07/08/2025
Lately, I’ve heard from many clients worried about what’s happening in Washington and what it means for their health coverage. There’s a lot of buzz (and confusion) about the “Big Beautiful Bill” that just passed. Here’s how the bill actually affects ACA plans, Medicaid, and Medicare:
ACA (Affordable Care Act) Changes
· Open enrollment will now end December 15 instead of January 15. If you don’t have coverage be sure to start the process early.
· Auto enrollment is going away. So even if you have coverage you’ll have to reapply each year.
· Like Medicare, ACA plans will now require that applicants be U.S. citizens or legal residents for at least 5 consecutive years.
· The enhanced premium tax credits (the bigger discounts that many received from 2022–2025) will not be renewed. Starting in 2026, premiums will now be capped at 9.8% of your income, instead of 8.5%. Additionally, if you make more than 400% of the Federal Poverty Level (FPL), you’ll no longer qualify for help with premiums (this is how it was before 2022).
· Premium discounts won’t apply unless you document your eligibility up front.
Medicaid Changes
· The funding formula for Medicaid has changed. The federal government will now cover 80% of Medicaid costs (down from 90%). The states will pick up the remaining 20%.
· States can still tax healthcare providers to fund Medicaid, but the federal match will decrease gradually to 3.5%.
· States using Medicaid funds for undocumented or non-qualified residents will lose their federal match.
· Adults who are able-bodied, childless, and under retirement age must put in 80 hours a month of work, job training, or volunteer service to remain eligible.
· Coverage is being eliminated for non-citizens (legal or illegal).
· States must regularly confirm eligibility. Those whose financial situation improves may lose Medicaid unless they prove they still qualify.
Medicare Changes
· U.S. citizenship is now required to qualify for Medicare. Previously, legal residents could qualify after 5 years. Under OBBBA, only U.S. citizens are eligible. If you’re currently on Medicare as a legal resident, you’ll need to complete naturalization to stay on the program.
· More small or rural facilities can now be designated as “Rural Emergency Hospitals”, which helps bring Part A services closer to under-served areas.
· Medicare’s spending limit has been reduced by 4%. If Medicare overspends, a sequestration process kicks in. This could mean reduced payments to providers, which may impact services.
Do you have questions or concerns about these changes? Call/text me at 214.771.8545, message me through this page, or email me at [email protected].
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