Choosing Between Obamacare and Medicaid
What is Obamacare?
Obamacare is another name for the Affordable Care Act (ACA). The Affordable Care Act is a set of laws established in 2012 to help individuals afford private health insurance. These laws cover several aspects of private health insurances and government assistance. Some of these laws include encouraged state expansions of medical assistance, the requirement of big businesses to offer health care plans for employees, and fines for citizens who don’t obtain health coverage.
The term Obamacare usually refers to healthcare plans obtained through the ACA’s Health Insurance Exchange, or marketplace, on the website Healthcare.gov. Healthcare.gov is run by the federal government to make obtaining health insurance possible for all American citizens. Each health insurance policy offered by the Marketplace is required to provide a minimum set of necessary health benefits.
Government subsidies are available through the Marketplace. When you obtain your health insurance through Healthcare.gov, you can apply to see if you qualify for assistance to pay your premiums. Government subsidies work like getting a discount on your health insurance. The discount can only be used through the Marketplace or a similar state-run exchange. These subsidies are sent directly from the federal government to your health insurance provider.
What is Medicaid?
This program is a government run assistance program to provide health care for very low-income citizens. Eligibility requirements vary from state to state, and the program is free to those who qualify. The program is considered a social welfare program and the qualification requirements are extremely strict. Eligible citizens usually fall into the following groups
- Pregnant mothers- Depending on your current insurance situation and financial needs, the program will either supplement your health insurance or pay for all of your pregnancy care.
- Children under 18- Low-income families can usually get full or partial coverage for all children in the household.
- People with disabilities- Certain disabilities that render citizens unable to provide their own income meet coverage qualifications.
- Low-income citizens- Even if you don’t fit the other qualifications, you might be able to get coverage if you are in a low-income situation.
These services are paid directly by the government, and a health insurance card or paper voucher will be sent to you in the mail.
Decide Which Insurance Is Best for You
Comparing the two programs is difficult because they often cover different groups of people. Eligibility is the main factor to determine whether you really have a choice. If you are an American citizen who is not eligible for Medicare, you can purchase health insurance through the Marketplace. Whether you get a government subsidy depends on your income. Medicaid standards are very strict and vary from state to state. It’s important to note that there are some other differences between the two programs.
- You have a limited time to enroll for Obamacare each year. Open enrollment begins November first and runs through the middle of December. You cannot get insurance through the Marketplace after the beginning of the year without special circumstances that suddenly change your insurance needs. You can enroll in social welfare programs at any time.
- Government subsidies in Marketplace plans only cover monthly premiums. Co-pays and deductibles must be met by the policyholder. Medicaid is designed for very low-income individuals, so co-pays are very minimal or non-existent.
- Obamacare can’t be combined with Medicare, while government programs work together to provide full coverage.
The original plan for the Affordable Care Act was to provide an option for health care coverage for all Americans. However, a Supreme Court decision allowed each state to provide guidelines for Medicaid coverage. Some states chose not to expand coverage, creating a gap. If your income is below the level required for the Marketplace, and you don’t qualify for other assistance, you will get an exemption. People with an exemption don’t have to pay a fee, but they are responsible for paying for their own healthcare costs. If you are not covered by either program, it is important to check for local assistance in the form of health departments, free clinics, and charity programs. Some drug companies offer discounts to people unable to afford their prescriptions as well.
Who can Help
If you don’t know how to make the best decision for your health care, there are resources available to help you. If you are interested in applying for Medicaid, your local branch of the Department of Social Services is the best place to go. If you aren’t eligible, the social worker should be able to explain your options or direct you to the right organization. You can also go directly to Healthcare.gov to find out more information. If you don’t feel confident to work through the process alone, you can make an open enrollment appointment to have a local navigator help you through the application.
Healthcare coverage is a tricky situation divided between multiple agencies. Your health is important. Learning the facts about today’s healthcare system can help you avoid paying enormous medical bills in the future.