Introduction

Obtaining health care coverage is often an overwhelming and complicated topic - this article aims to reduce the burden of figuring it out on your own. We’ll break down some of what’s happening to Medicaid and ACA Marketplace Plans in plain language. While this does not include every single detail of the bill, we’ve highlighted the changes most likely to impact your coverage, followed by steps you can take to protect it. If you or your family relies on any of these health care programs, awareness is the first step to action.

One Big Beautiful Bill Act: What it Means

Last month, the One Big Beautiful Bill Act (OBBBA) passed through the Republican House majority. Today, it is being discussed in the Senate. If the bill passes through the Senate as is, the White House claims that this bill will “revitalize the U.S. economy." However, many health experts and non-partisan groups warn that it will become harder for low-income families to keep their healthcare coverage. If enacted, we will see changes starting as soon as 2026.

Medicaid 

You’ll need to reapply more often. States will have to review enrollee eligibility every 6 months, starting December 2026. You may need to prove your eligibility every time, so it would be helpful to keep all of your documentation in one spot. That may look like keeping your paystubs, bank statements, tax returns, birth certificates, and any relevant information (depending on your state requirements) in a folder somewhere safe. 

New work requirements are coming. Starting December 2026, the bill will impose a national work requirement for certain adults between the ages of 19 to 64 to work, volunteer, or participate in a work program for at least 80 hours a month. Unless you fit within certain exemptions, you will need to fulfill this requirement for at least 1 month before enrolling to qualify for Medicaid. 

Depending on your state, there will be higher costs for some enrollees. Under this new bill, states would be required to charge Medicaid enrollees with incomes at or above 100% of the Federal Poverty Level (FPL) for certain healthcare services. Total fees cannot exceed 5% of an enrollee’s yearly household income. However, if an enrollee is unable to pay those costs and is seeking non-emergency care, healthcare providers would be able to refuse them service. These changes would begin by 2029. 

Below are two tables showing how much an enrollee would be expected to pay based on their household and income, Table 1 at 100% and Table 2 at 138% of the Federal Poverty Level. 138% is used by most states to determine Medicaid eligibility. These examples show yearly costs for families at different income levels. A single person earning $15,650/year could pay $783/year for care under this new bill.

ACA Marketplace

If you buy insurance through healthcare.gov or your state Marketplace, your monthly premiums are likely to go up. This is because the bill does not extend the premium tax credits, which are set to expire this year. Premium tax credits (PTC) are responsible for making Marketplace insurance more affordable and accessible by covering a portion of your insurance premium costs. Costs previously covered by PTCs will now fall on the enrollee, meaning higher monthly premiums for you. 

The annual open enrollment period will be shortened and will no longer have two separate deadlines. Previously, the open enrollment period ran from November 1 to January 1, with one deadline on December 15 and another on January 15. Under the new bill, the enrollment period will only run from November 1 to December 15. Make sure to mark your calendars and set reminders or alarms. If you miss the deadline, you will lose coverage.

What Can I Do Right Now? Focus on These Things

Here’s what you need to know and how to protect your healthcare and food benefits. These steps will help make it easier for you to find your information when you need it. 

1. Pay Attention to Mail. Save ALL documents.

Your state will be mailing out notices with more detailed information. Automatic enrollment will end for Marketplace enrollees, who will need to manually reverify their eligibility (the notices will specify when). Medicaid enrollees will also need to reverify more frequently. Save all documents.

2. Collect these documents. Put them in one spot.

• Paystubs

• Utility bills 

• Tax returns

• Proof of U.S. Citizenship or lawful presence

• Documentation for any other income (ex. self-employment income)

3. Mark your Calendar for your Renewal Date

If you miss the deadline, you may lose your health coverage. 

• Medicaid: Renewal date depends on when you enrolled.

• Marketplace: Open Enrollment (November 1 to December 15).

You can contact your state’s Medicaid agency directly, by phone, online, or in person, to find out exactly when your renewal date is. Contact information is readily available here—you just need to input your state: https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip

Lost Coverage? 

If you’ve lost Marketplace or Medicaid coverage, there are resources available.

Contact Medicaid

• Contact your state’s Medicaid office to understand why you lost coverage and what your options are. You may be able to appeal the decision or reapply. 

• Follow this link and input your state to find your local Medicaid contact: https://www.medicaid.gov/about-us/contact-us

Contact Marketplace

• Contact the Marketplace directly or talk to a local assistant. They can help walk you through your options. https://www.healthcare.gov/contact-us/ 

Medical Care and Prescriptions

• Community Health Centers offer free or sliding-scale doctors, prescriptions, and mental health care. Find one near you: https://findahealthcenter.hrsa.gov/. 

• Clinics listed on FreeClinics.com offer services for a free or reduced rate. Costs to patients are calculated based on income.

Call 211 for Resources

• 211 is a National Helpline that connects people to health and human resources and information (healthcare, food, paying bills). There may be resources available to you that you might not be aware of.

What’s Next? Staying Ahead of Changes

Right now, there’s still a lot we don’t know. Lawmakers are debating the Big Beautiful Bill, and if it passes, each state will handle these changes differently. Some states may fight, and others may adopt them quickly. Regardless, no one should have to navigate this alone. Even with uncertainty, being prepared gives you power. We’ll keep working to get you clear and accurate information, so you can focus on what matters most: Your health and your family.

Written by: Nina Zavala

Additional Reading

Medicaid Questions?

https://www.medicare.gov/basics/costs/help/medicaid

Explanation of Premium Tax Credits (PTC)

https://turbotax.intuit.com/tax-tips/health-care/what-is-the-premium-tax-credit/L6gAHB5ld

Understanding Marketplace “Silverloading”
https://www.brookings.edu/articles/understanding-marketplace-silver-loading/

Explanation of the Work Requirements

https://www.urban.org/urban-wire/reconciliation-bill-would-deny-medicaid-coverage-many-working-people#:~:text=Beginning%20in%20December%202026%2C%20adults,Affordable%20Care%20Act's%20Medicaid%20expansion.

Fact Sheet: One Big Beautiful Bill Act by American Hospital Association

https://www.aha.org/fact-sheets/2025-06-05-fact-sheet-one-big-beautiful-bill-act-would-significantly-reduce-availability-coverage-health-insurance