Is Medicare part of the Affordable Care Act?
Asked by: Miss Madelynn Funk | Last update: October 31, 2025Score: 4.6/5 (54 votes)
Does the Affordable Care Act include Medicare?
In keeping with the goal of improving the quality of care and eliminating waste without reducing benefits, the ACA has many provisions designed to improve and strengthen Medicare. Even if you don't currently receive Medicare benefits, you're still affected by changes to Medicare because your tax dollars fund them.
Can you have Medicare and ACA at the same time?
While you don't have to drop your ACA health insurance to enroll in Medicare, most people do. For those who qualify for premium-free Medicare Part A, your marketplace insurance premium subsidies end after you're eligible for Part A at age 65.
What is not included in the Affordable Care Act?
What Benefits Does the Affordable Care Act Not Cover? The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.
What is included in the Affordable Care Act?
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
Affordable Care Act or Medicare?
What are the 10 essential health benefits under the Affordable Care Act?
- Ambulatory patient services (outpatient services)
- Emergency services.
- Hospitalization.
- Maternity and newborn care.
- Mental health and substance use disorder services, including behavioral health treatment.
- Prescription drugs.
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.
What is the maximum out-of-pocket for the Affordable Care Act?
For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,450 for an individual and $18,900 for a family. For the 2025 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,200 for an individual and $18,400 for a family.
How do I know if I have the Affordable Care Act?
Check for Premium Tax Credits and Cost-Sharing Reductions
If you receive automatic financial help to pay for your coverage, you probably have an Obamacare plan. The ACA lets plan members apply for two types of assistance: premium tax credits and cost-sharing reductions.
Does the Affordable Care Act cover surgery?
10 covered benefits:
Hospitalization (like surgery and overnight stays) Pregnancy and newborn care (both before and after birth) Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy. Prescription drugs.
Can people over 65 get Obamacare?
Yes, in general, people age 65 or older who are not entitled to premium-free Medicare can purchase health insurance coverage in the Marketplace (except undocumented immigrants).
Who is not eligible for Medicare at age 65?
Medicare Part A Based on Age for People Who Must Pay a Premium. People who must pay a premium for Part A do not automatically get Medicare when they turn 65.
What are the top 5 medicare supplement plans?
💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.
Do I automatically get Medicare when I turn 65?
You'll get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) automatically when you turn 65. You'll still need to make important decisions about your coverage, like whether you need to add drug coverage.
Do I need health insurance if I have Medicare?
Why would I need more health insurance if I have Medicare? It's important to understand that Original Medicare, Part A and Part B, doesn't include most prescription drug coverage. If you'd like Medicare prescription drug coverage, you can get it from a private health insurance company that contracts with Medicare.
Do I qualify for Affordable Care Act subsidy?
Who is eligible for an ACA subsidy? Subsidy eligibility is based on income (ACA-specific MAGI). To qualify for a subsidy, a household must have an income of at least 100% of the federal poverty level (or above 138% of the federal poverty level in states that have expanded Medicaid).
What is the highest income to qualify for ACA?
In 2025, you'll typically be eligible for ACA subsidies if you earn between $15,060 and $60,240 as a single person. A family of four is eligible with a household income between $31,200 and $124,800.
Does everyone have Affordable Care Act?
Most people who live in the U.S. are eligible for healthcare insurance coverage under Obamacare. However, there are exceptions. You are not eligible for Obamacare if: You do not live in the U.S.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.
Who is not eligible for Obamacare?
Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.
Do prescriptions count towards out-of-pocket maximum?
The amounts you pay for prescription drugs covered by your plan would count towards your out-of-pocket maximum. If you purchase a prescription that is not covered by your plan for whatever reason (it's not on the plan's formulary, it's considered experimental, etc.), it would not count.
How much is Obamacare a month for a single person?
Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.
Does Medicare cover 100% of hospital bills?
Whether you're new to Original Medicare or have been enrolled for some time, understanding the limitations of your coverage is important as you navigate decisions about your healthcare. One of the main reasons why Original Medicare doesn't cover 100% of your medical bills is because it operates on a cost-sharing model.
Is Medicare free at age 65?
Medicare Part A (hospital insurance)
You're eligible for Part A at no cost at age 65 if 1 of the following applies: • You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB).
What are the four types of Medicare?
- Part A provides inpatient/hospital coverage.
- Part B provides outpatient/medical coverage.
- Part C offers an alternate way to receive your Medicare benefits (see below for more information).
- Part D provides prescription drug coverage.