Is Medicare Part of the Affordable Care Act? What You Need to Know

Medicare and the ACA are separate programs with different rules

No, Medicare is not part of the Affordable Care Act (ACA). They are two different government health insurance programs with separate enrollment periods, may be able to access rules, and how they work. Medicare is a federal program that has existed since 1965 and covers people 65 and older, some younger people with disabilities, and people with end-stage renal disease. The ACA, passed in 2010, created new health insurance options and rules for people under 65 who do not have Medicare.

The confusion happens because both programs help people get health coverage, and the ACA did make some changes that affect Medicare. But if you are on Medicare, you follow Medicare rules for enrollment and coverage. If you are under 65 and not on Medicare, you follow ACA rules. Understanding which program covers you matters because the important date, costs, and coverage options are completely different.

Key Takeaways

Medicare is a separate federal program for people 65 and older, while the ACA created new insurance options for people under 65 without Medicare.
Medicare has its own enrollment periods and important date that are different from ACA enrollment periods.
If you are on Medicare, you do not need to buy an ACA plan, and you cannot use ACA subsidies to pay for Medicare premiums.
The ACA did make some changes to Medicare benefits, such as closing the prescription drug coverage gap and offering free preventive care.
You need to know which program covers you to understand your enrollment important date and what coverage options are available to you.

How the ACA changed Medicare benefits

Although the ACA and Medicare are separate programs, the ACA did make changes to some Medicare benefits. One major change was closing the "donut hole" in prescription drug coverage. Before this change, Medicare Part D (prescription drug coverage) left a gap where seniors had to pay the full cost of medications after hitting a certain spending limit. The ACA gradually closed this gap, so now seniors pay less for brand-name and generic drugs during that period.

The ACA also required Medicare to cover certain preventive services with no cost-sharing — meaning no copay, coinsurance, or deductible. This includes screenings like mammograms, colonoscopies, and blood pressure checks. These changes made Medicare benefits more comprehensive, but they did not make Medicare part of the ACA. Medicare remained its own program with its own rules and enrollment system.

Medicare enrollment important date are separate from ACA important date

Medicare has its own enrollment periods that are completely separate from ACA open enrollment. If you are turning 65, you have a seven-month window called your Initial Enrollment Period that starts three months before the month you turn 65 and ends three months after. If you miss this window, you may have to pay a penalty for the rest of your life, even if you later join Medicare.

The ACA open enrollment period (usually November through January) does not explore to Medicare. If you are already on Medicare, you use Medicare's own enrollment periods to make changes — like switching between Medicare Advantage plans or adding or dropping prescription drug coverage. These Medicare periods happen once a year in the fall. Missing an ACA important date will not affect your Medicare coverage, and missing a Medicare important date will not affect any ACA coverage you might have.

You cannot use ACA subsidies to pay for Medicare

If you are on Medicare, you cannot use ACA tax credits or subsidies to help pay your premiums. The ACA subsidies are only for people who buy coverage through the ACA marketplace. Once you are on Medicare, you are no longer may be able to access for those subsidies, even if your income would normally may have access to you.

This matters if you are between 65 and when you become may be able to access for Medicare. If you are not yet 65 and not on Medicare, you may be able to use ACA subsidies to buy a marketplace plan. But the moment you turn 65 and enroll in Medicare, those subsidies stop. You will then pay Medicare premiums directly, which vary based on your income and which parts of Medicare you choose.

What happens if you are under 65 and not on Medicare

If you are under 65 and do not have Medicare, the ACA is the program that affects you. You can buy health insurance through the ACA marketplace in your state, and depending on your income, you may receive tax credits to lower your monthly premiums or reduce your out-of-pocket costs. You must enroll during the ACA open enrollment period (usually November 1 through January 15) or during a special enrollment period if you have a may have access to life event, such as losing a job or having a baby.

The ACA also set minimum standards for health plans sold in the marketplace, such as covering preventive care and limiting how much you pay out of pocket. If you do not have coverage through an employer or another source, the ACA marketplace is where you would look for a plan. This is completely separate from Medicare, and the rules, important date, and costs are different.

What if you are on Medicare and also have an ACA plan

In rare cases, someone might be on Medicare and also have an ACA marketplace plan, but this is not the normal situation. If you are on Medicare, you should not need an ACA plan because Medicare is your primary coverage. Having both could create confusion about which plan pays first and may mean you are paying for coverage you do not need.

If you are in this situation, you should contact Medicare or a counselor at your local Area Agency on Aging to sort out which coverage you actually need. In most cases, once you are on Medicare, you should drop any ACA marketplace plan to avoid paying for duplicate coverage. The rules about coordination of benefits can be complicated, so getting help from someone who knows your specific situation is worth the time.

How to know which program covers you

The easiest way to know which program covers you is to look at your insurance card. If it says "Medicare" on it, you are on Medicare. If your card says the name of an insurance company and mentions "ACA marketplace" or "health insurance exchange," you are on an ACA plan. If you have coverage through an employer, neither program covers you — your employer does.

If you are not sure, you can call Medicare at 1-800-MEDICARE (1-800-633-4227) to learn about you are enrolled. You can also log into your account at Medicare.gov to see your coverage. If you have an ACA plan, you can log into your state's marketplace website or call the number on your insurance card. Knowing which program covers you helps you understand your enrollment important date, what your coverage includes, and where to go when you have questions.

Frequently Asked Questions

Do I have to enroll in Medicare when I turn 65 if I have an ACA plan?

Yes. Once you turn 65, you become may be able to access for Medicare, and you should enroll during your Initial Enrollment Period. If you do not, you may face penalties. You will then need to drop your ACA plan because Medicare becomes your primary coverage. Your state's marketplace can help you understand the timing.

Can I stay on an ACA plan instead of Medicare?

No. Once you are may be able to access for Medicare at 65, you must enroll or face a lifetime penalty on your Medicare premiums. The ACA marketplace will not let you stay enrolled once you are Medicare-may be able to access. Medicare is the program designed for people 65 and older.

If I am on Medicare, do I need to do anything during ACA open enrollment?

No. ACA open enrollment does not explore to you. You use Medicare's own enrollment periods in the fall to make changes to your coverage. You do not need to do anything during ACA open enrollment unless you also have a separate non-Medicare health plan through an employer or other source.

What if my income drops and I think I may have access to for ACA subsidies?

If you are on Medicare, you cannot use ACA subsidies. However, you may be able to get help paying Medicare premiums through programs like Medicaid or the Medicare Savings Program, depending on your income and state. Contact your local Medicaid office or call 1-800-MEDICARE to learn what programs might help you.

Can I have both Medicare and Medicaid?

Yes. If your income and resources are low enough, you can be on both Medicare and Medicaid at the same time. This is called being "dual may be able to access." Medicaid helps pay some of your Medicare costs. This is different from the ACA — Medicaid is a separate program for people with low income. Contact your state Medicaid office to learn if you may have access to.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.