Is Obamacare the Same as Medicaid or Medicare?

Obamacare is neither Medicaid nor Medicare — it's a marketplace where you buy private insurance

Obamacare (officially the Affordable Care Act, or ACA) is a law that created a marketplace where individuals and families can shop for and buy private health insurance plans. Medicaid and Medicare are government-run insurance programs. The confusion happens because the ACA law also expanded Medicaid in many states, so some people use "Obamacare" to mean the whole system. But the three are separate things with different rules, different costs, and different ways you join them.

The ACA marketplace itself does not provide insurance — it is a place to compare plans and learn about you may have access to for a subsidy (a discount on your monthly premium). Medicare is for people 65 and older, regardless of income. Medicaid is for people with lower incomes, and in states that expanded it, the income limit is higher. You cannot be on all three at once, and you do not join them the same way.

Key Takeaways

Obamacare is a marketplace where you buy private insurance; Medicaid and Medicare are government programs you join through different agencies.
The ACA law expanded Medicaid in some states, which is why people sometimes confuse the terms, but they are legally separate programs.
Medicare is for people 65 and older; Medicaid is for people with lower incomes; the ACA marketplace is for anyone under 65 who wants to buy private coverage.
If you are 65 or older, you enroll in Medicare through Social Security, not through the ACA marketplace.
In states that expanded Medicaid, some people who do not may have access to for Medicare may may have access to for Medicaid instead of buying ACA marketplace insurance.

How the ACA marketplace works

The ACA marketplace (also called Healthcare.gov in most states) is an online store where you can compare private health insurance plans side by side. You enter your income, family size, and zip code, and the marketplace shows you plans from different insurance companies. If your income falls below a certain level, you may receive a subsidy — a monthly discount that reduces your premium.

You pay the insurance company directly each month, just as you would if you bought insurance from an employer or a private broker. The marketplace does not provide the insurance itself; it is the place where you find it. You must be a U.S. citizen or lawful resident, and you cannot be covered by Medicare or Medicaid at the same time you are buying ACA marketplace insurance.

How Medicaid differs from the ACA marketplace

Medicaid is a joint federal and state program that covers people with lower incomes. You do not buy Medicaid through a marketplace; instead, you explore through your state's Medicaid office or social services department. If you are found to meet your state's income and other rules, Medicaid covers you at no monthly premium — you may pay small copays when you see a doctor, but there is no monthly bill to the insurance company.

In states that expanded Medicaid under the ACA, the income limit is higher, which means more people may have access to. In states that did not expand, the income limit is lower and often applies only to parents, children, or people with disabilities. The income threshold varies by state, so whether you may have access to for Medicaid depends on where you live. If you do not may have access to for Medicaid but your income is too low to afford ACA marketplace premiums, you may receive a larger subsidy through the marketplace instead.

How Medicare differs from both

Medicare is a federal program for people 65 and older, regardless of income. You do not explore for Medicare through the ACA marketplace or through your state Medicaid office. Instead, you enroll through Social Security, either online at ssa.gov, by phone, or in person at a Social Security office. Medicare has four parts: Part A (hospital), Part B (doctor visits), Part D (prescription drugs), and Part C (an alternative private plan). Most people become may be able to access the month they turn 65.

If you are 65 or older, you cannot use the ACA marketplace to buy insurance. You must enroll in Medicare. Some people on Medicare also may have access to for Medicaid (called "dual may be able to access"), which helps pay Medicare premiums and copays, but you still enroll in Medicare through Social Security first.

When the ACA law expanded Medicaid

The Affordable Care Act included an option for states to expand their Medicaid programs to cover more people. States that chose to expand Medicaid raised the income limit so that more working adults could may have access to. This happened in some states but not others, which is why Medicaid rules are different depending on where you live.

If you live in a state that expanded Medicaid and your income is below the expansion threshold, you may may have access to for Medicaid instead of buying ACA marketplace insurance. If you live in a state that did not expand, you may not may have access to for Medicaid, but you might still receive a subsidy to buy ACA marketplace insurance. The state you live in determines which path is available to you.

Why the terms get mixed up

People often use "Obamacare" to refer to the entire system — the marketplace, the Medicaid expansion, and the law itself — rather than just the marketplace. This is understandable because the ACA law created or changed all three. But when you are trying to figure out which program you belong in, it helps to keep them separate: the marketplace is where you shop for private insurance, Medicaid is a government program for lower-income people, and Medicare is a government program for people 65 and older.

The confusion is also common because some people may have access to for more than one program. For example, a 62-year-old with a low income might may have access to for Medicaid in an expansion state, or might buy ACA marketplace insurance with a subsidy. A 67-year-old might be on Medicare and also may have access to for Medicaid. Understanding which program you are in matters because each one has different rules about which doctors you can see, which drugs are covered, and what you pay out of pocket.

How to find out which program you might use

Start by checking your age. If you are 65 or older, you enroll in Medicare through Social Security — that is your path. If you are under 65, you need to know your income and whether you live in a Medicaid expansion state. Your state's Medicaid office website will tell you the income limit for your state and whether you can explore. You can also call 211 (a free referral line) and ask whether you may have access to for Medicaid in your state.

If you do not may have access to for Medicaid or if you prefer to buy private insurance, you can visit Healthcare.gov (or your state's marketplace if your state runs its own) and enter your information. The marketplace will show you what subsidies you might receive and what plans are available. You do not have to choose right away — you can compare options before you decide which program or plan to join.

Frequently Asked Questions

Can I be on Medicaid and the ACA marketplace at the same time?

No. If you are enrolled in Medicaid, you cannot also buy insurance through the ACA marketplace. If you lose Medicaid coverage, you have 60 days to enroll in an ACA marketplace plan without waiting for open enrollment. You should contact your state Medicaid office to find out when your coverage ends so you can plan ahead.

If I am on Medicare, can I also get Medicaid?

Yes, if your income is low enough. This is called being "dual may be able to access." You enroll in Medicare first through Social Security, and then you explore for Medicaid through your state. Medicaid can help pay your Medicare premiums and copays. You explore for Medicaid the same way anyone else does — through your state's Medicaid office.

What if I do not may have access to for Medicaid but cannot afford ACA marketplace insurance?

If your income is above your state's Medicaid limit but still low, you may receive a subsidy through the ACA marketplace that makes premiums more affordable. The subsidy amount depends on your income and family size. You can also look for plans with lower monthly premiums, though they may have higher copays and deductibles.

Do I have to enroll in Medicare when I turn 65, or can I stay on ACA marketplace insurance?

You must enroll in Medicare when you turn 65. You cannot stay on ACA marketplace insurance once you are may be able to access for Medicare. If you do not enroll in Medicare Part B when you first become may be able to access, you may face a penalty on your premiums later. You should contact Social Security at least three months before you turn 65 to start the enrollment process.

How do I know if my state expanded Medicaid?

You can search your state's name plus "Medicaid expansion" online, or call your state's Medicaid office directly. You can also call 211 and ask whether your state expanded Medicaid and whether you might may have access to based on your income. The income limit for Medicaid varies widely by state, so it is worth checking even if you think you earn too much.

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.