Medicaid vs. Medicare: What’s the difference — and can you have both?
Learn the ins and outs of these important health care programs
Medicaid and Medicare sound a lot alike. And both are federally funded health care programs. After that, the two health plans start to look pretty different. That's because they are made for different people. Medicare benefits people over age 65 or people with a disability or certain illnesses. Medicaid tends to serve people with limited incomes and resources.
Still, it is possible to qualify for both Medicare and Medicaid. And you can have both plans at the same time. People who qualify for both are called “dual eligible.” Plans that offer Medicare Advantage benefits to Medicaid members are called Dual Eligible Special Needs Plans, or D-SNPs.
If you’re low income and dealing with health challenges, having both plans can make a big impact on your well-being. To help you understand the differences between Medicare and Medicaid, here’s a closer look at both.
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What Medicare covers
Medicare is made up of four parts: A, B, C and D.
Part A is hospital insurance. It generally includes:*
- Inpatient hospital care
- Skilled nursing facility care
- Nursing home care
- Hospice care
- Home health care
Part B is medical insurance. It covers:*
- Medically necessary services, such as doctor visits and lab tests.
- Preventive care, such as shots and screening tests
- Clinical research studies that include Medicare-covered services
- Ambulance services
- Durable medical equipment, such as walkers and oxygen equipment
- Mental health treatment
- A limited number of outpatient prescription drugs under certain circumstances
Part C is Medicare Advantage, or MA, plans. It includes Part A and Part B.
Part C usually includes a prescription drug plan (Part D). Vision, dental and hearing may also be included in a Medicare Advantage plan.*
Finally, Part D covers prescription drugs.
Different Medicare plans have different parts. Original Medicare includes Parts A and B. If you have Original Medicare and you want prescription drug coverage, you’ll need to buy it separately. Original Medicare also does not include routine vision, dental or hearing coverage.
What Medicaid covers
Medicaid gives health coverage to more than 73 million Americans.* States set up and manage their own Medicaid programs. That creates some differences among Medicaid plans. But every state must provide certain services. They include:*
- Inpatient and outpatient hospital services
- Doctor visits
- Laboratory and X-ray services
- Home health services
One of the easiest ways to find out what Medicaid covers in your state? Talk to a licensed agent. A licensed Aetna agent can answer all your questions about Medicaid for free. They can also confirm your eligibility.
What’s the difference between Medicare and Medicaid?
There are a few key differences between these two plans. One of the biggest differences is eligibility.
With Medicare, you generally qualify when you turn 65. You may also qualify if you are younger than 65 and have certain disabilities or illnesses. This includes permanent kidney failure and amyotrophic lateral sclerosis, or Lou Gehrig’s disease. Medicaid is based entirely on income and resources. You must be below a certain income level to qualify for Medicaid.*
The last major difference is cost. The cost for Original Medicare is the same no matter what state you live in. Medicare members also pay part of the costs through things like premiums and deductibles.
Medicaid members usually don’t pay anything for covered services. They may have to pay small out-of-pocket costs for certain services. But it’s limited to minimal amounts.*
What happens if you qualify for both Medicare and Medicaid?
If you’re eligible for both Medicare and Medicaid, then you may qualify for a Dual Eligible Special Needs Plan. This type of Medicare plan combines Medicare and Medicaid benefits into one plan. They often offer the most comprehensive health benefits of all the Medicare plans.
These plans also provide a care coordinator. This person can let you know what your benefits are. Aetna members get a care coordinator as part of a bigger care team. An Aetna D-SNP care team can help you:
- Build a customized care plan
- Manage your care
- Get the health and community resources you may need
- Coordinate your benefits
The plans also offer benefits beyond those of Original Medicare or Medicaid alone. All plans are different. But here are some of the added benefits and services that come with Aetna plans:*
- Dental, vision and hearing coverage
- A $0 copay on covered Tier 1 and Tier 2 prescription drugs at in-network pharmacies
- An Extra Benefits Card with a monthly allowance to help pay for certain everyday expenses that may help you stay well, including over-the-counter (OTC) health and wellness products like pain relievers and cold and flu medicines
- A $0 SilverSneakers® basic fitness membership and wellness resources in person and online
Finally, all members pay very low to no out-of-pocket costs in-network for covered services.* With Medicare and Medicaid working together, this type of plan can offer quality and affordable health care that may fit your needs.
*FOR MEDICARE PART A COVERAGE: Medicare.gov. What Part A covers. Accessed July 28, 2026.
*FOR MEDICARE PART B COVERAGE: Medicare.gov. Prescription drugs (outpatient). Accessed July 28, 2026.
*FOR MEDICARE PART C COVERAGE: Medicare.gov. What’s not covered? Accessed July 28, 2026.
*FOR HOW MANY MEDICAID SERVES: Medicaid.gov. June 2026 Medicaid & CHIP enrollment data highlights. <June 26, 2026. Accessed June 28, 2026.
*FOR WHAT MEDICAID COVERS: Medicaid.gov. Benefits. Accessed July 28, 2026.
*FOR MEDICAID ELIGIBILITY AND INCOME LEVEL: National Council on Aging. Medicare eligibility check: Do you qualify for benefits? February 19, 2026. Accessed July 28, 2026.
*FOR MEDICAID COSTS: Medicaid.gov. Cost sharing out of pocket costs. Accessed July 28, 2026.
*FOR ADDED BENEFITS: Benefits and coverage vary from state to state. Check with a licensed Aetna agent to confirm coverage in your area.
*FOR D-SNP COSTS. National Council on Aging. What is a Dual Eligible Special Needs Plan (D-SNP)? June 25, 2026. Accessed July 28, 2026.
Aetna Medicare is an HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change
Plan features and availability may vary by service area. For accommodation of persons with special needs at meetings, call 1-833-278-3924 (TTY: 711).
The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.
This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. Member name(s) and other details have been omitted or fictionalized to protect the member’s (members’) identity(ies). For more information about Aetna plans, refer to our website.
The benefit(s) mentioned are part of special supplemental benefits for the chronically ill (SSBCI). SSBCI conditions include certain cardiovascular disorders, chronic heart failure, and diabetes. Eligibility is determined by whether you have a chronic condition associated with the benefit(s) and you meet all other criteria. Even if you have a listed chronic condition, you may not necessarily receive the benefit because other eligibility and coverage criteria may apply. Standards and conditions vary for each benefit. Contact us to confirm the specific SSBCI condition requirements for the benefit(s) for this plan and determine your eligibility.
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