Millions of Americans are facing a new era of healthcare costs and eligibility hurdles, as sweeping legislative changes and rising medical expenses converge to reshape the nation’s safety net. Two major developments—the One Big Beautiful Act and a spike in Medicare premiums for 2026—are expected to touch nearly every household that relies on federal health programs, with the most vulnerable likely to feel the greatest impact.
According to reporting from SmartAsset, the One Big Beautiful Act marks the most significant overhaul of Medicaid and Affordable Care Act (ACA) regulations since their inception. The law, which slashes more than $1 trillion from Medicaid over the next decade, is projected to put up to 12 million Americans at risk of losing their coverage, especially in rural communities. These cuts are paired with a raft of new requirements: starting in late 2026, able-bodied adults aged 19 to 64 who are enrolled in Medicaid expansion programs will need to complete at least 80 hours per month of work or community engagement activities to maintain their coverage. That’s not all—biannual income verification and stricter eligibility checks are being introduced, creating more opportunities for coverage interruptions.
For those who rely on ACA marketplace plans, the ground is shifting as well. The open enrollment period will be shorter through 2027, ending on December 15 instead of stretching into the new year. Automatic re-enrollment will be eliminated in 2027, so enrollees will have to reapply and verify their eligibility every year. These changes, combined with the rollback of enhanced premium tax credits and tightened cost-sharing subsidies, could cause some marketplace premiums to spike by as much as 75% beginning in 2026. The Congressional Budget Office (CBO) projects that these provisions could lead to as many as 16 million additional uninsured individuals by 2034—a staggering figure that includes 10.9 million from direct Medicaid cuts and the expiration of enhanced premium tax credits, plus another 5.1 million from changes in marketplace policies and enrollment timing.
State-level impacts are expected to vary, but the consequences will be particularly harsh in places that expanded Medicaid. For example, SmartAsset notes that Illinois could see more than 330,000 residents lose Medicaid coverage due to the new work requirements and reduced federal funding. This could destabilize rural hospitals and local health infrastructure, which are already stretched thin.
But the changes don’t stop at Medicaid and ACA plans. According to projections from the Centers for Medicare and Medicaid Services (CMS) reported by Investopedia, Medicare Part B premiums are set to rise sharply in 2026. The new premium is estimated to be $206.50 per month, an 11.6% jump from the 2025 premium of $185—the largest increase since 2022. The annual deductible for Part B will also rise by 12%, from $257 to $288. These increases reflect a combination of factors: medical cost inflation, higher drug prices, and a growing number of people becoming eligible for Medicare. Meanwhile, the Medicare tax rate paid by current workers has remained unchanged, meaning beneficiaries themselves must shoulder more of the cost.
Medicare Part D, which covers prescription drugs, is also getting more expensive. The base beneficiary premium is expected to increase by about 6%, from $36.78 to $38.99. Deductibles will rise from $590 to $615, and the catastrophic coverage threshold—the point at which coinsurance drops to zero—will go up from $2,000 to $2,100. For those subject to the Income Related Monthly Adjustment Amount (IRMAA), fees for both Parts B and D will increase across all income tiers in 2026. Specifically, the Part B IRMAA will go up for anyone earning at least $106,000 as an individual or $212,000 as a couple, and the Part D IRMAA will range from $14.50 to $91 depending on income.
What’s behind these cost increases? Whitney Stidom, vice president of consumer enablement at eHealth, told Investopedia, “The healthcare price surge is being driven by multiple factors, including medical cost inflation, higher drug costs, and an increase in hospital and doctor visits among Medicare beneficiaries.” She advised, “For Medicare beneficiaries looking to save on healthcare costs for 2026, it is key to begin preparing now and seek expert guidance to review the various plan changes that are expected for this fall’s annual enrollment period.”
The annual Medicare enrollment period runs from October 15 through December 7, giving beneficiaries a window to switch from Original Medicare to a Medicare Advantage plan, or vice versa, and to adjust their Part D coverage. David Meyers, associate professor of health services policy and practice at Brown University School of Public Health, cautioned, “While Medicare Advantage plans advertise all these really great benefits, and some of them probably are really great, it’s worth reading the benefit guides and understanding what those benefits actually provide for you.” He recommends consulting state health insurance assistance programs (SHIP) for clear, unbiased information.
For those worried about the higher costs, there are several strategies to consider. Beneficiaries can prepare their budgets now for the higher premiums, look into Medicare Advantage plans (which may offer lower out-of-pocket costs but come with network restrictions), and explore supplemental Medigap policies to offset expenses not covered by Original Medicare. Lowering your IRMAA is another option—by managing your modified adjusted gross income, perhaps through Roth IRA conversions or qualified charitable distributions, you might reduce your future IRMAA liability. And for those with limited income and resources, the CMS’s Extra Help program can subsidize prescription drug costs, capping out-of-pocket expenses at low, fixed amounts.
As for consumers affected by the One Big Beautiful Act, SmartAsset recommends verifying ongoing eligibility, planning ahead for the 2027 rollout of the most significant changes, considering short-term or off-market plans to bridge coverage gaps, and consulting a financial advisor to navigate these complex shifts. The American Hospital Association and the Kaiser Family Foundation both warn that the new rules could lead to higher uninsured rates, increased financial strain on families, and further destabilization of healthcare providers, particularly in rural and underserved areas.
With so many moving parts, the best advice may be to stay vigilant, seek expert guidance, and review your options carefully before the next open enrollment period. The landscape of American healthcare is evolving rapidly—sometimes in ways that are hard to predict. But one thing is certain: for millions of Americans, the coming years will bring new challenges, new costs, and a need for proactive planning.
