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Medicare vs. Obamacare

Summary: Medicare and Obamacare coverage are both government-backed healthcare programs. However, they serve two different groups of people. Estimated Read Time: 5 min

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Table of Contents:

  1. Is Obamacare Medicare?
  2. How is Obamacare Different from Medicare?
  3. How Does the Affordable Care Act Affect Medicare?
  4. Which Medicare Programs are Covered by ACA Section 1557?
  5. Can I Choose Marketplace Coverage Instead of Medicare?
  6. How Do I Switch from Obamacare to Medicare?
  7. Can You Keep Obamacare After 65?
  8. Is Marketplace Coverage Creditable for Parts A and B?
  9. What happens When a Native American Has Marketplace Insurance and Becomes Eligible for Medicare?
  10. Medicare vs. Obamacare FAQs
  11. How to Get Help Going from Obamacare to Medicare

If you receive health insurance through the federal marketplace, you are familiar with Obamacare. Otherwise known as the Affordable Care Act, Obamacare made it possible for Americans to receive access to affordable health insurance.

If you currently have coverage through the Obamacare but are soon-to-be Medicare-eligible, you probably have questions about the future of your coverage. We’re here to help you navigate this change in your health care needs and avoid unexpected costs along the way.

Is Obamacare Medicare?

Obamacare plans are available through the federal health insurance marketplace, and are available to anyone in the U.S. Health plans are available to provide coverage to individuals, families, and small businesses who otherwise lack health care coverage. Individuals who qualify will receive tax breaks to help cover the premium cost for their plan making it accessible to individuals at all income levels.

Medicare, on the other hand, is a federal health insurance program in the U.S. for those age 65 and over. It also covers disabled individuals under 65 receiving SSDI benefits for 24 months or more and those diagnosed with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease.

If you are eligible for Premium-free Medicare Part A, you are no longer eligible to earn a tax credit for reduced-cost Marketplace plans. Thus, it often makes more sense to enroll in Medicare coverage once you become eligible.

Currently, an estimated 12 million people have insurance through the Marketplace. Of those insured, nearly 3.4 million people are ages 55 to 64 and nearing the Medicare eligibility age.

How is Obamacare Different from Medicare?

While both plan types are federally sponsored health insurance options, Obamacare and Medicare are not the same. Regardless of age, anyone in the United States who is looking for health insurance coverage can enroll through the Marketplace into an Obamacare plan.

With Medicare, only those who are eligible due to age or disability status can enroll in a plan. Additionally, Medicare only provides individual plans whereas the marketplace provides plans for the whole family.

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How Does the Affordable Care Act Affect Medicare?

The Health Insurance Marketplace doesn’t affect those with Medicare coverage.

If you’re currently enrolled in a Marketplace plan but are aging in or are becoming eligible for Medicare due to a disability, there are some steps you should take to ensure you do not see an increase in your monthly premiums and lose out on your Marketplace tax credits.

Once you are eligible for Medicare, you should enroll as soon as possible. This will ensure you are not left paying a late enrollment penalty or high costs for your Obamacare plan.

Once you reach Medicare eligibility, the federal government will not allow you to continue to utilize the Marketplace to find affordable coverage. If you decide to stay on your Marketplace plan once eligible for Medicare, you will be responsible for the full premium of the plan, which is often much more expensive than Original Medicare.

Which Medicare Programs are Covered by ACA Section 1557?

Section 1557 of The Affordable Care Act is the provision that prohibits discrimination in HHS-(federal) funded health care. It applies to all hospitals and providers accepting Medicare, Medicaid, Obamacare, and the Indian Health Service plans. This provision outlaw’s any type of discrimination based on age, gender, race, sexuality, national origin, or disability.

ACA Section 1557 makes it illegal to refuse care or reduce the quality of care to anyone utilizing federal health services for any reason.

Can I Choose Marketplace Coverage Instead of Medicare?

Choosing Marketplace coverage instead of Medicare is not illegal but can be a costly decision. Once you’re enrolled in Medicare Part A, you won’t be eligible for any of the savings you once received for your Marketplace plan. This means you’ll have to pay the full price for premiums each month. Also, if you delay enrollment in Medicare Part B, you’ll have to pay a lifelong penalty.

