I’ve heard about people taking entire two-week vacations this summer and tuning out the news. How do they do it? There’s so much happening. Sure, some of it is very far away. But there’s a lot of news that affects us here and now. Health insurance is one of those topics.
In the first few months of this year, a lot has changed for Medicare, Medicaid, and the ACA (Affordable Care Act). I’m not going to pretend to understand all the details. And, of course, whether or not you’re impacted will depend on your particular circumstances. But in case you’ve been on a beach with just a margarita and sunscreen, here are some things you’ll want to look into when you re-emerge into the real world:
Medicare is still with us, but…
Medicare provides health insurance for people age 65 and older, as well as people with disabilities, through the Social Security Administration. While the recent federal legislation mainly targeted Medicaid, it included a few changes to Medicare, including rules around eligibility, physician fees, orphan drugs, and nursing home staffing levels.
In addition, DOGE cut around 7,000 employees from the Social Security Administration. That means less people to serve the public. Fewer employees mean longer waits and slower service.
Medicaid is going to be a lot harder to come by
A lot of changes were made to Medicaid, and they’ll affect individuals as well as states. Medicaid is the joint federal/state program that helps cover medical costs for people with limited income and resources. Eligibility requirements and benefits vary from state to state because of how states have implemented the program.
Medicaid has been significantly revamped by the recent federal legislation. The biggest changes that will impact individuals are added work requirements, more frequent eligibility checks, and a narrower definition of who qualifies for coverage.
If you or someone you know is currently enrolled in Medicaid, or thinks they might qualify, you’ll want to study up on the changes. The new work and eligibility requirements will become effective later in 2026 or in 2027.
If you don’t have insurance through an employer, prepare for sticker shock
If you get your insurance through an ACA marketplace, like I have since I started working for myself, premiums for those plans are expected to increase significantly. That’s because subsidies are set to expire at the end of 2025.
It used to be that most working-aged people got health insurance through their jobs. But the job market has changed with the rise of the gig economy. Consider young adults who are just starting out: More than 30 percent of 18- to 29-year-olds surveyed said they worked short-term, part-time, or irregular jobs.
The end of ACA subsidies is expected to increase the number of uninsured. It will also make it harder for people to make the decision to leave a job that provides insurance.
How to get help
I recently took a free online class on Medicare (because, as I mentioned in the last newsletter, I’m getting close to “that age”). One thing I learned is that many states have trained volunteers who work as health insurance navigators. As insurance decisions have become increasingly complex, it’s valuable to get help from someone who knows what’s going on.
You can get free information and assistance through WAhealthplanfinder.org. If you live in another state, check for a similar program. There are healthcare insurance specialists who can help you navigate the website and compare available plans to your existing plan. Your Arrivity planner can make a recommendation.
Wise, informed insurance decisions are a fundamental part of a solid financial plan. Talk to your Arrivity financial planner to discuss your specific situation. Whether you have healthcare coverage through your employer, need private insurance through ACA marketplace, or are going onto Medicare, it’s important to stay informed.
Things you need to know as you approach a change in medical coverage and Medicare eligibility:
- If you are on a private plan, review your state’s ACA marketplace to review insurance costs for 2026. Don’t be caught by surprise.
- Understand your A, B, and Ds – Learn about the different parts of Medicare, what they cost, and the benefits they provide.
- Mark your calendar – You will not be enrolled in Medicare automatically. Plan to sign up within 3 months of your 65th birthday.
- Mind the gap – Medicare doesn’t cover everything. You’ll want to learn about Medigap and Medicare Advantage so you can choose a plan that meets your needs.
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Liz is a Late Boomer in the sandwich generation who started an independent writing and brand consulting practice after years as a senior marketing executive. She lives in Seattle, Washington. Her mother lives nearby and her daughter is a recent college graduate.
The foregoing content reflects the opinions or perspective of Liz Behlke and/or Arrivity financial planners and is subject to change at any time without notice. Content provided herein is for informational purposes only and should not be used or construed as investment advice or a recommendation regarding the purchase or sale of any security. There is no guarantee that the statements, opinions or forecasts provided herein will prove to be correct. Past performance may not be indicative of future results. Indices are not available for direct investment. Any investor who attempts to mimic the performance of an index would incur fees and expenses which would reduce returns Securities investing involves risk, including the potential for loss of principal. There is no assurance that any investment plan or strategy will be successful. Arrivity does not give tax or legal advice. Tax and/or legal strategies should be discussed with a professional before implementing.