Medicare and the Affordable Care Act are two programs designed to make healthcare more accessible, protecting you against rising health care costs related to age or medical conditions.
Medicare was first implemented in 1965 to provide health coverage to people 65 and over. Now it provides coverage to around one sixth of Americans.
Medicare
Medicare is a federal health insurance program designed to cover people aged 65 or over as well as some disabled younger individuals. Medicare also covers people suffering from End-Stage Renal Disease (ESRD, or permanent kidney failure requiring dialysis or transplant) who fall within its coverage.
The Affordable Care Act represents a radical transformation to how Medicare operates, providing more options and keeping costs in check, as well as making it simpler for seniors to receive care they require.
Medicaid is another government program designed to provide healthcare coverage to people living on limited incomes, including children, pregnant women, elderly adults and people with disabilities. It is managed and funded jointly by both federal and state governments.
The Affordable Care Act created Health Insurance Marketplaces that make it easier for individuals to compare plans and determine their eligibility for subsidies that help cover some or all of their premiums. In addition, this law expands Medicaid coverage to millions more low-income people while simultaneously improving its quality.
Medicaid
Medicaid is a joint federal and state healthcare program designed to assist low-income individuals, children, pregnant women, elderly persons, and people living with disabilities by covering services not covered by Original Medicare such as doctor visits, hospital stays, long-term care services and custodial care.
The Affordable Care Act (ACA) offers federal subsidies to assist individuals purchasing private insurance through health insurance exchanges. Individuals who earn between 100-200% of federal poverty levels may receive premium tax credits to reduce out-of-pocket healthcare costs.
Under the Affordable Care Act (ACA), states are mandated to expand Medicaid programs so as to cover more low-income adults; since 2014 when this requirement first went into effect, over 12 million individuals have gained coverage due to this.
Marketplace Plans
Marketplace health plans meet Affordable Care Act standards and cannot discriminate against people with preexisting conditions.
Most Marketplace plans provide comprehensive benefits, such as doctor appointments, preventive care visits, emergency room visits, prescription drugs and more. Some plans even offer extras like discounts on dental and vision services.
Cost-sharing subsidies may also help lower out-of-pocket medical costs such as deductibles and copays; silver-level plans are most likely eligible for these subsidies.
Premium tax credits may be claimed either on your tax return or as advance premium tax credits payable directly to the plan insurer every month. These subsidies are designed to assist low-income individuals purchase an eligible plan on the Marketplace.
In some states, unemployment compensation recipients can also qualify for premium subsidies; these subsidies will be calculated based on your income in the year when enrolling in a qualified plan versus what was reported on taxes last year.
Premium Subsidies
The Affordable Care Act offers various financial assistance programs to make health insurance more accessible, including premium tax credits and cost-sharing subsidies that reduce an individual or family’s out-of-pocket expenses when accessing health care services.
Subsidies for Marketplace enrollees typically depend on their income; those who earn slightly higher will typically receive greater subsidies than those earning slightly less.
One of the key features of the Affordable Care Act is its subsidized insurance options. Marketplaces enable people to purchase affordable plans that offer quality coverage.
However, subsidies provided by the Affordable Care Act can have adverse impacts on beneficiaries’ access to healthcare. For instance, states which did not expand Medicaid may prevent some individuals who fall below 138% of federal poverty level from qualifying for tax credit subsidy assistance because their state’s eligibility requirements don’t allow for coverage through Medicaid.
