San Diego are especially exposed. Updating your income estimate mid-year, as soon as it changes, is the simplest protection.
Assuming Medi-Cal is off the table because you own things. For most working-age adults there’s no asset test. An early retiree in Rancho Bernardo living off savings, with low taxable income, may qualify for Medi-Cal, depending on how income is counted.
Skipping the application because you assume you earn too much. The shared application screens each household member separately, and children qualify at much higher incomes than adults.
Choosing Bronze by reflex. Between 100% and 250% of the poverty level, Enhanced Silver plans can have far lower deductibles for only a small premium difference. Many people in this range compare both before deciding.
Letting auto-renewal pick your 2027 plan. With San Diego’s preliminary 13.1% average increase, shopping during October through January can matter. Covered California’s own figures show that switching to the cheapest plan in the same tier changes the regional average to 2.8%.
Ignoring county mail. DHCS repeatedly stresses opening letters and responding fast. Six-month checks for expansion adults start in March 2027, so there will be more paperwork, not less.
Going uninsured to save money. Beyond the medical risk, the FTB penalty for 2025 was at least $950 per uninsured adult, and it’s assessed on your state return.
Frequently Asked Questions
What is the income limit for Medi-Cal in 2026?
For most adults, it’s 138% of the federal poverty level. Covered California’s 2026 chart, citing DHCS, puts that at $22,025 for one person and $45,540 for a family of four. A DHCS consumer page still shows $21,597 and $44,367, which are based on the 2025 poverty guideline. Children qualify up to 266%. The county makes the final determination.
Can I have Medi-Cal and Covered California at the same time?
Not as one person. Anyone eligible for full-scope Medi-Cal can’t get Covered California tax credits, because Medi-Cal counts as qualifying coverage. Different family members can be in different programs, though. A common setup in San Diego is children on Medi-Cal and parents on a subsidized Covered California plan, all from one application.
Is Medi-Cal really free?
For most members today, yes: there’s no monthly premium and very little cost when you get care. DHCS has announced a $30 monthly premium from July 2027 for certain adults without satisfactory immigration status. It has also announced copays for some services for working-age adults earning over $15,560 a year from October 2028, capped at 5% of income.
When is open enrollment for Covered California 2027?
Open enrollment runs from November 1, 2026 to January 31, 2027, according to Covered California. Sign up by December 31 for coverage starting January 1; January sign-ups start February 1. Current members can renew or switch plans from October 1. Medi-Cal enrollment isn’t tied to these dates and is open all year.
What happens if I earn more than 400% of the poverty level?
Since the enhanced federal credits expired at the end of 2025, you get no federal tax credit above 400% of the poverty level. For 2026 coverage, that’s above $62,600 for one person or $128,600 for four. You can still buy a Covered California plan, but at full price. Some people lower their MAGI through pre-tax retirement or HSA contributions; a tax professional can advise.
How do I apply for Medi-Cal in San Diego County?
Apply online through BenefitsCal or CoveredCA.com, in person at an HHSA Family Resource Center, or by mail to the county’s P.O. Box 939044 address. You can request a paper application from the Access Customer Service Call Center at 1-866-262-9881 or by calling 2-1-1. Coverage approved through the shared application generally starts the first day of the next month.
Can undocumented immigrants get Medi-Cal in 2026?
Adults 19 and older without satisfactory immigration status can no longer newly enroll in full-scope Medi-Cal as of January 1, 2026. Those already enrolled can keep coverage if they renew on time. Children, pregnant people and certain former foster youth still qualify for full coverage, and everyone who meets income rules can get emergency Medi-Cal.
What if I lose Medi-Cal because my income went up?
Covered California’s special enrollment page lists losing Medi-Cal as a qualifying event with a 90-day window to pick a marketplace plan. Covered California’s Medi-Cal page encourages calling its service center within 60 days of the notice. Some people are automatically assigned a Covered California plan and just need to confirm and pay the first premium.
Do I have to pay a penalty if I don’t have health insurance in California?
Usually, yes, unless you qualify for an exemption. The Franchise Tax Board’s penalty for 2025 was the greater of $950 per adult and $475 per child, or 2.5% of income above the filing threshold. Exemptions include income below the filing threshold, short coverage gaps of three months or less, and unaffordable coverage.
Will Medi-Cal affect my green card application?
DHCS states that, as of June 2025, Medi-Cal is not considered in a public charge determination. The one exception is nursing home or other long-term institutional care for people entering the U.S. or applying for permanent residence. DHCS and county offices can’t give immigration advice, so many families confirm with a qualified immigration attorney.
Conclusion
The Medi-Cal vs Covered California decision is mostly made for you by your income and household. What you control is getting the income estimate right, applying through the shared application so every family member is screened, and shopping instead of auto-renewing. With San Diego facing one of the state’s larger 2027 rate increases, and 2027 bringing work rules, six-month renewals and new immigrant eligibility limits, it pays to act early.
