Medicare changes in the bill passed on July 4,2025

 Although most health insurance discussions about the reconciliation law passed on July 4, 2025 are about Medicaid, there are significant impacts to Medicare and the Affordable Care that will diminish those programs.  Most of the impacts are difficult to understand, maybe intentionally, but I'll try to describe some of the Medicare impacts so that you can rant and rage to your elected officials about the broken promises of the current administration.

1. In 2023, Centers for Medicare/Medicaid (CMS) issued an order to make it easier for newly Medicare eligible low income people to automatically get help with the cost of Medicare.  The new enrollees currently must apply for those programs separately from enrolling into Medicare to get the benefits and many do not know assistance programs even exist.  The new rules were to go into effect in 2026 (because enrollment systems needed to be enhanced).  This bill stops that initiative and postpones any implementation of it until 2035.  

2. Medicare/Medicaid eligible recipients who reside in nursing homes have consistently encountered "understaffing" in the nursing homes, causing them to have a low quality of care.  Again, in 2023, an order was issued to focus on increasing staffing as part of licensing a nursing facility.  Those staffing regulations have been suspended.  Also, Medicare/Medicaid people will be less able to "age in place" in their residence because there are cut backs in those programs.

3. Lawfully present immigrants who paid payroll taxes for Medicare, will NOT be eligible for enrollment into Medicare even though they paid into the system.

4. This is complex.  There is something called "PAYGO" that relates to the overall cost of Medicare, if it runs a deficit in a given year.  It almost always happens.  Usually the deficit Medicare runs is added to the national debt (I am grossly simplifying this).  If that isn't done, then the Medicare healthcare coverage has to be reduced.  For example, the "free screenings" in Medicare might no longer be "free".

5. Stand alone part D drug plan premium increases and availability of part D plans are at risk.  We already saw some of it in 2025. Prior to 2025, the choices for a part D plan in a given zip code were around 30 plans.  This year it dropped to about 11 plans.  More importantly, the premiums for the plans increased in 2025 but there was a cap on how much premiums could increase and it was no more than $35.  There appears to be no premium increase cap after this year so there is no knowing what part D premiums will look like in 2026.  

The Affordable Care Act insurance has been hit hard too. The subsidies are drastically reduced and the insurance companies are already talking about how the premiums for ACA policies are going up more than 25% in 2026. Many policy holders won't be able to afford the insurance.

Medicare Advantage Horror Story

 Most articles I read about pros and cons on Medicare Advantage plans do not go into "what ifs".  Here's a "what if" that is hair raising:

A person who was seemingly healthy, had a Medicare Advantage plan (notice, I said "had).  They went to visit a grown child in another state.  Unfortunately, they had a severe medical emergency shortly after arriving in that state and were admitted to the hospital.  It was kidney failure. 

Once the person was stabilized and put onto dialysis, the "emergency' was over.  Unfortunately, as soon as it was no longer an emergency, the Medicare Advantage plan also stopped providing medical insurance because the person was not in their home state, and the MA plan is not obligated to provide "national insurance" coverage.  However, the person was too sick to be transported home.  Since they could not be immediately transported back to their home state when the emergency hit, there was also no medical coverage for transporting the very sick person back home.

The only thing the person could do was flip out of the Medicare Advantage plan and flip into Original Medicare (OM), which is possible because Medicare eligible people who are hospitalized get a "Special Enrollment" that allows them to do it. The person was also able to get a medigap, but only the most expensive one which was $400/mo. Also, the OM coverage only became effective the first of the next month, and the MA plan is refusing to cover the hospital days until the end of the month so the person has thousands of dollars of medical expenses to try to force the MA plan to pay by going through an very onerous appeals process.

The person is now "stuck" in another state until they are healthy enough to be able to travel back home.