Medicare and the Affordable Care Act – What is the Difference?

Medicare and the Affordable Care Act – What is the Difference?

Can you have medicare and affordable care act

Medicare and the Affordable Care Act (ACA, or Obamacare) are distinct entities. While Medicare offers Medicare Advantage plans that meet specific guidelines to make coverage more cost effective and accessible, Marketplace plans make private health plans more cost effective and accessible to more Americans.

However, you cannot maintain both Marketplace plans and Medicare at the same time; doing so would be financially unfeasible.


Medicare is the health insurance program designed for people 65 or over, administered by the federal government in conjunction with states to provide coverage. Medicare’s four components – Parts A, B, C and D – offer hospital coverage while Part B covers outpatient medical services and Part D offers prescription drug coverage respectively. There are also various Medicare Advantage Plans which combine Parts A and B while providing more benefits than Original Medicare does.

Medicare isn’t free; there may be out-of-pocket expenses like deductibles, copays, and coinsurance to consider when choosing this program. Depending on your financial circumstances and needs, adding a Medicare Supplement policy might help cover these expenses. Medicare coverage is available to people age 65 and over as well as some younger individuals with disabilities or end stage renal disease who qualify. Those enrolling early will avoid incurring a late enrollment penalty fee.


Tens of millions of low-income Americans depend on Medicaid as a safety net to access healthcare. It provides health insurance coverage to children, parents and pregnant women meeting specific income eligibility requirements; as well as adults unable to afford private health coverage.

The Affordable Care Act introduced several changes to Medicaid. For instance, it prohibits lifetime limits and lower annual limits than in the past; and prohibited health insurers from cancelling coverage when you become sick.

Each state administers its own Medicaid program within the federal framework, with eligibility criteria differing by state. Most Medicaid programs pay providers through either fee for service payments or rate-based models, and most do not count irrevocable burial trusts as assets for eligibility; however, some states have laws which require applicants to surrender personal property worth over $1,500 when applying.

Marketplace plans

Marketplace plans are private health insurance plans offered through state or federally-run health insurance exchanges that meet Affordable Care Act (ACA) standards of coverage, and must provide coverage that covers ten essential health benefits without using medical underwriting, preexisting condition exclusion or annual or lifetime benefit caps. Furthermore, premium subsidies exist to help make Marketplace insurance accessible for low and middle income Americans.

The Marketplace provides individuals with one convenient website where they can easily compare all health plans available in their area on price, benefits and quality criteria. In addition, this portal offers information regarding eligibility for cost-sharing reductions and premium tax credits.

Individuals under 65 are only able to purchase Marketplace plans during open enrollment or by qualifying for a Special Enrollment Period (SEP), such as having a child, getting married or moving counties. Individuals over 65 may enroll in Medicare; or end-stage renal disease (ESRD) patients can keep their Marketplace plan and receive cost assistance through this program.


The Affordable Care Act, commonly known as Obamacare, has helped millions of Americans access more cost-effective health insurance coverage and ensures that at least 80 percent of premium dollars go directly towards medical care and quality improvements rather than overhead expenses like advertising and executive bonuses.

Nearly 90% of Americans are covered by health coverage either through Medicare, Medicaid or an ACA-compliant private policy. Employers must offer such insurance or face penalties; individuals without employer-based coverage can purchase health coverage through an online marketplace.

The marketplace provides pre-set bronze, silver, gold, and platinum plans with different costs and coverage levels. Under the Affordable Care Act (ACA), individuals may qualify for premium tax credits while out-of-pocket costs can be reduced through cost-sharing reduction benefits. It has endured legislative attacks as well as pandemic outbreaks, two Supreme Court challenges, presidential campaign promises to repeal it – yet remains law of the land today.

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About the Author: Raymond Donovan