As part of our commitment to keeping you informed, today’s post focuses on a newly passed bill that could reshape Medicaid and Affordable Care Act (ACA) coverage over the next decade. While you may have seen some recent headlines about health care cuts, most of the actual changes won’t take effect until 2026.

President Trump’s recent tax and spending bill includes nearly $1 trillion in reductions to federal health programs, especially Medicaid. However, these cuts are phased in over the next 9 years, meaning many of the changes won’t be felt right away. This delayed rollout is significant—it avoids immediate disruption, but also makes it harder for families to recognize what’s coming down the road.

• • • Work Requirements: Up to 12 million people could eventually lose coverage due to new work rules, which will begin to be enforced sometime in 2026.
    • Eligibility Checks: Starting December 31, 2026, recipients will face eligibility reviews every 6 months.
    • New Cost Sharing: As of October 2028, those covered under Medicaid expansion could face up to $35 per service.
    • State-Level Funding Cuts: Medicaid provider tax relief begins to phase down in 2028, potentially impacting hospital funding and services.

• • • Enhanced Subsidies Expire Soon: ACA marketplace plans will become more expensive—premium subsidies end Jan. 1, 2026, which could cause premiums to rise over 75%.
    • Planned Parenthood Cuts: Federal Medicaid funding will stop next year, with up to 200 clinics at risk of closure.
    • Immigrant Eligibility Restrictions: Changes limiting Medicaid access for lawfully residing immigrants take effect October 2026.

Even though most changes are delayed, some hospitals and clinics are already reacting. For example, Community Hospital in McCook, Nebraska, recently announced it will close due to Medicaid uncertainty.

Lawmakers and advocacy groups are expected to push back or delay some provisions before they take effect. In the meantime, both political parties are using the bill as a talking point—so expect to hear more in the coming months.

At Emerald Medicare, we’re keeping a close eye on these developments so you don’t have to. While nothing changes today, understanding the long-term outlook helps you plan wisely and stay protected.

If you have questions about how these changes may affect your situation in the future, we’re here to help.

As your go-to team of Medicare experts, we’re committed to keeping you informed about the latest developments and trends that could impact your healthcare decisions. With 2025 on the horizon, there are key changes and trends affecting Medicare that you should be aware of. These shifts are likely to influence everything from your premiums to the cost of your care, to the benefits available under different Medicare plans. Let’s explore what you can expect from Medicare in 2025.

Rising Healthcare Costs and the Impact on Medicare

Healthcare costs to both consumers and insurance carriers continue to be a significant concern in the United States, especially for those aged 65 and older. In fact, 50% of all medical costs in the U.S. are related to prediabetic conditions, insulin care, or medications. Additionally, $1 in $5 of the Gross National Product (GNP) in America is spent on healthcare, highlighting the growing financial burden on the system and its users. With healthcare being the top concern for 63% of people aged 65 and above, making the right Medicare decisions is more crucial than ever (per seniorliving.org).

In 2025, we anticipate further adjustments to all Medicare plans to address these rising health care costs. For instance, the Inflation Reduction Act will impact Medicare Advantage benefits, cost-sharing, and Medigap premium prices, particularly affecting Part D premiums and co-pays. These changes are still being worked out and expected to be finalized by October 2024, so staying informed and connected with your Medicare broker will be essential for all Medicare beneficiaries.

Changes to Medicare Advantage (MA) Plans

As you may know, Medicare Advantage (MA) plans have come under scrutiny for deceptive marketing practices, leading to increased oversight from the Centers for Medicare & Medicaid Services (CMS). In 2025, CMS is expected to introduce new regulations aimed at improving service delivery, reducing marketing abuses, and cutting down on the number of unsolicited calls to consumers. These changes are designed to protect enrollees and ensure they receive the coverage and benefits they deserve without being misled.

One significant trend in MA plans for 2025 is the standardization and simplification of ancillary benefits. Beneficiaries can expect changes to over-the-counter benefits, the exploration of in-home benefits, non-emergency transportation, dental benefit enhancements, and even expanded mental health coverage. Additionally, gym membership benefits may be adjusted to include home-based fitness options, reflecting the growing demand for flexibility in how Americans exercise and stay fit.  

The Prescription Drug Cost Cap and New Payment Plans

Another significant change being rolled out for 2025 is the introduction of a $2,000 limit on prescription drug costs for each individual for the calendar year. This cap will provide much-needed relief to many Medicare beneficiaries who struggle with the high cost of medications. Alongside this, new payment plans for expensive medications will be introduced, making it easier for enrollees to manage their healthcare expenses over time. This development is particularly important given the rising costs of prescription drugs and the growing reliance on medications to manage chronic conditions.

Enhancements in Medicare’s Star Ratings and Family Caregiver Support

Medicare plans are rated based on feedback from real policyholders, which covers areas such as customer service and chronic condition management. In 2025, carriers are likely to focus on improving these star ratings by encouraging enrollees to take full advantage of the benefits offered under their plans. This could lead to more proactive communication and support from your plan provider, ensuring you’re getting the most out of your coverage.

Another important change on the horizon is the introduction of training for family caregivers by medical professionals. CMS recognizes the vital role that family caregivers play in the healthcare system and is planning to offer more resources to help them manage their important role in support of their loved ones.

The Role of Artificial Intelligence (AI) in Medicare

Artificial Intelligence (AI) is set to revolutionize healthcare and Medicare services in 2025. AI will enhance efficiency in various tasks, such as Part D reviews, marketing, and virtual assistance. These advancements are expected to streamline some of the administrative aspects of Medicare, making it easier for beneficiaries to find answers to their individual questions about their plans and their medications.

Special Programs and Benefits for Dual-Eligible Individuals

For individuals who are eligible for both Medicare and Medicaid, Dual-Eligible Special Needs Plans (DSNPs) will continue to offer a range of additional benefits in 2025. These plans include support for utilities assistance, extra transportation, healthy foods and wellness items, hearing aids, pet supplies, a personal care team, and more. As these benefits expand, DSNPs will become an increasingly attractive option for those who qualify.

Prepare for the Near Future with Emerald Medicare

As we look ahead to 2025, it’s clear that the landscape of Medicare is evolving in ways that will impact beneficiaries across the board. From changes in healthcare costs and prescription drug coverage to advancements in AI and enhanced support for caregivers, staying informed will be key to making the right decisions.

At Emerald Medicare, we’re here to help you navigate these changes with confidence. Our team of experts is focused on providing you with the education and guidance you need to make the best choices for your healthcare.