What is Medicare?
Medicare is health insurance from the U.S. government. It’s for people who are 65 or older. There are also some people under 65 with certain disabilities or diseases who can get Medicare.
What is Medicaid?
Medicaid is health insurance for people with low income. Some children, older adults and people who are disabled or pregnant can also get it. Each state has a Medicaid program. But the rules can be different depending on the state you live in.
Can you have both Medicare and Medicaid at the same time?
Yes. This is called being “dual eligible.” There are two main types:
- Full dual eligible: You have Medicare and all Medicaid benefits.
- Partial dual eligible: You have Medicare, and Medicaid helps pay some costs, like monthly premiums.
How does it work if I am dual eligible?
When you have both Medicare and Medicaid, they can work together to help cover your care and lower what you pay:
- Medicare pays first for your health care, like when you go to the doctor, hospital or pharmacy.
- Medicaid may help pay the rest, like your extra costs. Some examples are:
- Monthly premiums: The money you pay each month for your plan.
- Deductibles: The money you pay before your plan starts to pay.
- Copays and coinsurance: The money you pay when you go to the doctor or get medicine.
Medicare vs. Medicaid vs. dual eligible comparison chart
| Question | Medicare | Medicaid | Dual-eligible (both) |
|---|---|---|---|
| What is it? | A health insurance program from the U.S. government. | A health insurance program that is run by each state. | A plan that covers Medicare and Medicaid. |
| Who can get it? | People age 65 or older. Some younger people can also get it if they have certain disabilities or serious illnesses. | People who have a low income. Some children, older adults and people who are disabled or pregnant may also qualify. | People who qualify for Medicare and their state’s Medicaid. |
| Who pays for it? | The federal (U.S.) government pays for it. | The federal government and state governments share the cost. | Medicare pays first. Medicaid helps pay for things that Medicare doesn’t cover. |
| Who runs it? | The federal government runs Medicare. | Each state runs its own Medicaid program. The rules can be different depending on where you live. | Medicare and Medicaid work together to help cover care and costs. |
| What parts or programs does it have? | Part A (hospital care), Part B (doctor visits), Part C (Medicare Advantage) and Part D (prescription drugs). | Medicaid doesn’t have different parts like Medicare. | This is a Part C (MA) plan. It often includes Medicare Part D for prescription drugs. |
| What plan choices are there? | You can choose Original Medicare or Medicare Advantage (MA) plans. Some plans offer added benefits. Aetna® Medicare offers MA plans. Learn about our plans. | Each state offers different plans. Your choices depend on the state. Aetna Better Health® offers Medicaid plans in many states. Find out if we offer in yours. | Many people join a Dual Eligible Special Needs Plan (D-SNP) that helps them manage both programs. Learn about Aetna Medicare D-SNPs. |
| Does it cover prescription drugs? | You need a separate drug plan unless your plan has one. | Medicaid covers prescription drugs. Coverage can be different in each state. | Medicaid helps pay for drug costs that Medicare doesn’t cover. |
| Does it cover long‑term care? | Only covers short stays in a nursing facility after a hospital stay. | Often covers long‑term care, like nursing homes and care at home. | Medicaid helps cover long‑term care that Medicare does not pay for. |
| Are there special or coordinated plans? | Some MA plans offer more help and benefits. | Some plans help manage care. | Special plans help manage both Medicare and Medicaid together. |
| What does it cost? | May have monthly costs and fees when you get care. | Usually costs little or nothing. | Medicaid helps pay Medicare costs. |
| How often do you apply or renew? | You usually apply once. You can change plans each year. | You need to apply every year. | Medicare stays the same. Medicaid needs to be renewed each year. |
| How do you apply? | Apply through Social Security. | Apply through your state’s Medicaid program or HealthCare.gov. | Apply for each program if you qualify for both. |
I’m on both Medicare and Medicaid — what plan is good for me?
- Doctor visits
- Prescription drugs
- Dental and vision care
- Rides to doctor visits
How do I enroll in a D-SNP?
You’ll need to do a few things before you can enroll in a D-SNP:
- Enroll in Original Medicare (Part A and Part B) by visiting Medicare.gov or SocialSecurity.gov.
- Once you’re enrolled in Original Medicare, you’ll need to apply for Medicaid. Every state has its own rules. Go to Medicaid.gov to see if you are eligible.
- If you’re approved for both Medicare and Medicaid, you can enroll in a D-SNP.
You can also get a D-SNP through Aetna Medicare. Learn more about our D-SNPs.
Why a D-SNP may be the right plan for you
A D-SNP may be the right plan for you if you have both Medicare and Medicaid. It makes your coverage easier to use. You may get help paying for care and have lower costs. Many D-SNPs also give added benefits, like dental, vision and rides to the doctor.
Ready to shop Aetna Medicare plans?
Enter your ZIP code to find Aetna Medicare plans in your area. Compare benefits, costs and drug coverage and see if your providers are in our network.
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