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Is Medicare considered insurance under Obamacare?

Keep in mind...
  • Medicare is the national program of health care for older and disabled Americans
  • Medicare is a four-part government operated program serving over 46 million older residents, and nine million disabled persons
  • Medicare in some combinations meets the standards for health insurance under that Affordable Care Act
  • Some Parts of Medicare do not meet the Affordable Care Act requirements when standing alone

The Affordable Care Act set standards for health insurance. It added requirements that protect consumers by ensuring adequate coverage for today’s medical environment It set minimum standards that policies must meet in order to satisfy the individual mandate and avoid the tax penalty.

Some parts of Medicare meet the requirements of the law for quality health plans. Comparison shopping is a powerful tool for finding the best values in health insurance. Using comparison shopping techniques, consumers can put their priorities into the screening and selection process.

The Law Sets a Minimum for Protection

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The Affordable Care Act reformed health policy by placing a flexible set of requirements on all insurance policies sold on the Marketplace. The law advances the concept of minimum essential coverage, and the insurance industry was required to meet these standards, or the coverage would not avoid the uninsured tax penalty. The below-listed types of insurance meet the requirements of the Affordable Care Act.

What is Medicare?

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Medicare is the national program for health care for older Americans. It consists of four parts as enacted by the Congress. It is a massive system that offers health services and insurance coverage to disabled and older citizens. It consists of government-run programs and private insurance plans.

Funded by trust funds, Medicare provides payments for medical care and related services across the US. Workers pay Medicare taxes during their employment years and accumulate a sufficient number of covered quarters of work time.

  • Medicare Part A: Hospital Insurance is the vital protection everyone needs for serious illnesses that requires inpatient care.
  • Medicare Part B: Medical Insurance covers medical services and out-patient care. It includes the equipment and supplies needed to maintain patients in their home environments.
  • Medicare Part C: Medicare Advantage is a program of private insurance plans that meet or exceed the coverage of the Original Medicare.
  • Medicare Part D: Prescription Drug Benefits is an insurance program provided by private companies with oversight by the Centers for Medicare and Medicaid.
  • Medicare Supplement or Medigap coverage augments Medicare Part A and Part B. It can cover the unfunded gaps in Medicare Part B benefits that typically occur in the range of 20 percent or more.

The Individual Mandate

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Universal coverage was a major reform of the Affordable Care Act. Every eligible person must get insured or pay the penalty. In 2017, the uninsured tax payment is $695 for adults and up to 2.5 percent of family income. It is important to note that merely having insurance coverage is not enough.

A qualified insurance plan must meet the standards set in the Affordable Care Act for essential health benefits, limits, and no cost prevention services. In certain combinations, Medicare can meet the requirements of the ACA and satisfy the individual mandate.

Qualified Health Plans

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Qualified health plans are insurance policies sold on the federal marketplace and state exchanges. The law requires qualified health plans that contain the benefits considered important and necessary. This level of coverage is the minimum essential coverage.

Before the Affordable Care Act, many insurance companies issued policies that did not provide adequate coverage. There were tragic results such as insured persons falling into bankruptcy due to large amounts of medical debt.

The Affordable Care Act introduced more rigid standards for coverage and limitation on consumer obligations. The idea was to present the consumer with an easily understood statement of coverage and that it would include basic protections against excessive spending. The below-listed items describe the basics:

The below-listed items describe the basics:

  • A minimum actuarial value of 60 percent
  • Must contain the ten essential health benefits
  • Must have limits on consumer spending

The Affordable Care Act Strengthened Medicare

The ACA added new benefits, protections, and financial security for Medicare. It put a program in place to curtail waste. It reduced payments to Medicare Advantage providers and helped close the Donut Hole for prescription drugs. The ACA added resources for doctors treating Medicare beneficiaries and made the program more solvent.

Using Medicare to Meet the ACA Standard

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Most people with Medicare coverage will not risk the tax penalty for no insurance. The exceptions are that neither Part B: Medical Insurance nor Part D: Prescription Drugs meet the requirements when standing alone. The below-listed items describe the parts of Medicare that meet the standards for qualified insurance coverage under the Affordable Care Act; these programs provide minimum essential coverage.

  • Medicare Advantage consists of private insurance plans that provide a range of benefits similar to Original Medicare.
  • Original Medicare consists of the combination of Medicare Part A and Medicare Part B coverage.
  • Medicare Part A is the vital hospital insurance coverage. It is the heart of the Medicare system for protecting beneficiaries.

Medicare Can Qualify Under Obamacare

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Medicare is a vast system of doctors, hospitals, and other medical care providers. It encompasses services such as durable medical equipment, skilled nursing, inpatient care, and outpatient care. The Original Medicare, Medicare Part A, and Medicare Part C meet the requirements of the Affordable Care Act. Persons using any of these coverage options do not need to do anything else to avoid the penalty for no insurance.

Comparison shopping is an excellent method for finding the best values in private insurance plans offered by Medicare. Click here to start your free health insurance comparison with your zip code!

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