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Medicare Road map: What’s the difference between Medicare and Medicaid?

Alice Gomstyn By: Alice Gomstyn

Not sure how Medicare and Medicaid are different? You're not alone. These two government-funded health insurance programs have similar names and offer overlapping benefits, so it's easy to get confused. But there are key differences between the two, and whether you qualify for one, the other, or both, it's helpful to know what makes each program unique. Here are the key differences between Medicare and Medicaid:

Infographic comparing Medicare and Medicaid

Who funds it?

The federal government funds Medicare.

The federal and state governments fund Medicaid.

Who administers it?

The federal government administers Medicare. Private insurance companies administer Medicare Advantage plans.

State governments administer Medicaid.

Is there variety among plans?

Consumers can choose to receive Original Medicare. Or they can choose to receive a Medicare Advantage plan. This is an alternative way to get Original Medicare.

Medicare Advantage plans can offer benefits that Original Medicare does not, including dental, vision or hearing services; prescription drug coverage; and fitness club membership. What’s offered depends on where you live.*


Learn more about Aetna's Medicare Advantage plans here: <aetnamedicare.com>

There are two different types of Medicaid plans: traditional and managed care. Some states offer both types. In a traditional plan, health care providers charge the state for every service a patient receives. In a managed care plan, benefits and services are delivered through insurers such as Aetna.
Learn more about Aetna's Medicaid plans here: <aetnabetterhealth.com>

Who is eligible?

People who are 65 or older, younger people with a qualifying disability and people with end-stage renal disease are eligible for Medicare.

People who have a disability or who meet income and family size eligibility requirements, which vary by state, are eligible for Medicaid.

How do you apply?
Apply for Medicare through the Social Security Administration: ssa.gov/benefits/medicare.

Apply for Medicaid through healthcare.gov or your state's Medicaid website: medicaid.gov. If you don’t choose a plan, one may be automatically assigned to you.

What does it cost?

Medicare recipients may be responsible for out-of-pocket costs, such as premiums and copays, depending on their plan. States offer Medicare Savings

Programs that can help cover some of these costs.

Most Medicaid recipients pay nothing for medical coverage, though vision and dental coverage may require copays.

Those receiving Medicaid through Medicaid expansion programs may be responsible for additional costs. Learn more about Medicaid expansion programs, which allow states to expand Medicaid eligibility beyond traditional requirements, at healthcare.gov/medicaid-chip/medicaid-expansion-and-you/.

What are the coverage differences?

For Medicare, coverage varies depending on whether consumers choose Original Medicare or a Medicare Advantage Plan.

Medicaid may offer benefits that Medicare may not, such as covering the cost of long-term nursing home care and home health care services.

Coverage varies depending on whether the recipient has a fee-for-service plan or a managed care plan.

How often do you need to apply?

Medicare recipients only need to apply once. Those eligible for Medicare due to age may apply as early as three months before the month of their 65th birthday. Those who choose a Medicare Advantage plan will need to enroll annually.

Medicaid recipients must "recertify" every year by proving they meet eligibility requirements.

Are you dual eligible?

About 12 million people are dual eligible, meaning they’re eligible to enroll in both Medicaid and Medicare. Dual enrollees typically use Medicare as their main form of coverage, while Medicaid serves as their supplemental insurance.

Not everyone who is dual eligible receives the same level of coverage:

  • Those who are "full dual eligible" are enrolled in Medicare and receive full Medicaid benefits.
  • Those who are "partial dual eligible" receive assistance from Medicaid to pay Medicare premiums.

Aetna offers a Dual Special Needs Plan that features additional benefits, such as more dental, vision and prescription drug coverage as well as transportation to doctor's appointments.

Eligibility guidelines are available here: medicaid.gov/medicaid/eligibility/index.html

Infographic comparing Medicare and Medicaid

 

Medicare

Medicaid

Who funds it?

The federal government

The federal and state governments

Who administers it?

The federal government (Original Medicare)

Private insurance companies (Medicare Advantage)

 

State governments

Is there variety among plans?

Consumers can choose to receive Original Medicare. Or they can choose to receive a Medicare Advantage plan. This is an alternative way to get Original Medicare.

Medicare Advantage plans can offer benefits that Original Medicare does not, including dental, vision or hearing services; prescription drug coverage; and fitness club membership. What’s offered depends on where you live.*



Learn more about Aetna's Medicare Advantage plans here: <aetnamedicare.com>.

There are two different types of plans: traditional and managed care. Some states offer both types. In a traditional plan, health care providers charge the state for every service a patient receives. In a managed care plan, benefits and services are delivered through insurers such as Aetna. Learn more about Aetna's Medicaid plans here: <aetnabetterhealth.com>.

Who is eligible?

People who are 65 or older, younger people with a qualifying disability and people with end-stage renal disease

 

People who have a disability or who meet income and family size eligibility requirements, which vary by state

How do you apply?

Through the Social Security Administration: ssa.gov/benefits/medicare

 

Through healthcare.gov or your state's Medicaid website: medicaid.gov. If you don’t choose a plan, one may be automatically assigned to you.

What does it cost?

Medicare recipients may be responsible for out-of-pocket costs, such as premiums and copays,  depending on their plan. States offer Medicare Savings Programs that can help cover some of these costs.

Most Medicaid recipients pay nothing for medical coverage, though vision and dental coverage may require copays.

Those receiving Medicaid through Medicaid expansion programs may be responsible for additional costs. Learn more about Medicaid expansion programs, which allow states to expand Medicaid eligibility beyond traditional requirements, at healthcare.gov/medicaid-chip/medicaid-expansion-and-you/.

What are the coverage differences?

For Medicare, coverage varies depending on whether consumers choose Original Medicare or a Medicare Advantage Plan.

Medicaid may offer benefits that Medicare may not, such as covering the cost of long-term nursing home care and home health care services.

Coverage varies depending on whether the recipient has a fee-for-service plan or a managed care plan.

How often do you need to apply?

Medicare recipients only need to apply once. Those eligible for Medicare due to age may apply as early as three months before the month of their 65th birthday. Those who choose a Medicare Advantage plan will need to enroll annually.

Medicaid recipients must recertify" every year by proving they meet eligibility requirements.

Are you dual eligible?

About 12 million people are dual eligible, meaning they’re eligible to enroll in both Medicaid and Medicare. Dual enrollees typically use Medicare as their main form of coverage, while Medicaid serves as their supplemental insurance.

Not everyone who is dual eligible receives the same level of coverage:

  • Those who are "full dual eligible" are enrolled in Medicare and receive full Medicaid benefits.
  • Those who are "partial dual eligible" receive assistance from Medicaid to pay Medicare premiums.

Aetna offers a Dual Special Needs Plan that features additional benefits, such as more dental, vision and prescription drug coverage as well as transportation to doctor's appointments.

Eligibility guidelines are available here: medicaid.gov/medicaid/eligibility/index.html

It's important to understand the ins and outs of government-funded health insurance plans and make sure you're getting the most of the plan or plans you're eligible for. Learn more:

Aetna Medicare
Aetna Medicaid

* To learn more, visit https://www.aetnamedicare.com/en/understanding-medicare/medicare-advantage-right-for-you.html.

About the author

Alice Gomstyn is a veteran parenting blogger and business reporter. She is an admitted sugar addict but plans to cut back on the sweet stuff and load up on veggies like never before. Bring on the broccoli!

Need help?

Call us at 1-833-329-0412 (TTY: 711) to chat about any Medicare questions you have.