I promised in my June newsletter to keep you informed of health insurance provisions enacted by the One Big Beautiful Bill. Here’s what made it into the final version.
Related to Medicaid:
Work requirements will be here by December 31, 2026 or sooner. Adults enrolled in Medicaid will have to report that they work at least 80 hours per month or a seasonal equivalent. There are exceptions to this requirement:
- Parents with children ages 13 and under are exempt,
- As are people deemed ‘medically frail’
- And individuals who are pregnant or postpartum.
- An important note about these work requirements is that if you lose your Medicaid coverage for failing to meet the work reporting requirements, you are also ineligible for premium tax credits for insurance through the marketplace.
- Also effective no later than December 31, 2026, Medicaid eligibility redeterminations will take place every six months instead of annually.
The bill also limits retroactive Medicaid coverage to 1-2 months instead of 3.
- It also prohibits Medicaid funds to be paid to providers of specific organizations primarily involved in family planning, but this is a very specific aspect of the bill that I’m not going to get into the details of this in this video but if you have questions let me know.
Medicare:
- Very minimal changes were made to Medicare.
Health Savings Accounts:
- Almost none of the provisions made it to the final cut, but one huge change is that all bronze plans available on the individual health insurance market would be considered HDHP plans that are compatible with Health Savings Accounts. If you’re on a bronze plan, we’ll talk about this during open enrollment.
And finally, the ACA:
- Income, immigration, family size and everything else about your household needs to be verified before coverage begins. This effectively ends autorenewals.
The bill also limits eligibility for premium tax credits for specific immigrant classes.
Moving on from the One Big Beautiful Bill, but staying on the topic of the Affordable Care Act, there are probably serious premium increases coming in 2026 for marketplace coverage. Office of the Insurance Commissioner just approved an average 21% increase in health insurance premiums. Additionally, during COVID there were two Acts implemented that temporarily enhanced federally funded premium tax credits. Those are scheduled to sunset at the end of 2025 and there is little to no indication that the federal government will extend these enhanced PTCs.
What this means for you: when open enrollment starts on November 1st, schedule an appointment with me to review your options.