A practical next step is to run your household through Covered California’s Shop and Compare tool before open enrollment opens on November 1. Then book a free appointment with a certified enroller, or call the county’s Access line at 1-866-262-9881 if Medi-Cal looks likely. A licensed agent or certified enrollment counselor can tell you which program and plan fits your situation.
Sources
- California Department of Health Care Services (DHCS). “Medi-Cal Changes.” https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/ (accessed September 21, 2026)
- DHCS. “Eligibility by Federal Poverty Level.” https://www.dhcs.ca.gov/medi-cal/qualify/qualify-for-medi-cal-eligibility-chart/ (accessed September 21, 2026)
- DHCS. “Apply for Medi-Cal.” https://www.dhcs.ca.gov/medi-cal/apply/ (accessed September 21, 2026)
- DHCS. “Medi-Cal Immigrant Eligibility FAQs.” https://www.dhcs.ca.gov/medi-cal-immigrant-eligibility-faqs/ (accessed September 21, 2026)
- Covered California. “Program Eligibility by Federal Poverty Level for 2026” (3/2026). https://www.coveredca.com/pdfs/FPL-chart.pdf (accessed September 21, 2026)
- Covered California. “Covered California Rates and Plans for 2027: California Continues Fight for Health Insurance Affordability and Access” (July 21, 2026). https://www.coveredca.com/newsroom/news-releases/2026/07/21/covered-california-rates-and-plans-for-2027-california-continues-fight-for-health-insurance-affordability-and-access/ (accessed September 21, 2026)
- Covered California. “Federal Changes to Your Health Insurance” (Important Changes, updated June 15, 2026). https://www.coveredca.com/important-changes/ (accessed September 21, 2026)
- Covered California. “Medi-Cal.” https://www.coveredca.com/health/medi-cal/ (accessed September 21, 2026)
- Covered California. “Special Enrollment.” https://www.coveredca.com/special-enrollment/ (accessed September 21, 2026)
- Covered California. “Start Your Enrollment.” https://www.coveredca.com/get-started/ (accessed September 21, 2026)
- Covered California Outreach & Sales. “Covered California Qualified Health Plan 2026 Regional Rates by County” (September 2025; single 25- and 40-year-old, preliminary rates). https://hbex.coveredca.com/toolkit/downloads/CCA_26_QHP_Plan_Rates_by_County.pdf (accessed September 21, 2026)
- U.S. Department of Health and Human Services, Federal Register. “Annual Update of the HHS Poverty Guidelines” (January 15, 2026). https://www.federalregister.gov/documents/2026/01/15/2026-00755/annual-update-of-the-hhs-poverty-guidelines (accessed September 21, 2026)
- California Franchise Tax Board. “Personal Health Care Mandate.” https://www.ftb.ca.gov/file/personal/filing-situations/health-care-mandate/personal.html (accessed September 21, 2026)
- County of San Diego Health and Human Services Agency. “How to Apply for Medi-Cal.” https://www.sandiegocounty.gov/content/sdc/hhsa/programs/ssp/medi-cal_program/how_to_apply.html (accessed September 21, 2026)
- Optum San Diego / County of San Diego. “San Diego County Medi-Cal Health Plans” poster (updated September 10, 2024). https://www.optumsandiego.com/content/dam/san-diego/documents/healthysandiego/forms/Medi-Cal%20Options%20Poster_Eng_V1%20FINAL_9.12.24.pdf (accessed September 21, 2026)
Disclaimer
Disclaimer: This article is for general information and educational purposes only. It is based on publicly available information believed to be accurate at the time of writing, and rates, rules, products and eligibility requirements change frequently. It is not financial, insurance, tax or legal advice, and no advisor-client relationship is created by reading it. We are not licensed financial advisors, insurance agents, tax preparers or attorneys, and nothing here is a recommendation to buy, sell or hold any product, policy or security. Your own situation is different from the examples used here, so please consult a licensed financial advisor, insurance agent, tax professional or attorney before making any decision. We make no warranty as to the accuracy or completeness of the information and accept no liability for any loss arising from its use. Some links may be to third-party sites we do not control.
Internal Link Ideas
- Covered California Plans for San Diego Residents: 2026 Enrollment Guide (topic #21)
- Health insurance options for self-employed and gig workers in San Diego
- Medicare basics for San Diego residents turning 65
- How HSAs work with Bronze plans in California
- Dental insurance options in San Diego after Medi-Cal dental changes
External Authoritative Links
- DHCS Medi-Cal Changes: https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/
- Covered California Shop and Compare: https://apply.coveredca.com/lw-shopandcompare/
- FTB Individual Health Care Mandate: https://www.ftb.ca.gov/file/personal/filing-situations/health-care-mandate/personal.html