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:
| Question | 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? |
What’s offered depends on where you live.
Learn more about Allina Health | Aetna Medicare Advantage plans. | There are two different types of plans: traditional and managed care. Some states offer both. In a traditional plan, doctors and hospitals bill the state for each service. In a managed care plan, a health plan like Aetna® provides your care.
Learn more about Aetna Medicaid plans. |
| 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. | Through HealthCare or your state's Medicaid website. If you don’t choose a plan, one may be chosen for 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 people with Medicaid pay nothing for their care. But they may have small copays for vision and dental care.
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| What are the coverage differences? | For Medicare, coverage varies depending on whether you 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 you have 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 review their plan annually. | 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" 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.
Get help with enrollment
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