Aetna Better Health: Understanding Medicaid vs. Medicare Coverage

Aetna Better Health covers both Medicaid and Medicare, but they are separate programs with different rules, costs, and coverage

Aetna Better Health is the name Aetna uses for its managed care plans under both Medicaid and Medicare. The two are not the same program. Medicaid is for people with lower incomes; Medicare is for people 65 and older, regardless of income, and for some younger people with disabilities or end-stage renal disease. If you are looking at Aetna Better Health plans, you need to know which program you are actually in — that determines your monthly cost, what doctors you can see, and what the plan covers.

The confusion happens because Aetna uses the same brand name for both. You cannot be in "Aetna Better Health" without being in either Medicaid or Medicare first. Your state or the federal government decides which one you belong to based on your age, income, and disability status. Aetna then offers managed care plans within that program.

Key Takeaways

Aetna Better Health Medicaid is for people under 65 with lower incomes; Aetna Better Health Medicare is for people 65 and older or with certain disabilities.
Medicaid plans through Aetna typically have no monthly premium, while Medicare plans charge a monthly premium in addition to your Medicare Part B cost.
Your state runs Medicaid, so Aetna Better Health Medicaid plans vary by state; Medicare is federal, so Aetna Better Health Medicare plans are more consistent across the country.
Both types of plans use networks of doctors and hospitals, and you usually need a referral to see a specialist.
You enroll in Medicaid or Medicare through your state or Medicare.gov; you then choose an Aetna Better Health plan within that program.

How Aetna Better Health Medicaid works

Aetna Better Health Medicaid plans are offered in certain states and serve people who meet your state's income and asset limits. Most Aetna Better Health Medicaid plans charge no monthly premium — Medicaid pays Aetna a fixed amount per member each month. You may have small copays when you see a doctor or fill a prescription, but the plan itself does not cost you a monthly fee.

Coverage varies by state because each state designs its own Medicaid program. Aetna Better Health Medicaid in California covers different services than Aetna Better Health Medicaid in Florida. You need to check your state's Medicaid website or contact Aetna directly to see what is covered in your state's plan. Most plans include doctor visits, hospital care, prescription drugs, and preventive services, but the details differ.

To join an Aetna Better Health Medicaid plan, you first have to be approved for Medicaid in your state. You explore through your state's Medicaid office or online portal. Once you are approved for Medicaid, you can then choose an Aetna Better Health plan if one is available in your area. Not all states offer Aetna Better Health Medicaid, and not all regions within a state may have it.

How Aetna Better Health Medicare works

Aetna Better Health Medicare plans are Medicare Advantage plans (also called Part C). They are available nationwide and serve people 65 and older, some people under 65 with disabilities, and people with end-stage renal disease. Unlike Medicaid, you do not need to prove low income to join a Medicare Advantage plan — you only need to be enrolled in Medicare Part A and Part B.

Aetna Better Health Medicare plans charge a monthly premium on top of your Medicare Part B premium. The amount varies by plan and by region. Some plans have a $0 premium, but you still pay your Part B premium to Medicare. You also typically pay copays or coinsurance when you use services, and there is usually an annual out-of-pocket limit.

Medicare Advantage plans, including Aetna Better Health Medicare, often include prescription drug coverage (Part D) and extra benefits like dental, vision, or hearing aids. Original Medicare does not include these, so Aetna Better Health Medicare can be a way to get them without buying separate policies. However, you are locked into Aetna's network of doctors and hospitals, and you usually need a referral to see a specialist.

Monthly costs: Medicaid vs. Medicare plans

Aetna Better Health Medicaid typically has no monthly premium. Medicaid is a joint federal and state program for people with lower incomes, and the state pays the plan directly. You may have small copays — often $1 to $5 per doctor visit or prescription — but there is no monthly bill to you.

Aetna Better Health Medicare requires a monthly premium. You pay this in addition to your Medicare Part B premium (which is deducted from your Social Security check or billed separately). The Medicare Advantage premium varies by plan and location. Some plans in some areas have a $0 premium, but many charge $20 to $100 or more per month. You also pay copays or coinsurance when you use services, up to an annual out-of-pocket limit.

If you are on a fixed income, the difference matters. Medicaid plans cost less upfront, but Medicare Advantage plans may offer more services (like dental or vision) that would otherwise cost extra. Compare the actual plans available to you in your area to see which costs less for the care you actually use.

