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 (Examples include doctor visits and lab tests.) 
   
• Preventive care (Examples include shots and screening tests.) 
   
• Clinical research studies that include Medicare-covered services
   
• Ambulance services 

• Durable medical equipment (Examples include 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 does not include routine 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 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. 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. 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 qualify for a Dual Eligible Special Needs Plan. A D-SNP combines Medicare and Medicaid benefits into one plan. D-SNPs often offer the most comprehensive health benefits of all the Medicare plans.

D-SNPs also often provide a care coordinator. This person can let you know what your benefits are. 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. 

It’s here — health care you can rely on!

To see if an Aetna® Dual Eligible Special Needs Plan, or D-SNP, is right for you, call us at 1-833-228-1297 (TTY: 711) between 8 AM and 8 PM, 7 days a week.

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

If you're 65 or older and have diabetes or an eligible heart disease, you may qualify for an Aetna® Chronic Condition Special Needs Plan (C-SNP). C-SNPs are currently available in select counties in IL and PA.

You may be eligible for an Institutional Special Needs Plan (I-SNP) if you’ve lived (or plan to live) in a participating facility for 90+ days or you have Medicare Part A (hospital insurance) and Part B (medical insurance).

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

*FOR MEDICARE PART A COVERAGE: Medicare.gov. What Part A covers. Accessed September 20, 2024.

*FOR MEDICARE PART B COVERAGE: Medicare.gov. Prescription drugs (outpatient). Accessed September 20, 2024.

*FOR MEDICARE PART C COVERAGE: Medicare.gov. What’s not covered Accessed September 20, 2024.

*FOR HOW MANY MEDICAID SERVES: Kaiser Family Foundation. 10 things to know about Medicaid. June 30, 2023. Accessed September 20, 2024. 

*FOR WHAT MEDICAID COVERS: Medicare.gov. Benefits. Accessed September 20, 2024.

*FOR MEDICAID ELIGIBILITY AND INCOME LEVEL: U.S. Department of Health and Human Services. Who’s eligible for Medicare? December 8, 2022. Accessed September 20, 2024.

*FOR MEDICAID COSTS: Medicaid.gov. Cost sharing out of pocket costs. Accessed September 20, 2024. 

*FOR D-SNP COSTS: National Council on Aging. “What is a Dual Eligible Special Needs Plan (D-SNP)?” November 30, 2022. Accessed September 20, 2024.

Aetna Medicare is an HMO, PPO plan with a Medicare contract. Our D-SNPs 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.

For members in California, New Jersey and New York FIDE plans: The benefits mentioned are part of special supplemental program for the chronically ill. Eligibility is determined by whether you have a chronic condition associated with this benefit. Standards may vary for each benefit. Conditions include Hypertension, Hyperlipidemia, Diabetes, Cardiovascular Disorders, Cancer. Other eligible conditions may apply. Contact us to confirm your eligibility for these benefits. 

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). 

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).

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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