Changes in ACA and Medicaid: What You Need to Know and How to Prepare

It’s no surprise that the Affordable Care Act (ACA) is again in the headlines, with the new presidential administration taking office in the next few weeks. Medicaid seems to also be in the same familiar spot. 

So, let's make sure we understand these two programs, who can qualify for their benefits, and what possible changes are on the horizon. Most importantly, I will identify some points for you to consider as you review your needs.

What is the Affordable Care Act (ACA)? 

The Affordable Care Act, also commonly known as ObamaCare, was signed into law in 2010 by President Barack Obama to increase healthcare coverage for more people. 

Surprisingly, many people believe that the ACA is only for poor people, but it isn’t. Anyone not qualifying for Medicare can apply for insurance coverage through ACA or the Marketplace.  

Many people with employer-based insurance find getting insurance through the ACA/Marketplace may be less expensive.

Currently, financial subsidies are available to people with qualified lower incomes. Unfortunately, many of the subsidies provided through the ACA to help with the cost of insurance will expire at the end of 2025. 

This may result in many people dropping insurance because of the costs. It is yet to be determined what the incoming presidential administration will do regarding this; however, we will continue to update you on whatever important financial information is released that might affect you.  

Who Can Enroll in a Marketplace/ACA Exchange Plan?

• US citizens

• Must reside in the US or be a legal resident (National)

• DACA legal residents

The associated costs of ACA plans include premiums, copays, deductibles, and coinsurance.

What Can You Do? 

Be aware that the future could change the Affordable Care Act and, therefore, insurance coverage. If you’re unsure what your coverage costs could be, contact your current provider. 

Take the time to be proactive about your options, such as:

• Joining your or your spouse's employer plan during open enrollment, which is usually near the end of the calendar year. 

• Review your income and see what changes might allow you to continue to realize insurance cost savings if you’re already insured through the Affordable Care Act.

  • You may have to work with a financial advisor to review income options with you, especially if you're taking income from savings or retirement programs. If you anticipate your income will drop this year, find out how that may open up insurance coverage options.

What is Medicaid?

Medicaid is a State—and Federally Funded and managed program that provides insurance based on income and family size. People can be covered under Medicaid and other insurance, such as Tricare and Medicare.

These are the four types of Medicaid Programs:

1. Traditional Medicaid: Provides coverage for doctor visits, hospital visits, and long-term care.

2. Children’s Health Insurance Program (CHIP): Provides coverage for children and families whose income is too high for traditional Medicaid but too low for private insurance.

3. Medicaid Expansion: This program, which states were optionally required to participate in, provided coverage to more low-income people.

4. Medicare Savings Programs: This program provides financial assistance to those who qualify for both Medicaid and Medicare to pay for Medicare out-of-pocket expenses.

The following are covered through Medicaid under federal regulations: 

• Inpatient and outpatient hospital services

• Physician services

• Lab and x-ray services

• Family planning services

• Early and periodic screening

• Diagnostic and treatment for children

• Nursing and facility services for eligible adults

• States may choose to offer additional benefits within the broader federal guidelines

Important Medicare and ACA Enrollment Periods

Even though some of these have passed, it’s very important to be aware of these annual enrollment periods: 

October 15th - December 7th

Medicare Open Enrollment: You can switch from original Medicare to a Medicare Advantage plan or vice versa. You can also change your Part D prescription drug plan coverage to other options. 

January 1st - March 31st

Open Enrollment for Medicare: Where you can change or drop your Medicare Advantage Plan.

General Enrollment for Medicare: You can enroll in Part A and/or Part B if you missed your initial enrollment period.

November 1st - January 15th 

Affordable Care Act or Obamacare: You can enroll in a Marketplace plan.

Conclusion 

As we enter the new year, be aware of the changes to Medicare and the ACA that may affect your coverage. Medicaid may have higher income levels as well as work requirements. 

In addition, some of the important and far-reaching benefits of The Affordable Care Act, expanded through The Inflation Reduction Act of the Biden Administration, are set to expire at the end of 2025. For more information on this topic, please watch the webinar I hosted on this subject below: 

If you have any questions or concerns, please contact one of our Financial Advocacy leads or Coaches here (go to Coach and select your disease). Or tune into our bimonthly webinars and open Q&As to keep up with the latest information that might affect your healthcare coverage and costs.

Explore our Webinars on Financial Assistance

Addition: Important Financial Information for Veterans 

Those of you who are military veterans entitled to TriCare through Veterans’ Service may also be eligible for Medicaid and or Medicare. Tricare will pay first and Medicaid second. You cannot opt out of Tricare to get benefits through Medicare or Medicaid.

Dual Coverage Tricare and Medicare: Medicare will be the first payer for services covered by Medicare and Tricare, with Tricare picking up the remaining cost of care. For services covered by Tricare but not Medicare, Tricare will pay first, and Medicare will pay nothing.  

Because Medicare has yearly changes, if you are insured under Tricare and Medicare, make sure you keep up with changes that can affect your coverage.