Network and referral requirements

Both Aetna Better Health Medicaid and Medicare plans use a network of doctors and hospitals. You get the best rates if you see doctors in the network. If you see an out-of-network doctor, you may pay more or the plan may not cover it at all. Some plans allow out-of-network emergency care, but routine care usually has to be in-network.

Both types of plans typically require a primary care physician (PCP). Your PCP is your main doctor and coordinates your care. If you need to see a specialist, you usually have to get a referral from your PCP first. Without a referral, the plan may not cover the specialist visit. This is different from Original Medicare, which lets you see most specialists without a referral.

When you choose an Aetna Better Health plan, you pick your PCP from the plan's network. Make sure your current doctors are in the network before you enroll, or be prepared to switch. You can change your PCP once a year or if your doctor leaves the network.

Prescription drug coverage

Aetna Better Health Medicaid plans include prescription drug coverage as part of the plan. Your state decides which drugs are covered and what your copay is. Most plans cover generic drugs at a lower copay than brand-name drugs. Some drugs may require prior approval from the plan before the pharmacy will fill them.

Aetna Better Health Medicare plans usually include prescription drug coverage (Part D) as part of the plan. This is different from Original Medicare, where you have to buy Part D separately. The plan's formulary (list of covered drugs) and copays vary by plan. Like Medicaid plans, some drugs may need prior approval.

If you are switching between Medicaid and Medicare — for example, if you turn 65 and move from Medicaid to Medicare — your prescription coverage will change. Make sure your current medications are covered under the new plan before the switch happens. You can ask Aetna or your state Medicaid office for a formulary (the list of covered drugs) before you enroll.

How to enroll in an Aetna Better Health plan

For Medicaid: First, explore for Medicaid through your state's Medicaid office or website. Each state has a different name for its Medicaid program (for example, Medi-Cal in California, Medicaid in New York). Once you are approved, you will receive information about available plans in your area. You can then choose an Aetna Better Health plan if one is offered. Enrollment usually happens once a year during an open enrollment period, but you may be able to enroll right away if you are newly approved for Medicaid.

For Medicare: You must be enrolled in Medicare Part A and Part B first. You can enroll in Medicare at 65 through Medicare.gov, or earlier if you have a disability or end-stage renal disease. Once you are in Medicare, you can choose an Aetna Better Health Medicare plan during the Annual Enrollment Period (October 15 to December 7 each year) or during the Initial Enrollment Period when you first become may be able to access for Medicare. You can also switch plans once a year during the Annual Enrollment Period.

In both cases, you can call Aetna directly to ask which plans are available in your area and to get help comparing them. Aetna's phone number is on your Medicaid or Medicare materials. You can also contact your state Medicaid office or call Medicare at 1-800-MEDICARE for help.

Frequently Asked Questions

Can I have both Aetna Better Health Medicaid and Medicare at the same time?

Yes, if you are 65 or older and have low enough income to may have access to for Medicaid, you can be in both programs at the same time. This is called being "dual may be able to access." In this case, Medicare is your primary insurance and Medicaid is secondary. You may be able to enroll in an Aetna Better Health plan that serves dual-may be able to access people, or you may be in separate Medicaid and Medicare plans. Contact your state Medicaid office and Medicare to understand your options.

What happens to my Aetna Better Health plan if I move to a different state?

Your Aetna Better Health Medicaid plan ends when you move, because Medicaid is run by each state. You will need to explore for Medicaid in your new state and choose a new plan. For Medicare, Aetna Better Health plans are available in most states, but the specific plans and networks vary by location. You can change your plan when you move during the Annual Enrollment Period or within 60 days of moving, depending on your situation.

Do I have to use Aetna Better Health, or can I stay on Original Medicare or Medicaid?

You do not have to choose an Aetna Better Health plan. For Medicaid, your state may offer other managed care plans or you may be able to stay on fee-for-service Medicaid (where you can see any doctor who accepts Medicaid). For Medicare, you can stay on Original Medicare instead of choosing a Medicare Advantage plan. Ask your state Medicaid office or Medicare what options are available to you.

What if my income changes and I no longer may have access to for Medicaid?

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. Your Aetna Better Health Medicaid plan will end. If you are 65 or older, you will still have Medicare. If you are under 65, you may be able to buy coverage through the health insurance marketplace or through your employer. Contact your state Medicaid office to understand when your coverage ends and what your options are.

Are Aetna Better Health plans the same in every state?

No. Aetna Better Health Medicaid plans vary significantly by state because each state designs its own Medicaid program. Aetna Better Health Medicare plans are more consistent across states, but the specific plans, networks, and premiums still vary by region. Always check the plans available in your specific state and county before enrolling.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.