Comparison of Medi-Cal Benefits and Covered California Essential Health Benefits

Executive Summary

Covered California’s second open enrollment period began on November 15, 2014, and Californians must once again navigate the maze of health insurance options available through California’s health insurance marketplace. Some consumers, due to changes in income for example, may have to transition from Medi-Cal coverage to private coverage in Covered CA, or vice versa. In addition to experiencing changes in provider networks and out-of-pocket costs, these individuals may also face changes in their covered benefits.

This fact sheet is for consumer advocates assisting enrollees who are transitioning from Medi-Cal to Covered CA coverage or vice versa and provides: 1) a general overview of how benefits are covered in Medi-Cal and Covered CA, 2) a list of considerations when comparing benefits, and 3) a chart that outlines some specific differences.