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Posted 07/05/2023 in Medicare Advantage

Are Medicaid and Medicare Advantage the Same?

Are Medicaid and Medicare Advantage the Same?

Are Medicaid and Medicare Advantage the Same?

The terms "Medicare" and "Medicaid" often get misused. We can see why - they start the same way, and both "-care" and "-aid" mean the same thing. It's no wonder most people can't keep them straight!

Individuals eligible for Medicaid can also get a particular Medicare Advantage plan called a Duo Special Needs Plan. Let's jump into an overview of each program.


The Medicaid program is designed for individuals and families who need financial assistance. Each state administers its program according to federal guidelines. Both state and Federal governments fund Medicaid, which provides health insurance and other financial aid for those who qualify.

There are five main eligibility criteria. Eligibility is based on the following:

  • Categories: children, families, individuals with disabilities, seniors, etc
  • Income: different thresholds for each category
  • Resources: Your assets
  • Immigration status: available for legal U.S residents only
  • Residency: based on the state you reside

The two main groups that Medicaid serves are healthy individuals and families with low incomes and individuals with disabilities or chronic conditions.

The Federal Poverty Level (FPL) determines if an individual will qualify for Medicaid. The FPL is the minimum amount a person or family will need for the necessities: food, clothing, transportation, shelter, etc. The FPL is recalculated each year.

The Medicaid program has many different facets, but for our purposes, understand that individuals of any age can qualify for Medicaid.

Medicare Advantage Duo Special Needs Plans

To be eligible for Medicare, you must meet specific criteria. Most people "age into" Medicare when they turn 65. You can also qualify if you have been on disability for two years or have been diagnosed with End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease. The Medicare program is not designed for those who need financial assistance like the Medicaid program.

Medicare Advantage is one way that Medicare beneficiaries can get their Medicare benefits. While individuals on Medicaid do not have to enroll in an Advantage (Part C) plan, one plan is explicitly designed for eligible individuals for both programs: Medicare Advantage Duo Special Needs Plan (D-SNP).

Insurance companies design their DSNPS for individuals eligible for Medicare and Medicaid. 

Your state often covers monthly premiums if you qualify for a D-SNP plan.   Requirements and regulations differ in each state, so you must contact your local government office to determine if you are eligible.

In short, Medicaid and Medicare Advantage are not the same. However, there are Medicare Advantage Plans designed for people on Medicaid. If you would like a personalized analysis of what you qualify for, contact one of our member Medicare Insurance Brokers today!