Obamacare and Medicare

Christian Worstell
In this article...
  • Learn about the differences between Obamacare vs. Medicare, as well as the relationship between the two types of health insurance. You can’t have Obamacare (the Affordable Care Act, or ACA) and Medicare at the same time, and this guide can help you determine which program is the right fit for you.

Obamacare and Medicare are two very different programs. In this guide, we look at the differences between Obamacare vs. Medicare, including who they cover and how they’re paid for. We also explore the relationship between these programs and the ways Obamacare (the Affordable Care Act, or ACA) has impacted Medicare.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Are Obamacare and Medicare the Same Thing?

Obamacare and Medicare are not at all the same thing.

  • Obamacare is a nickname for the Affordable Care Act (ACA), which is a series of health care legislation bills that went into effect in 2010, much of which remains in place today. A central part of Obamacare is a “marketplace” of private insurance plans that was created to provide health insurance options for people who lack employer-sponsored plans or other means of health insurance coverage.

  • Medicare is a federal health insurance program that took effect in 1966 and covers people aged 65 and older and some people under 65 who have a qualifying health condition or disability.

When people discuss Obamacare vs. Medicare, they are generally referring to the private under-65 health insurance plans sold on the marketplace vs. the public health insurance program that covers retirees, older adults and people with qualifying disabilities.

How Are Obamacare and Medicare Different?

There are several differences between Obamacare and Medicare.


Most people do not pay a premium for Medicare Part A, which is Medicare hospital insurance. The standard premium for Medicare Part B (medical insurance) is $174.70 per month in 2024.

Premiums for private Medicare plans like Medicare Advantage (Medicare Part C) plans and Medicare Part D prescription drug plans can vary based on a number of factors such as where you live.

By contrast, the average benchmark premium for Obamacare marketplace plans is more than $477 per month in 2024.


More than 66 million people were enrolled in Medicare in 2023, compared to around 16.4 million Americans who were enrolled in Obamacare in 2023.


While Medicare does receive some revenue by charging premiums, the bulk of the program’s funding comes from payroll taxes.

Obamacare works in a very different way: ACA Marketplace plans receive some federal funding, but the bulk of their revenue comes from premiums charged to plan members.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

How Are Obamacare and Medicare Similar?

Despite their differences, Obamacare and Medicare are similar in certain ways.


Original Medicare (Part A and Part B) has standardized benefits that are set by the federal government through the Centers for Medicare & Medicaid Services (CMS).

Private Medicare health plans such as Medicare Advantage plans have a little more flexibility in their coverage. Medicare Advantage plans cover everything that Part A and Part B cover, but they can also offer benefits Original Medicare doesn’t cover.

Obamacare plans feature coverage that must follow certain state and federal guidelines but can vary from one plan to the next.

Medicare and Obamacare are bound by many of the same federal coverage requirements, however, and they provide largely similar benefits.

Plan selection

Private Medicare plans and Obamacare Marketplace plans are similar in that plan selection can vary quite a bit by location and carrier. Your ZIP code can largely affect the plans that are available for you to enroll.

Government assistance

Both Obamacare and Medicare have assistance programs and subsidies available to help low-income beneficiaries better afford their plan premiums, deductibles, copayments and other costs associated with their coverage.

How Does Obamacare Affect Medicare?

While Obamacare and Medicare are two totally separate programs, there are a few ways in which Obamacare affects Medicare.

First and foremost, Affordable Care Act laws required health insurance companies — and Medicare — to provide coverage for a series of preventive services, screenings, tests and vaccines. Some other ways that Obamacare has influenced Medicare include:

  • Reducing Medicare beneficiaries’ prescription drug costs while in the Medicare Part D coverage gap, or “donut hole”

  • Expanding access to surgery, primary care and mental health services in underserved areas designated as health professional shortage areas (HPSAs)

  • Increasing the use of value-based payment systems where health care providers are reimbursed based on patient outcomes and not based on services rendered

  • Increasing Medicare funding by implementing an additional fee on Medicare Part B and Part D premiums for high income earners

Can You Get Obamacare If You Are on Medicare?

No. In fact, it’s illegal for anyone to sell you an Obamacare Marketplace insurance plan if they know you are enrolled in Medicare. And since you would receive mostly identical coverage on an Obamacare plan as your Medicare insurance, it would only be hurting your own wallet to pay for Obamacare.

Lastly, any premium subsidies you are receiving to help pay for your marketplace plan will be forfeited once you become eligible for premium-free Medicare Part A. However, you may qualify for a Medicare Savings Program or other programs that can help you pay for some of your Medicare costs.

Can You Keep Obamacare After Age 65?

While you cannot enroll in an Obamacare plan once you already have Medicare, you do have the option of choosing marketplace coverage after age 65 if you have delayed your Social Security benefits and haven’t enrolled in Medicare yet. Or if you have enrolled in Medicare but did not qualify for premium-free Part A, you may drop Medicare and enroll in Obamacare.

But once again, it wouldn’t make much financial sense to maintain both an Obamacare plan and Medicare at the same time.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

Read More
A couple uses their laptop computer while having coffee
This step-by-step guide can help you compare Medicare Advantage (Part C) plans to find the right type ...
A man uses his home computer while his wife looks over his shoulder
This chart comparing Medicare Supplement (Medigap) plans outlines the benefits of each of the 10 different ...
Home Health Nurse With Patient
Aetna and Cigna are among the most well-known health and Medicare insurance companies in the U.S. ...