Obamacare and Medicaid often get confused, but these two programs provide different levels of coverage to those with low incomes.
There are differences among plans offered under these programs, such as their level of coverage and costs. Furthermore, there are disparities in eligibility criteria.
Eligibility
The Affordable Care Act (ACA) extended Medicaid eligibility to adults who had previously been excluded, such as non-disabled childless adults with incomes up to 133% of the federal poverty level. This expansion has led to a dramatic spike in Medicaid enrollment rates.
The Affordable Care Act (ACA) made changes to how income is calculated for eligibility purposes. The new methodology uses modified adjusted gross income (MAGI) from Form 1040 plus tax-exempt interest, tax-exempt Social Security benefits and foreign earned income exempt from taxes to calculate an individual’s income within each of four existing categorical groups.
Under the Affordable Care Act (ACA), states are required to determine income eligibility based on MAGI budgeting methods for each of four categories and then subtract five percent from the highest applicable FPL. For adults 18 or older, this amount has been raised from 133% to 138% of FPL.
Coverage
Obamacare and Medicaid are two of the most popular health insurance plans in America, yet they are distinct. It’s essential to know the distinction between them so you can select a plan that best meets your individual needs.
Obamacare covers individuals through the marketplaces, while Medicaid is a joint state-federal government program that offers health care to low income citizens and those with certain disabilities. It offers subsidized hospital stays, doctor visits, and custodial care at no additional cost.
Since 2014, Medicaid’s major coverage expansions under the ACA have helped reduce the number of uninsured people. Millions have gained coverage through Medicaid – even those with pre-existing conditions!
Costs
The health insurance market is a complex system. Your choice of plan, income and benefits all play a role in how much you pay each month.
In 2019, the average monthly premium for Affordable Care Act plans ranged from $331 for a Bronze plan to $47 for Silver plans. More than 12 million Americans with ACA coverage receive advanced premium tax credits based on their income, which reduce their costs by an average of $508 each month, according to Kaiser Family Foundation data.
Marketplace-eligible adults experienced overall healthcare spending that was more than 80% higher than for Medicaid-eligible adults, though this difference disappeared when claims were adjusted according to Medicaid prices.
Subsidies
Subsidies help lower your premium payments for ACA-compliant plans on the Marketplace, including the benchmark plan — which is the second-lowest silver plan available on Exchange.
Cost-sharing reductions (CSRs) offer additional savings by decreasing deductibles, copayments and coinsurance for low income individuals who purchase health care plans. With these plans, individuals who purchase them on a regular basis could potentially save more than a third of their overall health care costs in the long run.
Furthermore, the Affordable Care Act required insurance companies to stop charging consumers excessive premiums that do not reflect actual medical costs. These regulations set limits on how much money insurers could charge for premiums.
The Affordable Care Act has also eliminated many copayments and other out-of-pocket costs for screenings and preventive services. These services help patients avoid major illnesses or diseases that could otherwise require costly, debilitating treatments in the future.
Cancelled plans
Cancelled plans can have an impact on obamacare medicaid eligibility. Examples include canceled student, employment and group policies.
States use data to assess eligibility and require enrollees to report any changes that affect their status. After reviewing the person’s coverage history, states can reevaluate whether or not they meet the eligibility requirements; if so, Medicaid or CHIP coverage will be terminated.
The continuous enrollment provision has helped maintain coverage during the COVID-19 public health emergency (PHE). Unfortunately, when PHE ends and federal funding stops flowing to states, disenrollments could resume again – potentially reversing recent gains in coverage.
