Medicaid and the Affordable Care Act are not the same program
Medicaid is a joint federal and state program that covers low-income people of any age. The Affordable Care Act (often called Obamacare) is a 2010 law that changed how health insurance works in the United States. The law created new marketplaces where people can buy private insurance, expanded Medicaid in some states, and set rules for all health plans.
The confusion happens because the Affordable Care Act expanded Medicaid in states that chose to do so. But Medicaid itself existed long before the law passed in 2010. You can have Medicaid without the Affordable Care Act playing any role in your coverage, and you can use the Affordable Care Act marketplace to buy private insurance instead of Medicaid.
Think of it this way: the Affordable Care Act is the rulebook that changed the game. Medicaid is one of the programs that operates under those rules now, but it is a separate program with its own history, its own may be able to access rules, and its own funding.
Key Takeaways
- Medicaid is a program for low-income people that has existed since 1965; the Affordable Care Act is a 2010 law that changed health insurance rules.
- The Affordable Care Act expanded Medicaid in states that chose to participate, but Medicaid may be able to access and coverage vary by state regardless of the law.
- You can receive Medicaid without ever using the Affordable Care Act marketplace, and you can use the marketplace to buy private insurance instead of Medicaid.
- The Affordable Care Act created tax credits and subsidies that help people buy private insurance; Medicaid is a separate benefit with its own income limits.
How the Affordable Care Act changed Medicaid
The Affordable Care Act gave states the option to expand Medicaid to cover more people. In states that expanded, Medicaid now covers adults earning up to a certain income level (usually around 138% of the federal poverty line, though this varies). Before the expansion, many states only covered children, pregnant women, parents, and people with disabilities.
Not all states expanded Medicaid. As of now, some states have not taken the expansion, which means their Medicaid programs cover fewer people. If you live in a state without expansion and your income is too high for the existing Medicaid rules but too low to afford private insurance, you may fall into a coverage gap.
The Affordable Care Act also set minimum standards for what health plans must cover, how much they can charge, and what they can deny. These rules apply to private insurance sold on the marketplace and to Medicaid plans, but Medicaid itself is still a separate program with its own rules.
Medicaid versus Affordable Care Act marketplace insurance
Medicaid is a government program that pays for your medical care. You do not pay a monthly premium for Medicaid (though some states charge small copays at the doctor's office). Your income and family size determine whether you may have access to.
The Affordable Care Act marketplace is where you can buy private health insurance from companies like Blue Cross, Aetna, or regional insurers. You pay a monthly premium. If your income is low enough, you may receive a tax credit or subsidy that reduces your premium, but you are still buying private insurance, not Medicaid.
When you apply through the marketplace, the system will check whether you may have access to for Medicaid first. If you do, you will be told that Medicaid is available to you. If you do not, you can shop for private plans and see what subsidies you might receive.
What "Obamacare" actually means
"Obamacare" is a nickname for the Affordable Care Act, named after President Barack Obama, who signed it into law in 2010. The law's official name is the Patient Protection and Affordable Care Act. Some people use "Obamacare" to refer to the entire law, while others use it specifically to mean the marketplace where you buy private insurance.
The law did many things: it created the marketplace, it expanded Medicaid in participating states, it required most people to have health insurance, it set rules for what insurance must cover, and it created subsidies to help people afford coverage. Medicaid is one piece of that larger law, but it is not the whole thing.
Why people confuse the two
The Affordable Care Act and Medicaid are tangled together in practice. When you apply for coverage through the marketplace, you fill out one form that checks both Medicaid and the marketplace at the same time. The website or phone line you use might be called "Healthcare.gov" or your state's equivalent, and it handles both programs.
Media coverage often uses "Obamacare" to mean any government health coverage, which adds to the confusion. In reality, Medicaid, Medicare, and the Affordable Care Act marketplace are three separate programs with different rules, different funding, and different may be able to access requirements.
If someone tells you that you "got Obamacare," they might mean you enrolled in Medicaid, or they might mean you bought a private plan through the marketplace with a subsidy. The term is vague enough that it can mean either one.
How to know which program you are in
Your insurance card will tell you which program covers you. If it says "Medicaid" on the card, you are in Medicaid. If it says the name of a private insurance company (like Blue Cross, Aetna, Cigna, or a regional plan), you bought private insurance through the marketplace.
You can also check your account on Healthcare.gov or your state's marketplace website. It will show you whether you are enrolled in Medicaid or in a private plan. If you are in a private plan, it will also show you how much subsidy you are receiving each month.
If you are unsure, you can call your state's Medicaid office or the marketplace customer service line. They can tell you exactly what program you are in and what your coverage includes.
Frequently Asked Questions
If I have Medicaid, do I need to do anything because of the Affordable Care Act?
Medicaid rules changed in some states because of the Affordable Care Act expansion, but if you already have Medicaid, you keep your coverage. You do not need to re-enroll through the marketplace. Your state's Medicaid program will tell you if anything changes about your coverage or may be able to access.
Can I choose between Medicaid and a marketplace plan?
If you may have access to for Medicaid, most states require you to enroll in Medicaid rather than buy a private plan through the marketplace. Medicaid is usually free or very low-cost, while marketplace plans require you to pay a premium. However, rules vary by state, so check with your state's Medicaid office.
What if my state did not expand Medicaid?
If your state did not expand Medicaid and your income is too high for the existing Medicaid rules, you may still be able to buy a private plan through the marketplace and receive a subsidy to help pay the premium. The marketplace is available to everyone, regardless of whether your state expanded Medicaid.
Does Medicaid cover the same things as marketplace insurance?
Both Medicaid and marketplace plans must cover certain essential health benefits because of the Affordable Care Act, such as doctor visits, hospital care, and prescription drugs. However, Medicaid coverage details vary by state, and different marketplace plans have different networks and copays. Your specific coverage depends on which plan or program you are in.