Obamacare vs. Medicare | What Are the Benefits and Who Do They Cover?

Medicare is the federal health insurance program for people who are 65 years or older and people younger than 65 who have a disability or qualifying medical condition.

Obamacare is another name for the Patient Protection and Affordable Care Act of 2010 (ACA). The primary goal of Obamacare is to give more Americans the ability to purchase affordable health insurance.

Couple researching in a library

What is the Health Insurance Marketplace?

Under Obamacare, private insurers sell health insurance plans with varying levels of coverage on the Health Insurance Marketplace, a service that helps people shop for and enroll in affordable health insurance.

If you are enrolled in Medicare, you cannot enroll in a private health insurance plan from the Health Insurance Marketplace.

However, if you’re currently enrolled in a health insurance plan from the marketplace and are approaching Medicare eligibility, you can drop your private insurance plan and enroll in Medicare once you are eligible.

Am I required to enroll in Medicare or can I keep my Obamacare plan?

Although you have the option to keep your private health insurance plan when you turn 65, there are several reasons you may want to consider making the switch to Medicare when you’re eligible.

  • If you fail to enroll in Medicare when you’re first eligible and decide to enroll later, you could face late enrollment penalties that increase your Medicare Part B (medical insurance) premiums and make your coverage more expensive for as long as you have Medicare Part B.

  • Although Medicare recognizes group health insurance through an employer as “creditable coverage,” it does not treat private insurance purchased on the Health Insurance Marketplace the same way.

    In other words, people who delay Medicare enrollment after age 65 because they receive health benefits through their employer typically don’t face late enrollment fees when they lose their creditable group coverage and enroll in Medicare.

People who opt to keep their private insurance plan rather than enroll in Medicare when they’re first eligible may face late enrollment fees if they decide to enroll in Medicare later.

Obamacare coverage

Plans purchased on the Health Insurance Marketplace can vary widely in benefits, coverage, and costs. However, under Obamacare, all insurance plans must provide services in the following categories:1

  • Hospitalization
  • Outpatient care
  • Preventive care
  • Maternity and newborn care
  • Emergency room services
  • Pediatric care
  • Lab tests
  • Mental and behavioral services
  • Prescription drugs
  • Services and devices to help people with chronic conditions, injuries and disabilities

The services listed above are known as “The 10 essential benefits of Obamacare.”

Obamacare also provides protections to enrollees that were not required before the passing of the 2010 legislation. For example, Obamacare requires insurance plans to cover people with pre-existing conditions and makes it illegal for health insurance companies to cancel your health insurance because you get sick.2

Although the goal of Obamacare is to make health insurance coverage more affordable for all Americans, people who qualify for Medicare could determine that Medicare is still the more affordable option.

Medicare coverage

Since Original Medicare is administered by the federal government, the benefits and coverage are standardized, meaning they’ll be the same for everyone who’s enrolled.

Original Medicare is made up of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Some examples of the types of services covered by Medicare Part A include:

  • Inpatient hospital care
  • Inpatient care in a skilled nursing facility
  • Hospice care

Examples of the types of services covered by Medicare Part B include:

  • Medically necessary doctor’s services
  • Durable medical equipment such as canes, walkers and wheelchairs
  • Outpatient care
  • Some mental health services
  • Preventive services and some other medical services

Original Medicare does not typically cover prescription drugs or routine dental, vision or hearing care.

Medicare beneficiaries who want prescription drug coverage have the option to enroll in a Medicare Prescription Drug plan (Medicare Part D) or a Medicare Advantage plan that includes coverage for prescription drugs.

Many Medicare Advantage plans also cover routine dental, vision and hearing care, none of which are covered by Original Medicare.

Learn more about your Medicare insurance plan options

A licensed insurance agent can help you explore your Medicare options and provide you with detailed information about costs, coverage and benefits of plans that are available in your area.

Speak with a licensed agent today by calling TTY Users: 711 24 hours a day, 7 days a week.

 

1 HealthCare.gov. 10 health care benefits covered in the Health Insurance Marketplace. (Aug. 22, 2013). Retrieved from www.healthcare.gov/blog/10-health-care-benefits-covered-in-the-health-insurance-marketplace.

2 HealthCare.gov. Rights and protections. Retrieved from www.healthcare.gov/health-care-law-protections/rights-and-protections.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.