So, when it all adds up, switching from the Marketplace to Medicare once you become eligible is a no-brainer for many.

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How Do I Switch from Obamacare to Medicare?

Once you enter your Initial Enrollment Period, you can begin the process of enrolling in Medicare. Once you have enrolled, you will be given a Special Enrollment Period to leave your Marketplace plan. During this time, you will want to notify your current plan about your move to Medicare to ensure all of your lose ends are tied up before your Medicare coverage goes into effect.

You can keep your Marketplace, or Obamacare, plan until your Medicare coverage begins. Once your Marketplace plan ends, your Medicare plan will seamlessly begin covering you. This avoids a lapse in coverage.

Can You Keep Obamacare After 65?

You are able to keep your Obamacare qualified health plan after age 65 and becoming eligible for Medicare. But it’s against the law for someone to knowingly sell a Marketplace policy to someone eligible for premium-free Part A. Be aware of this, especially during the fall Open Enrollment Period each year.

Also, if you have Marketplace coverage and a federal employee tells you that you don’t need to enroll in Medicare when you’re eligible, you may qualify for equitable relief.

Americans receiving Social Security payments ahead of retirement will be automatically enrolled in Medicare. Therefore, it’s up to them to drop their coverage through Marketplace.

Is Marketplace Coverage Creditable for Parts A and B?

Marketplace coverage isn’t creditable coverage for Parts A and B because it’s not required to be as good as Original Medicare. This means that you’ll need to pay penalties after the first 12 months if you delay coverage. So it’s best to sign up during your Initial Enrollment Period or the General Enrollment Period if you miss your Initial Enrollment Period.

What happens When a Native American Has Marketplace Insurance and Becomes Eligible for Medicare?

If you have access to the Indian Health Service, it acts as a last resort and pays after all other contributions. IHS is not health insurance. If you’re a Native American or Alaska Native with a Marketplace plan and become eligible for Medicare, you should drop your Marketplace plan and sign up for Medicare.

For the most comprehensive coverage, you should pair Native American Health Insurance with Medicare. The only exception would be if you haven’t worked enough quarters and don’t get Part A premium-free.

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Medicare vs. Obamacare FAQs

If one spouse is eligible for Medicare, can the other remain on Obamacare?

If you’re eligible for Medicare and your spouse is not, or vice-versa, the other spouse can remain on Obamacare. You’ll have to end Obamacare coverage for one person, but coverage can continue for the other people in the household.

Can I enroll through the Marketplace to supplement my Medicare insurance?

No, you can’t use the Marketplace to buy supplemental coverage for your Medicare. But, you can buy a Medigap policy for extra coverage.

What changes did the Affordable Care Act make to Medicare?

The ACA helped decrease spending for prescription drugs, which ultimately closed the “donut hole” for Medicare Part D. It also helped boost Part B and Part D premium payments for beneficiaries with higher incomes.

How is Obamacare different from Medicare?

Medicare is a federal program, which receives funds from the government. The Affordable Care Act is a set of laws that govern the U.S health care industry. Additionally, Obamacare plans are sold through private insurance companies.

How to Get Help Going from Obamacare to Medicare

We know that the process of starting Medicare after years of Obamacare Marketplace coverage can be confusing.

At MedicareFAQ, our agents have extensive knowledge fo Medicare coverage and will be able to help you understand which products are best for you.

We work with several carriers and plan types, so we’re sure to find a plan that best fits your needs and keeps costs in mind at the same time. Call us at the number above or fill out our rate form. Every day, we help people find plans to fit their needs and budget. We look forward to doing the same for you.

If you are looking to buy coverage through the Health Insurance Marketplace, you should visit HealthCare.gov.

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Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

2 thoughts on "Medicare vs. Obamacare"

  1. Excelent report . I would need to contact you or somebody from your team. May I have your email or phone number? Thanks a lot . Beatriz Laino

    1. Thank you, Beatriz! To get in contact with us, you can call the number located at the top of the webpage or complete this form to be connected with an agent.

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