It’s not too early to review your insurance plan, especially if you receive coverage through an insurance marketplace or Medicaid. 

The president’s new budget and tax law is expected to affect Medicaid and insurance marketplaces established by the Affordable Care Act. The nearly 2,000-page law will increase the federal deficit and decrease funding for Medicaid and other social safety net programs, according to the nonpartisan Congressional Budget Office. 

The severity of the changes will depend on how the federal government and individual states implement the law’s provisions.   

Another factor that could affect the law’s impact: Congress could change some elements of the law before they go into effect.  

Medicaid

If you or a family member receive insurance through Medicaid, take steps now to prepare. Make sure your state Medicaid agency has your correct contact information. Respond promptly to administrative requests related to your eligibility or coverage renewal.  

Note: Many states don’t include the term Medicaid in their Medicaid programs’ names. Make sure you know whether your health insurance coverage is provided through Medicaid.  

Most changes to Medicaid are set to begin by the start of 2027. The new law calls for increased work requirements and requires states to re-evaluate enrollees’ Medicaid eligibility every six months. These changes would apply primarily to people covered by Medicaid expansion: those whose income is no more than 138% of the federal poverty level ($21,597 for a single person in 2025) who aren’t elderly, pregnant, disabled or a caretaker of children or people with disabilities.  

Others who can request work exceptions include people with chronic illness, guardians of children under age 13, and caretakers and guardians of people with disabilities. However, the department of Health and Human Services hasn’t yet released an official definition of chronic illness in relation to the new law. 

Insurance marketplace 

The new law and related regulations include changes to the Affordable Care Act insurance marketplaces that take effect at the end of 2025. The biggest change is a likely increase in monthly premium costs, unless Congress extends the current enhanced premium tax credits, which are set to expire at the end of the year.  

Other changes to ACA marketplace insurance create barriers for enrolling in and renewing plans. Those changes include shorter open enrollment windows and limits on the “auto-renewal” option for existing enrollees. Everyone will have to proactively re-enroll.  

If you are enrolled and want to keep your marketplace insurance coverage, plan ahead so you’re ready when open enrollment begins Nov. 1: 

• Keep an eye on your state’s marketplace website for information about the new law and details that might apply to your existing plan. 
• Gather the information you’ll need to verify eligibility during open enrollment. 

Even if you’re happy with your current plan, it’s best to compare plans when open enrollment begins.  

For more information, email PHA’s Treatment Access program or call 240-485-0758.