What’s the difference between Medicare and Medicaid?

Medicare vs. Medicaid

Who administers it?

Medicare

The federal government (Original Medicare)

Private insurance companies (Medicare Advantage)

Medicaid

State governments

Is there variety among plans?

Medicare

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 and hearing services, prescription drug coverage and fitness club memberships. What’s offered depends on where you live.

Medicaid

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 Medicaid plans here: AetnaBetterHealth.com

Who is eligible?

Medicare

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

Medicaid

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

How do you apply?

Medicare

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

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

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.

Medicaid

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?

Medicare

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

Medicaid

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

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

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

Are you dual eligible?

About 12.5 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" are enrolled in Medicare and 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 appointments.

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