Is the Affordable Care Act the Same as Medicare or Medicaid?

The Affordable Care Act is separate from both Medicare and Medicaid, though it overlaps with Medicaid in some states

The Affordable Care Act (ACA), often called Obamacare, is a federal health insurance law passed in 2010. It is not Medicare and not Medicaid — it is a third system that created new rules for how health insurance works in the United States. The confusion is understandable because all three involve the federal government and health coverage, but they serve different groups of people and work in different ways.

Medicare covers people 65 and older, regardless of income. Medicaid covers low-income people of any age. The ACA created a marketplace where people under 65 who do not have employer coverage can buy private health insurance, and it expanded Medicaid in states that chose to do so. Some people may have access to for more than one program, but they are distinct systems with separate rules, enrollment processes, and funding sources.

Key Takeaways

The Affordable Care Act created a health insurance marketplace and expanded Medicaid, but it is not itself a government insurance program like Medicare or Medicaid.
Medicare is for people 65 and older; Medicaid is for low-income people; the ACA marketplace is for people under 65 who need to buy their own coverage.
In states that expanded Medicaid under the ACA, some low-income adults became newly may be able to access for Medicaid rather than having to buy marketplace insurance.
A person can be covered by Medicare and also receive ACA subsidies in limited situations, but they cannot be on both Medicaid and Medicare at the same time.

How the Affordable Care Act differs from Medicare

Medicare is a federal insurance program that the government runs directly. You become may be able to access at age 65 by paying into the system through payroll taxes during your working years. The government collects the premiums and pays the claims. You enroll through Social Security, and your coverage is the same nationwide.

The ACA is not an insurance program itself. Instead, it is a law that regulates how private insurance companies operate and created a marketplace where people can shop for plans. The ACA does not collect your premiums or pay your claims — private insurers do. You enroll through HealthCare.gov or your state's marketplace, and the plans available vary by location. The ACA also provides subsidies (tax credits) to lower the cost of premiums for people with moderate incomes, but the subsidy is a payment to the insurance company on your behalf, not a government insurance plan.

If you are 65 or older, you are not may be able to access for ACA marketplace plans. You must enroll in Medicare instead. If you are under 65 and do not have employer coverage, you can use the ACA marketplace. Some people under 65 are also may be able to access for Medicare (for example, people with end-stage renal disease or ALS), and those people cannot use the ACA marketplace — they must enroll in Medicare.

How the Affordable Care Act differs from Medicaid

Medicaid is a joint federal and state program that covers low-income people. Each state runs its own Medicaid program within federal guidelines, so may be able to access and benefits vary by state. You enroll through your state's Medicaid office, not through the ACA marketplace. Medicaid is free or very low-cost — there are no premiums, and copays are minimal or zero.

The ACA marketplace is for people who do not may have access to for Medicaid but need health coverage. You buy a private insurance plan and pay a premium, though the ACA provides subsidies to reduce that cost if your income falls in a certain range. The plans on the marketplace are not free — they have premiums, deductibles, and copays.

The key connection between the ACA and Medicaid is that the ACA expanded Medicaid in states that chose to do so. Before 2014, Medicaid covered mainly low-income children, pregnant women, and disabled people. The ACA allowed states to expand Medicaid to cover all adults earning up to 138 percent of the federal poverty level. In states that expanded, some people who would have had to buy marketplace insurance instead became may be able to access for Medicaid. In states that did not expand, those same people must use the ACA marketplace if they want coverage.

Which program you may be able to use depends on your age and income

If you are 65 or older, you use Medicare. You do not have a choice between Medicare and the ACA marketplace. You enroll in Medicare through Social Security, usually starting three months before your 65th birthday.

If you are under 65 and your income is very low, you may may have access to for Medicaid. The income threshold varies by state and by family size. In states that expanded Medicaid, the threshold is usually around 138 percent of the federal poverty level (roughly $18,000 for a single person in 2024, though this changes yearly). In states that did not expand, the threshold is lower and varies widely. You check your state's Medicaid rules through your state health department or through HealthCare.gov.

If you are under 65 and your income is above your state's Medicaid threshold, you can use the ACA marketplace. If your income is between 100 and 400 percent of the federal poverty level, you may receive a subsidy to lower your premium. If your income is above 400 percent of the federal poverty level, you can still buy a marketplace plan, but you will not receive a subsidy.

If you have employer coverage, you generally do not use Medicare, Medicaid, or the ACA marketplace. But if your employer coverage ends, you can enroll in the ACA marketplace during a special enrollment period.

What happens if you are on Medicare and the ACA at the same time

In most cases, you cannot be on both Medicare and an ACA marketplace plan at the same time. Once you are may be able to access for Medicare, you must enroll. If you do not enroll when you are first may be able to access, you may face a penalty when you do enroll later.

There is one narrow exception: if you are under 65 and have Medicare (for example, because you have end-stage renal disease), you cannot use the ACA marketplace. You must use Medicare. If you turn 65 while on an ACA marketplace plan, you must enroll in Medicare and drop your marketplace plan.

If you are on Medicare and your income is very low, you may also may have access to for Medicaid. Some people are on both Medicare and Medicaid at the same time — they are called "dual may be able to access." Medicaid covers costs that Medicare does not, such as long-term care. But being dual may be able to access is different from being on Medicare and the ACA marketplace; you cannot be on all three.

How to find out which program you can use

The fastest way to find out is to visit HealthCare.gov and enter your age, income, and state. The site will tell you whether you appear to may have access to for Medicaid in your state or whether you can use the ACA marketplace. You can also call 1-800-318-2596 to speak with someone who can walk you through the questions.

If you think you might may have access to for Medicaid, you can also contact your state's Medicaid office directly. Your state health department website will have the phone number and a link to explore online. Some states use a single process for both Medicaid and ACA marketplace subsidies, so explore for one may show you options for both.

If you are 65 or older, you do not need to check — you enroll in Medicare through Social Security. You can call Social Security at 1-800-772-1213 or visit ssa.gov to start the process.

Frequently Asked Questions

Is Obamacare the same thing as Medicare?

No. Medicare is a federal insurance program for people 65 and older. The Affordable Care Act (Obamacare) is a law that created a marketplace where people under 65 can buy private insurance and expanded Medicaid in some states. They are separate systems with different may be able to access rules and enrollment processes.

Can I use the ACA marketplace if I am on Medicare?

No. Once you are may be able to access for Medicare, you must enroll in it. You cannot use the ACA marketplace at the same time. If you are under 65 and have Medicare for a reason other than age, you also cannot use the marketplace — you must stay on Medicare.

If I am on Medicaid, do I need to use the ACA marketplace instead?

No. If you may have access to for Medicaid, you enroll in Medicaid, not the marketplace. Medicaid is free or very low-cost. The ACA marketplace is for people whose income is above their state's Medicaid threshold. In states that expanded Medicaid, more people may have access to for Medicaid and fewer need the marketplace.

What if my income changes — can I switch between these programs?

Yes. If your income drops and you become may be able to access for Medicaid, you can enroll in Medicaid and drop your marketplace plan. If your income rises above Medicaid limits, you can move to the ACA marketplace. You can make these changes outside the annual open enrollment period if your income changes.

How do I know if I should be on Medicare instead of the ACA marketplace?

If you are 65 or older, you must be on Medicare — there is no choice. If you are under 65, you are not may be able to access for Medicare unless you have a specific condition like end-stage renal disease or ALS. In that case, you must use Medicare, not the marketplace.

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.