Is Obamacare the Same As Medicaid?

While Obamacare and Medicaid are related, they’re not the same thing. Medicaid is a government-run, public health insurance program. Obamacare—officially called the Affordable Care Act, or ACA—is a federal law. Obamacare makes it easier for people to afford private health insurance, gives states the option to expand Medicaid to cover more low-income adults, and provides new ways to deliver medical care that can bring overall costs down for Americans.

So while Obamacare and Medicaid are connected, they work differently, cover different people, and come with different costs.

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How are Obamacare and Medicaid similar?#how-are-obamacare-and-medicaid-similar

Both Obamacare and Medicaid exist to make healthcare more accessible for people who might otherwise go without coverage. Both also involve private insurance companies, which surprises a lot of people. Health plans sold through the Obamacare Marketplace, also called the Health Insurance Marketplace, are offered by private insurers like Anthem, Cigna, Centene, and Molina. And most people enrolled in Medicaid are on “managed care plans” that are also run by private insurance companies that contract with the government.

The two programs can also have connected enrollment processes. While some states have their own Medicaid application portals, many use the federal Obamacare Marketplace ( Healthcare.gov) for Medicaid enrollment. If you apply for marketplace coverage and your income makes you eligible for Medicaid, your state may automatically enroll you in Medicaid instead.

How are Obamacare and Medicaid different?#how-are-obamacare-and-medicaid-different

There are four main areas of difference between Obamacare plans and Medicaid: what they are, how much you have to pay, who’s eligible, and when you can enroll,

Obamacare sets the rules that private health insurers have to follow when selling plans on the marketplace—it’s not a healthcare plan itself. Medicaid is an actual insurance program, jointly funded by each state and the federal government. It’s the largest health coverage program in the country.

When it comes to cost, Obamacare and Medicaid are very different. Medicaid is designed for people with limited income, so in most cases you won’t pay anything out-of-pocket for care. Marketplace plans following Obamacare rules typically come with several types of costs, even after financial aid:

Premium: The monthly fee you pay to keep your plan active, whether or not you use any healthcare that month. Think of it as a subscription fee.
Deductible: The amount you pay before your insurance kicks in. If your deductible is $1,000, you cover the first $1,000 of costs yourself each year before your insurance starts paying.
Copayment: A flat fee for a specific service, like $30 each time you see a doctor.
Coinsurance: Your share of a bill after your deductible is met, usually a percentage. If your coinsurance is 20%, you pay 20% of the bill and your plan covers the rest.

Obamacare subsidies are financial help that lowers your monthly premium. Obamacare offers subsidies to households with incomes between 100% and 400% of the federal poverty level.

You can’t get Obamacare subsidies if you qualify for Medicaid. Healthcare through the Obamacare Marketplace and Medicaid are meant to cover different people. If you have Medicaid coverage, you can't enroll in a marketplace plan and vice versa.

How to get Obamacare#how-to-get-obamacare

Any legal U.S. resident who isn’t incarcerated can enroll in an Obamacare health plan. You shop for plans through the federal Health Insurance Marketplace at healthcare.gov. There, you can compare options and find out if you qualify for subsidies to lower your costs.

Marketplace enrollment is only open during a set window each year. Outside of that period, you can only sign up during a special enrollment period when you have a qualifying life event, like losing your existing coverage, getting married or divorced, or having or adopting a child.

Every marketplace plan is required to cover a core set of services, no matter which insurer offers it:

Prescription drugs
Pediatric services
Preventive and wellness care, including chronic disease management
Emergency services
Hospital stays
Mental health and addiction treatment
Pregnancy, maternity, and newborn care
Ambulance and patient transport
Lab work
Rehabilitative and habilitative services and devices

How to get Medicaid#how-to-get-medicaid

Medicaid eligibility depends on where you live. Each state sets its own rules, so income limits and qualifying criteria vary. In most states, eligibility is based on a combination of income, household size, age, disability, or other factors.

Unlike marketplace plans, you can apply for Medicaid at any time throughout the year. If you're eligible, coverage can start quickly.

Obamacare gave states the option to expand Medicaid to cover adults under 65 with household incomes up to 138% of the federal poverty level, at no cost to them. As of 2026, 40 states and Washington, D.C. have adopted the expansion. But 10 states have not, and that gap has real consequences. In those states, some people earn too much to qualify for Medicaid but too little to get meaningful subsidy help through the federal marketplace, leaving them without an affordable path to coverage.

If you're not sure whether you qualify for Medicaid, you can check at healthcare.gov or contact your state's Medicaid office directly. Applying through the federal marketplace will also flag whether you're eligible.