Medicare vs. Obamacare
Written by: Rachael Zimlich, RN, BSN
Reviewed by: Eboni Onayo, Licensed Insurance Agent
Obamacare refers to health insurance purchased through the federally established healthcare Marketplace.
Marketplace plans were created by the Affordable Care Act.
These plans are private insurance plans that are designed to match certain needs and budgets.
Medicare is a health program offered by the government to older adults and people with certain disabilities.
You cannot have both Obamacare and Medicare.
Obamacare is a term used to describe the services provided under the Affordable Care Act’s Marketplace plans. These private insurance plans were designed to offer comprehensive but lower-cost plans for people who don’t receive health benefits through an employer or the government.
Can you get Obamacare if you are on Medicare? If you are eligible for Medicare — a health plan offered by the government to certain people — you must end your Marketplace coverage to join Medicare.
Find a local Medicare plan that fits your needs
What are the Differences Between Medicare and Obamacare?
Medicare is health insurance offered by the federal government to help adults over age 65 and people with certain disabilities pay for healthcare. These plans divide the cost of your healthcare between you and the federal government. There are private insurance Medicare plans — called Medicare Advantage plans — that can be purchased, but they have to meet requirements set by the federal government to offer at least as much coverage as Original Medicare plans.
Obamacare plans, on the other hand, are private insurance plans that are designed to meet the healthcare needs of people who might not otherwise have access to healthcare. These plans, also known as Marketplace plans, were developed after the passage of the Affordable Care Act — a law that aimed to make healthcare more accessible and affordable. The federal government helped get these plans developed but does not administer the plans or offer any financial help. When the Marketplace first opened in 2014, there was a penalty charged to anyone without health insurance. This rule was changed in 2019, and there is no longer any penalty for failing to carry health insurance.
Medicare eligibility requirements
To qualify for Medicare, you must be 65 or older, or you must have qualified for disability from the Social Security Administration for 24 months or have end-stage renal disease or ALS (Lou Gehrig’s disease).
How much you pay for Medicare will depend in part on how much you paid during your lifetime in Medicare taxes. If you have paid Medicare taxes through an employer for 10 years or more, you don’t have to pay a monthly premium for Part A of Original Medicare. Part B, however, requires a standard premium.
Marketplace (Obamacare) eligibility
While it’s true that just about “anyone” is eligible for a Marketplace plan, there are a few specifics.
Eligibility requirements for these plans are:
- You must be a U.S. citizen.
- You must live in the United States.
- You cannot be incarcerated.
Medicaid, Medicare and Marketplace differences
While all these plans focus on offering healthcare coverage to people with special financial or medical needs, the key differences are in what type of entity offers the plans.
- Medicare is a healthcare plan offered by the federal government, usually to people age 65 and older.
- Medicare Advantage plans are offered by private insurers as an alternative to Parts A and B of Original Medicare.
- Medicaid is a government health plan administered by states for people with certain disabilities or financial hardships, regardless of age.
- Marketplace plans are private insurance products designed to offer comprehensive healthcare that is affordable for those with limited access to health insurance otherwise.
How Does Obamacare Affect Medicare Recipients?
Obamacare doesn’t affect your ability to qualify for Medicare. Obamacare is intended as an affordable option for people who may not qualify for public assistance health programs like Medicare or Medicaid. Most people who qualify for Medicare drop their current plan — be it a Marketplace health plan or other private plan — and sign up for Medicare instead.
Can you get ACA marketplace dental coverage if you’re on Medicare?
If you want dental services and you are enrolled in Parts A and B of Original Medicare, you may be able to switch to a Medicare Advantage plan that includes dental care. You may also just choose to pay out-of-pocket for these services.
You cannot sign up for a Marketplace dental plan while you have Medicare. You can only add dental services through the Marketplace when you sign up for a Marketplace health insurance plan.
Are you eligible for cost-saving Medicare subsidies?
Does Obamacare Cover My Spouse Not Yet Eligible for Medicare?
Medicare coverage is individual in nature, so younger spouses don’t qualify for Medicare when the older spouse turns 65. The younger spouse must also wait until age 65.
Obamacare, however, is available to your spouse whether you are on Medicare or not.
Can You Keep Obamacare Marketplace Coverage After 65?
Medicare isn’t mandatory. However, you may be enrolled in some parts of Medicare automatically, and opting out can be complicated.
Additionally, if you decide to wait to sign up for certain Medicare services, you could be faced with late enrollment penalties. These penalties are based on the age when you were first eligible for Medicare and when you finally enrolled.
In some cases, you may choose to keep your pre-Medicare coverage (if it’s something other than Obamacare) after you sign up for Medicare. In these cases, one payer will be the primary payer and one will be secondary. You will need to ask your insurance company about specific coverage rules if you want to keep your plan with Medicare.
What extra benefits and savings do you qualify for?
Medicare and Obamacare Fact Check
- Medicare is a federal health program.
- You can opt out of Medicare, but may have to pay penalties if you enroll later.
- Marketplace plans are private insurance plans.
- Marketplace/Obamacare plans are not mandatory.
- There are no penalties if you don’t have healthcare and decline a Marketplace plan.