Both Medicare and Medicaid serve as the backbone of health care coverage in the United States, Medicare for people over 65 and certain individuals with disabilities, and Medicaid for low-income populations. As of this year, the programs cover more than 138 million people. The adjustments arriving in 2026 are expected to affect access, affordability, and the stability of coverage for a wide portion of the population.
Introduced through legislation known as the One Big Beautiful Bill (OBBB), the new policies are already generating debate among health care professionals, lawmakers, and public policy experts. According to reporting from Newsweek, many experts warn the upcoming changes could result in millions losing health insurance or facing new barriers to care.
Medicaid Restructuring Targets Eligibility and Funding
Under the OBBB, Medicaid will undergo an extensive restructuring that includes an estimated $1 trillion in funding cuts. According to the digital publisher, the legislation reduces the federal match rate for the 40 states that expanded Medicaid under the Affordable Care Act (ACA), forcing states to cover a greater share of the program’s cost. This change will primarily impact adults earning less than $21,000 per year who qualified through ACA expansion.
Julie Donohue, chair of health policy and management at the University of Pittsburgh, explained that approximately 10 million low-income Americans are expected to lose insurance coverage due to the changes, citing 15 provisions in the law that either restrict eligibility or reduce federal funding. In addition, the Congressional Budget Office (CBO) has forecast that at least 1.3 million people will become uninsured in 2026 alone.
Alongside funding cuts, the bill introduces new eligibility requirements. Most adults aged 19 to 65 must complete 80 hours per month of verified work or community engagement activities, such as volunteering, education, or employment, to maintain coverage. Exceptions apply for pregnant individuals, those with disabilities, or individuals caring for young children.
States are expected to begin enforcing these rules by January 2027, but recipients will be required to track their work hours starting as early as fall 2026. According to Paul Shafer, co-director of the Medicaid Policy Lab at Boston University, many recipients may lose coverage simply due to the administrative burden of proving eligibility. Shafer added that those most vulnerable, such as individuals with unstable housing or limited digital access, will be disproportionately affected.
Medicare Changes Raise Out-of-Pocket Costs and Reduce Options
Medicare will also see cost-related changes in 2026, notably an increase in premiums, deductibles, and coinsurance for Part A and Part B plans. According to Allison Hoffman, a professor of health policy at the University of Pennsylvania, Part B premiums will rise by about 10 percent, translating to roughly $18 more per month for most enrollees. For retirees on fixed incomes, she notes, even small increases can be difficult to manage.
Although some Medicare Part D drug plans will raise prices, others are staying level or decreasing. The Inflation Reduction Act, passed under the Biden administration, will bring new price controls on 25 commonly used prescription drugs, including treatments for diabetes, asthma, and cancer. While Hoffman acknowledged these changes may offer some savings, she said they will be modest for most recipients.
Telehealth access, widely expanded during the COVID-19 pandemic, is also set to change. National flexibilities allowing remote health services are scheduled to expire after January 30, 2026. For rural residents or those with mobility challenges, this could mean a return to in-person care as the only option.
Meanwhile, six states, New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington, will pilot a new Medicare model that includes prior authorization and AI-based review systems for certain services. While the model does not alter existing coverage criteria, Hoffman warned that it could lead to care delays and more denials, similar to concerns raised about the Medicare Advantage program.
Hoffman also noted a projected decline in the number of available private Medicare Advantage and drug plans in some regions, potentially forcing recipients to switch plans or accept higher premiums and reduced benefits.
