Is Obamacare Different from Medicare?


Navigating the complex world of healthcare in the United States can be challenging, especially with the multitude of programs and options available. Two key healthcare programs that often cause confusion are Obamacare and Medicare. While both aim to improve access to healthcare and reduce the financial burden on individuals, they serve different purposes and cater to different populations.

In this blog, we’ll determine the distinctions between Obamacare and Medicare to help you better understand these essential components of the American healthcare system.

What is Obamacare?

Obamacare, formally called the Patient Protection and Affordable Care Act (ACA), was enacted by President Barack Obama in 2010. This landmark legislation sought to address several critical issues in the American healthcare system.

  • Affordability – At the core of Obamacare is the mission to make healthcare more affordable and accessible. It introduced provisions to regulate insurance premiums, offer subsidies based on income, and expand Medicaid eligibility in some states. These measures aimed to reduce the financial burden on individuals and families when seeking medical care or purchasing health insurance.
  • Health Insurance Marketplace – One of its central features is the Health Insurance Marketplace. This online platform allows individuals and families to shop for health insurance plans that comply with ACA regulations. The marketplace is designed to promote transparency, enabling consumers to compare different plans, their costs, and coverage benefits.
  • Essential Health Benefits – It mandates that health insurance plans offered through the marketplace cover a set of essential health benefits. These include preventive services, prescription drugs, maternity care, mental health and substance use disorder (SUD) services, as well as pediatric care. Furthermore, the ACA made it illegal for all insurance companies to deny coverage and charge higher premiums based on pre-existing conditions.
  • Individual Mandate – Though it was later repealed, it initially included an individual mandate, requiring most Americans to have health insurance coverage or face a penalty. This was intended to encourage broad participation in the insurance pool, spreading the risk and keeping premiums lower.
  • Expansion of Medicaid – Perhaps one of the most significant aspects of it was the expansion of Medicaid in many states. This allowed low-income individuals and families who fell below a certain income threshold to access Medicaid coverage, providing a safety net for those who might have otherwise gone without insurance.

What’s the Difference between Obamacare and Medicare?


1. Target Population


This primarily targets individuals under the age of 65 who do not have access to employer-sponsored health insurance. It is designed for a broad demographic, including self-employed individuals, those working for small businesses without health coverage, and people who have lost their jobs or need individual and family insurance.


Medicare, on the other hand, primarily serves Americans aged 65 and older. It also includes certain younger individuals with disabilities, amyotrophic lateral sclerosis (ALS), or end-stage renal disease (ESRD). Essentially, it caters to the senior and disabled populations.

2. Funding and Financing


The funding for Obamacare comes from various sources, including individual and employer premiums, government subsidies, and penalties collected from individuals who did not comply with the now-repealed individual mandate. The federal government administers and regulates the Health Insurance Marketplace, where individuals purchase insurance plans that comply with ACA regulations.


Medicare is primarily funded through payroll taxes paid by employees and employers during their working years. The federal government oversees Medicare and ensures that beneficiaries receive their entitled coverage through various parts, such as Part A and Part B. Beneficiaries may also pay premiums for certain parts, depending on their circumstances.

3. Coverage and Benefits


These plans offered through the Health Insurance Marketplace cover essential health benefits. As mentioned earlier, these benefits include prescription drugs, preventive services, mental health and substance use disorder services, pediatric care, maternity care, and more. 


Medicare provides coverage under different parts, with each addressing specific healthcare needs. Part A offers hospital insurance, while Part B covers medical services. Medicare Part C, known as Medicare Advantage, is an excellent alternative to Original Medicare and often includes prescription drug coverage. 

Medicare Part D is a standalone prescription drug plan. Unlike Obamacare, Medicare does not include a mandate for insurance companies to cover specific essential health benefits.

4. Enrollment and Application


Enrollment in Obamacare plans typically occurs during the annual Open Enrollment Period. Special Enrollment Periods are available for individuals experiencing qualifying life events such as marriage, having a child, or loss of other coverage. Applicants can access the Health Insurance Marketplace through the official website or via certified brokers and navigators.


Medicare has specific enrollment periods based on individual circumstances. Initial Enrollment occurs when individuals first become eligible, with subsequent opportunities during the Annual Enrollment Period and Special Enrollment Periods. Medicare is administered by a federal agency under the Department of Health and Human Services called the Centers for Medicare & Medicaid Services (CMS), and individuals can apply through the Social Security Administration’s website or local offices.

Can You Have Both Obamacare and Medicare?

In most cases, you cannot have both Obamacare and Medicare simultaneously. Medicare is typically for individuals aged 65 and older or those with certain disabilities, while Obamacare is designed for individuals under 65. However, there are specific scenarios and exceptions:

  • If you already have Medicare, it’s usually not possible to purchase a Marketplace plan. An exception exists if you have Medicare Part A but must pay premiums.
  • If you’re eligible for Medicare but not enrolled, you can enroll in a Marketplace plan. However, this may result in late penalties when you do enroll in Medicare.
  • If you have a Marketplace plan and later become eligible for Medicare, consider canceling your Marketplace coverage to coincide with your Medicare coverage.
  • Individuals with End-Stage Renal Disease (ESRD) may qualify for a Marketplace plan if they don’t already have Medicare Part A or Part B.


The choice of having both Medicare and Obamacare should be carefully considered, taking into account individual circumstances and eligibility criteria. It’s important to understand the rules and regulations governing dual coverage and, if needed, seek guidance from healthcare advisors or insurance experts to make the best decisions for your specific healthcare needs.

For those seeking assistance with Medicare Part D, Medicare Advantage, and Medicare Supplement Plans, AHG Brokers is here to help. Our experienced team specializes in navigating the complexities of Medicare, ensuring you have the right coverage for your needs. Don’t hesitate to reach out to us for expert guidance and personalized solutions. Contact us today!

Would You Like Us To Review Your Policies?

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at Alliance Health Group is here and ready to make the process as painless as possible. We look forward to meeting you!