Here is what you’ll find in this week’s newsletter!

1. Important links 🔗 - the best articles we found this week about the Medicare Market along with links to Jared’s recent LinkedIn posts.

2. Deep Dive 📚 - One Big Beautiful Bill Act

3. Sponsor Snapshot 🚀 - brought to you by Medicare Market Insights +

4. Compliance Chatter 📢 - Several new regulations to review!

It’s only a 5 minute read, but it will make you 10x smarter.

DEEP DIVE 📚

One Big Beautiful Bill Act

This week we are going to look at the One Big Beautiful Bill Act, signed into law by President Trump on July 4, 2025. 

As the name implies, it’s a big bill 😊! But don’t worry, we are going to summarize what you need to know and how Medicare will be impacted.

First, what is the One Big Beautiful Bill Act (OBBBA)?

The OBBBA is a reconciliation bill that includes legislation from congressional committees to increase or decrease deficits and spending for federal programs and increase the statutory debt limit. This bill touches everything from tax relief/reform, nutrition, educational loans, investment in rural America, and the armed services, to most importantly (at least for us), health insurance.

Provisions of the bill impact Medicaid, ACA, Health Savings Accounts (HSA), and Medicare.

Our focus is Medicare, so let’s dig in!

How will the One Big Beautiful Bill Act impact Medicare?

Eligibility Requirements

The OBBBA creates new guidelines that to be eligible for Medicare, an individual must be:

1. a citizen or national of the United States;

2. an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act;

3. an alien who has been granted the status of Cuban and Haitian entrant; or

4. an individual who lawfully resides in the United States

Over the next year, the Commissioner of Social Security will review and identify individuals receiving Medicare benefits who do not meet the new requirements and will notify these individuals that Medicare benefits will terminate beginning 18 months after the enactment of the legislation (January 2027).

Medicare Savings Programs (MSPs)

MSPs are federally funded programs managed by the states that help individuals with limited income and resources cover Medicare premiums, deductibles, and coinsurance.

OBBBA places a moratorium until September 30, 2034 on the implementation, administration, and enforcement of certain provisions within CMS Final Rule 88 Fed. Reg. 65230, which aim to simplify the process for eligible individuals to enroll and retain their eligibility in MSPs.

Physician Fee Schedule

The OBBBA increases the Medicare Physician Fee Schedule by 2.5% for services furnished on or after January 1, 2026, and before January 1, 2027.

“Orphan” Prescription Drugs

Prior to the OBBBA, orphan drugs were excluded from the Inflation Reduction Act’s price negotiations and defined as a “drug designated for only one rare disease or condition and the approved indication (or indications) is for such disease or condition.”

The OBBBA modifies the orphan drug exclusion to include drugs designated and indicated for “one or more rare diseases or conditions.”

The amount of time a drug was previously classified as an orphan drug will not count towards the 7- or 11-year timeframe required for the drug to be eligible for selection.

These changes apply to the initial price applicability years beginning January 1, 2028.

Medicare Spending

Assuming Congress takes no further action, the increase in the deficit due to the OBBBA would trigger mandatory Medicare spending cuts under the Statutory Pay-As-You-Go Act of 2010. These cuts would total approximately $490 billion to Medicare between 2027–2034, according to the Congressional Budget Office.

Dual-Eligible Individuals

The OBBBA includes provisions impacting Medicaid, including stricter eligibility checks, work requirements for some Medicaid beneficiaries, and limitations on Medicaid spending.

If Medicaid benefits are reduced or removed, low-income individuals enrolled in both Medicaid and Medicare could struggle to afford health care.

Additional health care impacts relevant to Medicare population:

Rural Health Facility funding

The OBBBA appropriates CMS $10 billion each year from 2026 to 2030 to allot the states to transform rural health.

These funds will be used to improve:

1. access to hospitals, health care providers and services in rural areas;

2. health care outcomes;

3. provider recruitment and training;

4. long-term financial solvency and operating models;

5. data and technology solutions to improve care; and

6. local and regional partnerships between rural hospitals and other health care providers

Long-Term Care Facility Staffing

The OBBBA places a moratorium until September 30, 2034, on the implementation, administration, and enforcement of CMS Final Rule 89 Fed. Reg. 40876 establishing minimum staffing standards that nursing homes must meet under the Medicare and Medicaid programs. The staffing standards were set to be implemented in parts between May 2026 and May 2027.

That’s all we have today. If watching and tracking Medicare legislation is your thing, check out Insurance Regulatory Insights, our monthly newsletter focusing on insurance regulatory action.

If you’re ready, here are some ways we can help you:

• Newsletter Sponsorship opportunities: Promote your product or services to leaders in the Medicare space. Let’s discuss. (link)

• Market Research: Reports that help you wrap your arms around the Senior focused insurance markets. (link)

• Consulting: We can help you develop new insurance products for the Medicare market, appraise your books of business, and keep you compliant. Let’s discuss. (link)