Aetna offers both Medicaid and Medicare plans, but they are separate products for different groups of people
Aetna is an insurance company that contracts with both the Medicaid program (run by states) and the Medicare program (run by the federal government). When you see "Aetna Medicaid" or "Aetna Medicare," you are looking at two completely different insurance products. Which one you can use depends on your age, income, and disability status — not on Aetna's choice.
If you are under 65 and your state's Medicaid program has contracted with Aetna, you may be able to enroll in an Aetna Medicaid managed care plan. If you are 65 or older or have certain disabilities, you may be able to enroll in an Aetna Medicare Advantage plan. You cannot use both at the same time, and being approved for one does not mean you may have access to for the other.
Key Takeaways
- Aetna Medicaid plans are for people under 65 with low income who are enrolled in their state's Medicaid program.
- Aetna Medicare plans are for people 65 and older, or younger people with certain disabilities, who are enrolled in Medicare.
- Your state decides which insurance companies, including Aetna, can offer Medicaid plans in your area.
- You must first be approved for Medicaid or Medicare through your state or the federal government before you can choose an Aetna plan.
- Aetna's customer service phone number, covered services, and copays differ between its Medicaid and Medicare products.
How Aetna Medicaid works and who can use it
Aetna Medicaid is a managed care plan — meaning Aetna contracts with your state to deliver Medicaid benefits to a group of members. Your state's Medicaid program pays Aetna a monthly fee for each person enrolled, and Aetna then pays doctors, hospitals, and pharmacies on your behalf.
To use an Aetna Medicaid plan, you must first be approved for Medicaid by your state. Income limits, asset limits, and other rules vary by state and by category (for example, parents, children, pregnant people, or people with disabilities). Once you are approved for Medicaid, your state may let you choose which insurance company delivers your benefits — and Aetna may be one of the options in your area. Not all states use Aetna, and not all regions within a state have Aetna plans available.
Aetna Medicaid plans cover doctor visits, hospital care, prescription drugs, and other services set by your state. The exact copays, deductibles, and covered drugs vary by state and by plan. You can contact your state's Medicaid office or Aetna directly to find out which plans are available where you live and what they cover.
How Aetna Medicare works and who can use it
Aetna Medicare is a Medicare Advantage plan (also called Part C). It is offered by Aetna to people who are already enrolled in Medicare — either because they are 65 or older, or because they have been receiving Social Security Disability Insurance (SSDI) for at least 24 months.
To use an Aetna Medicare plan, you must first enroll in Medicare through Social Security or the Centers for Medicare and Medicaid Services (CMS). Medicare is a federal program, not a state program. Once you have Medicare, you can choose to stay in Original Medicare (Parts A and B) or switch to a Medicare Advantage plan like Aetna's. During the annual enrollment period (October 15 to December 7), you can change plans or switch back to Original Medicare.
Aetna Medicare Advantage plans typically include prescription drug coverage (Part D), dental, vision, and hearing benefits that Original Medicare does not cover. However, they usually have higher copays for specialist visits and may require you to use doctors and hospitals in Aetna's network. You can contact Aetna or Medicare.gov to compare plans and see which ones are available in your area.
The difference between Aetna Medicaid and Aetna Medicare at a glance
| Feature | Aetna Medicaid | Aetna Medicare |
|---|---|---|
| Who runs it | Your state's Medicaid program | Federal government (CMS) |
| Who can use it | People under 65 with low income approved for state Medicaid | People 65+, or younger people with SSDI for 24+ months, enrolled in Medicare |
| How you enroll | First get approved for Medicaid by your state, then choose Aetna if available | First enroll in Medicare, then choose Aetna during open enrollment |
| When you can enroll | Year-round, depending on your state's rules | October 15 to December 7 each year (or when you first turn 65) |
| Prescription drug coverage | Included in the plan | Usually included, but may be separate |
| Dental and vision | Varies by state and plan | Usually included |
What to do if you think you need Aetna Medicaid
Start by contacting your state's Medicaid office to learn about you meet the income and other requirements for Medicaid in your state. You can reach your state Medicaid office through your state's health department website or by calling 211 (a free referral line). Your state will tell you whether you are approved and which insurance companies, including Aetna, offer plans in your area.
If Aetna is available in your area and you are approved for Medicaid, you can enroll in an Aetna Medicaid plan during your state's enrollment period. Some states allow year-round enrollment; others have specific open enrollment windows. Your state's Medicaid office will explain the timeline and how to choose a plan. Once you enroll, Aetna will send you a member ID card and information about your coverage.
What to do if you think you need Aetna Medicare
First, make sure you are enrolled in Medicare. If you are 65 or older, you can enroll through Social Security or at Medicare.gov. If you are younger than 65 and have been receiving SSDI for at least 24 months, you are automatically enrolled in Medicare. You can check your enrollment status at Medicare.gov or by calling 1-800-MEDICARE.
Once you are enrolled in Medicare, you can compare Aetna Medicare Advantage plans during the annual open enrollment period (October 15 to December 7). Visit Medicare.gov, enter your zip code, and see which Aetna plans are available near you. You can also call 1-800-MEDICARE to speak with someone who can help you compare plans. If you enroll in an Aetna plan, your coverage begins January 1 of the following year.
Frequently Asked Questions
Can I have both Aetna Medicaid and Aetna Medicare at the same time?
No. You can only be enrolled in one health insurance plan at a time. However, some people may have access to for both Medicaid and Medicare (called "dual may be able to access"). If you are dual may be able to access, you must choose whether to use Medicaid or Medicare for your primary coverage. Some states offer special plans for dual-may be able to access people, but you still cannot hold both plans simultaneously.
How do I know if Aetna Medicaid is available in my state?
Contact your state's Medicaid office or call 211. They can tell you which insurance companies offer Medicaid plans in your area. You can also visit your state's Medicaid website, which usually lists all available plans and insurers. Aetna is not available in every state or in every region of every state.
What if I lose my job and need to switch from Aetna Medicare to Aetna Medicaid?
Losing your job may make you newly may be able to access for Medicaid. Contact your state's Medicaid office to see if you now meet the income requirements. If you are approved for Medicaid, you can enroll in an Aetna Medicaid plan if one is available in your area. You may also be able to keep your Medicare coverage through COBRA or the Marketplace, depending on your situation.
Do Aetna Medicaid and Aetna Medicare cover the same doctors?
No. Aetna Medicaid and Aetna Medicare have separate networks of doctors and hospitals. A doctor who accepts Aetna Medicaid may not accept Aetna Medicare, and vice versa. Before you enroll in either plan, ask Aetna for a list of doctors in your area or check their website to make sure your current doctor is in the network.
What happens if I turn 65 while I have Aetna Medicaid?
When you turn 65, you become may be able to access for Medicare. You must enroll in Medicare (usually automatically if you are receiving Social Security). You can keep your Aetna Medicaid plan until your Medicare coverage begins, but you cannot have both at the same time. Your state's Medicaid office and Aetna can help you understand your options and timing.