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How is ObamaCare different from Medicaid?
Often confused for one another are Obamacare and Medicaid. While the two share various similarities, they vary greatly in many regards.
On a general basis, Obamacare, or the Affordable Care Act, aims to provide affordable health coverage to all Americans. On the other hand, Medicaid provides coverage for those in need that cannot afford coverage otherwise.
Read on for more details about the two government-funded programs.
Obamacare/Affordable Care Act
What many may not initially recognize is that Obamacare is a synonymous nickname for the Affordable Care Act (ACA).
There are 10 main sections of the ACA designed to help patients have access to affordable benefits. These sections include:
- Quality, Affordable Healthcare for All Americans
- The Role of Public Programs
- Improving the Quality and Efficiency of Healthcare
- Prevention of Chronic Disease and Improving Public Health
- The Difference between the ACA and Obamacare
- Healthcare Workforce
- Transparency and Program Integrity
- Improving Access to Innovative Medical Therapies
- Community Living and Assistance Services and Supports Act (CLASS Act)
- Revenue Provisions
- Reauthorization of the Indian Healthcare Improvement Act
From these 10 sections came the 10 essential benefits that are included in minimum essential coverage. Designed so every American has access to healthcare. These benefits include:
- Prescription drug coverage
- Pediatric services
- Preventative, wellness services, and chronic disease management
- Emergency services
- Hospital-stay coverage
- Mental health and addiction services
- Pregnancy, maternity, and newborn care
- Ambulance patient services
- Laboratory services
- Rehabilitative and habilitative services and devices
Obamacare was designed to provide basic coverage for all Americans.
Before Obamacare, those with pre-existing conditions could be refused coverage or charged more for their plan. Obamacare ensures that insurance companies allow those with pre-existing conditions to receive the same care as those without.
The most critical difference between Medicaid and Obamacare is that Obamacare health plans are offered by private health insurance companies whereas Medicaid is a government program.
Medicaid is a government-funded health insurance program that provides health coverage for low-income Americans. In its simplest form, Medicaid is a social welfare program similar to SNAP benefits (food stamps).
A notable difference between the two programs is that in most cases, it’s significantly more difficult to obtain Medicaid than Obamacare coverage. As long as you’re a legal resident of the United States, you are entitled access to purchase ACA-compliant health coverage at an affordable rate.
The criteria to qualify for Medicaid varies depending on the state. It was initially intended for all states to require free Medicaid to all legal residents with incomes up to 138% of the federal poverty level. That being said, a Supreme Court ruling made it optional for states to comply with this requirement of ACA.
Another key difference between these two is the variation in their enrollment periods.
Eligible Americans are able to enroll in Medicaid anytime throughout the year. On the other hand, Obamacare enrollment is only open during the specified annual open enrollment period. That being said, there may be some special circumstances that may allow eligible enrollees to register at varying dates if they meet one of the following criteria: loss of insurance, change of marital status, the birth or adoption of a child, etc.
In most cases, Medicaid requires little or even no payments by means of copayments, deductibles, etc. Being that it is intended for those with limited income and subsidized by the government, requiring significant payments from enrollees would defeat the overall purpose of the program.
On the other hand, Obamacare plans are often coupled with significant payments from beneficiaries to receive care.
If you have questions about coverage options or are looking for an affordable coverage solution, reach out to our team of benefits experts at SBMA Benefits. Our team specializes in affordable ACA-compliant benefits and is available to support your acquisition of health coverage.