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 combine both Medicare and Medicaid are called Dual Eligible Special Needs Plans, or D-SNPs.  

If you’re low income and dealing with health challenges, having both plans can be a real lifeline, says Michelle Katz, LPN, MSN. She's a health care advocate in Washington, D.C. 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 (Examples include doctor visits and lab tests.) 
   
• Preventive care (Examples include shots and screening tests.) 
   
• Clinical research 
   
• Ambulance services 

• Durable medical equipment (Examples include walkers and oxygen equipment.) 
   
• Mental health treatment 
   
• Very rarely, Part B may also cover prescription drugs  

Part C is Medicare Advantage, or MA, plans. It includes Part A and Part B. 

Part C usually includes a prescription drug plan. 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 does not include vision, dental or hearing coverage. 

What Medicaid covers 

Medicaid gives health coverage to more than 90 million Americans.* States set up and manage their own Medicaid programs. That creates some differences between 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 automatically qualify when you turn 65. You may also qualify if you are younger than 65 and have certain disabilities or illnesses. That includes permanent kidney failure and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease). Medicaid is based entirely on income and resources, says Katz. You must be below a certain income level to qualify for Medicaid.*  

Another difference is coverage. Medicare is a federal program. That means that there are national standards for coverage. So no matter what state you live in, you get the same Medicare benefits.  

Medicaid is both a federal and state program. The federal government sets rules for coverage. Every Medicaid program must follow them. But every state runs their own Medicaid programs. As a result, some benefits vary between states.  

The last major difference is cost. The cost for Original Medicare is the same no matter what state you live in. Medicare members 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 is 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 qualify for a Dual Eligible Special Needs Plan. A D-SNP combines Medicare and Medicaid benefits into one plan. “They usually offer the most comprehensive health benefits of all the Medicare plans,” says Katz.  

D-SNPs also often provide a care coordinator. This person really "gets" the differences in Medicaid and Medicare coverage, says Katz. They can let you know what your benefits are, says Katz. Aetna D-SNP members get a care coordinator as part of an entire care team. An Aetna D-SNP care team can help you: 

• Access your state Medicaid benefits  
   
• Coordinate visits to all your health care providers  
   
• Find in-network doctors 
   
• Schedule appointments, and more 

D-SNPs also offer benefits beyond those of Original Medicare or Medicaid alone. All D-SNPs are different. But here are some of the added benefits and services that come with Aetna D-SNPs:* 

• Dental, vision and hearing coverage  
   
• A $0 copay on covered in-network prescription drugs 
   
• An Extra Benefits Card with monthly allowances called “wallets” to spend on everyday things that help you stay well. Members can use the card to help pay for approved items and services. On the list: healthy foods and select over-the-counter health and wellness items. Depending on the plan, the card can also be used for rent or mortgage assistance, personal care items, utilities, transportation and pet care items. 

Finally, all D-SNP members pay very low to no out-of-pocket costs.* By combining Medicare and Medicaid, D-SNPs can offer quality and affordable health care that may fit your needs. 

Check your D-SNP eligibility the easy way   

A licensed Aetna® agent/representative can help you find out if you qualify for a D-SNP and answer your questions for free. Schedule a call with a licensed Aetna® agent/representative today — it can’t hurt to learn more.

If you are eligible for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).

Aetna® is a recipient of the Newsweek America’s Best Customer Service Award for 2023.* 
 

*FOR COVERAGE BY STATE: Benefits and coverage vary from state to state. Check with a licensed Aetna agent to confirm coverage in your area. back 

*FOR MEDICARE PART A COVERAGE: Medicare.gov. What Part A covers. Accessed July 20, 2023. back 

*FOR MEDICARE PART B COVERAGE: Medicare.gov. Prescription drugs (outpatient). Accessed July 30, 2023. back 

*FOR MEDICARE PART C COVERAGE: What’s not covered by Part A & Part B? Accessed July 30, 2023. back 

*FOR HOW MANY MEDICAID SERVES: Kaiser Family Foundation. 10 things to know about Medicaid. June 30, 2023. Accessed September 1, 2023. back 

*FOR WHAT MEDICAID COVERS: Medicare.gov. Benefits. Accessed July 30, 2023. back 

*FOR MEDICAID ELIGIBILITY AND INCOME LEVEL: U.S. Department of Health and Human Services. Who’s eligible for Medicare? December 8, 2022. Accessed July 30, 2023. back 

*FOR MEDICAID COSTS: Medicaid.gov. Cost sharing out of pocket costs. Accessed July 30, 2023. back 

*FOR D-SNP COSTS. “What is a Dual Eligible Special Needs Plan (D-SNP)?” November 30, 2022. Accessed July 30, 2023. back 

*FOR NEWSWEEK AWARD: The 2023 Newsweek America’s Best Customer Service rankings were identified from the results of an independent survey of more than 30,000 U.S. customers who have either made purchases, used services, or gathered information about products or services in the past three years. Customers evaluated several brands: In total, over 200,000 evaluations were collected. The awarded brands each received on average 100 evaluations from customers. For more information, visit https://www.newsweek.com/rankings/americas-best-customer-service-2023 

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. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.  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. Eligibility for the Model Benefit or Reward and Incentive (RI) Programs under the Value-Based Insurance Design (VBID) Model is not assured and will be determined by Aetna after enrollment, based on relevant criteria (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program. If your plan’s Extra Benefits Card includes roll-over, any unused amount will rollover into the next month/quarter. The monthly/quarterly amount can be rolled over through the end of the plan year but will not carry over into the next plan year. Plan features and availability may vary by service area. For accommodation of persons with special needs at meetings, call 1-855-401-5713 (TTY: 711). 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.  

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