Current Healthcare Issues Facing the United States

Do you understand how health care occurs over your lifetime?  Here is a short summary.

Healthcare is expensive in America, and the cost is only expected to rise. As we don’t have a single-payer system in which the government covers all healthcare costs, responsibility falls on a combination of entities.

Generally, healthcare costs are paid via:

• <18 years—a combination of the child’s parents’ employer-sponsored healthcare plan and their parents.
• 18–25 years—a combination of one of the child’s parent’s employer-sponsored healthcare plans and their parents’ income, or the young adult’s own employee-sponsored health insurance plan combined with their income.
• 25–65 years—if single, a combination of your salary, savings, and your employer-sponsored healthcare plan.

If married, a combination of each salary, savings, and one of your employer’s sponsored plans.

• >65 years—    if single, a combination of your savings, pension, and social security

If married, a combination of your and your spouse’s savings, pensions, and social security. Younger spouses may still be on an employer-sponsored plan.

Even with health insurance, the cost of healthcare is astronomical.

According to research from Synchrony, the average insured American with an employer-sponsored health insurance plan can now expect to spend more than $320,000 (including insurance premiums and out-of-pocket costs) during his/her/their adult lifetime. For Americans who purchase their own insurance, this number may be more than double.

There is much more to health care than this. Read on.

What happens if you are poor or unable to pay? Here are some of the answers.

As is evident above, our current healthcare system’s functionality depends on the majority of the country being employed. This design is unsustainable and inadequate for many reasons.

What if you lose your job or your company doesn’t offer health insurance? Even if you find a new job, companies often do not start benefits until at least 30 days of employment. What if you have a major health event before that time? What if you become disabled and can’t work?

Even with insurance, healthcare is often still cost-prohibitive. The minimum wage has not increased in many states over many years, yet the cost of living continues to soar. The cost of healthcare is so high that people may feel they must choose between their financial and physical health.

The answer our country has chosen is called safety net programs. This is the next section.

To help people with incomes below a certain threshold (explained in more detail below), the federal and state governments implement safety net programs.

SNAP, MEDICAID, MEDICARE, and the Affordable Care Act (ACA) are the major programs in the US. Future sections will explain in more detail how these assistance programs work.

Simple explanation of each:

• SNAP — Food assistance for very poor individuals and families, generally with gross monthly income up to 138% of the federal poverty level (FPL).
• CHIP – A program for children’s health coverage for poor families.
• MEDICAID — Help with medical benefits for very poor individuals with income up to 138% of the FPL.
• MEDICARE — Help for medical benefits during retirement.
• ACA — Helps more people to qualify for medical help, medical insurance, and extended coverage.

Federal Poverty Level Limitations

The Federal Poverty Level (FPL) is the common name for the federal poverty guidelines issued each year in the Federal Register. The FPL is an economic measure determined by the Department of Health and Human Services (HHS) used to determine whether an individual’s or a family’s income qualifies them for certain federal benefits and programs. The FPL is the same for the entire continental US even though the cost of living varies wildly across the country.

If the guidelines were adjusted to account for cost-of-living differences, we would see drastic changes in the percentage, number, and distribution of families that are considered poor. Since they are not, many people who truly need medical assistance are unable to access it.

You can typically qualify for safety net programs by earning less than 138% of the FPL; however, there may be some other stipulations mandated by the state. The amount provided by these programs will not be sufficient in many parts of the country to completely cover your healthcare costs.

These safety net programs are explained in the following sections.

People need to eat. What if you can’t afford food. This program helps in this area.

The Supplemental Nutrition Assistance Program, or SNAP is a government program administered by the US Department of Agriculture, but benefits are distributed through the states.

SNAP (food stamps) provides children with access to more nutritious food, can help them do better in school, and increases the likelihood of graduating, while also potentially making families eligible for other benefits like free school meals and reduced-cost phone and internet services. SNAP benefits, delivered via an Electronic Benefit Transfer (EBT) card, are determined by a household’s size, income, and certain expenses. SNAP aims to help extremely poor adults.

How it helps:

Food and Health

• Nutritious food: SNAP helps families buy healthy food, which is crucial for a child’s growth and development.
• Reduced food insecurity: Children in families receiving SNAP benefits are less likely to experience food insecurity, which can have a negative impact on their health and well-being.
• Improved health: Research shows children who receive SNAP benefits are healthier, and their families are less likely to skip necessary healthcare to afford food.

Education and Future

• Better school performance: Access to adequate nutrition helps improve children’s memory, social skills, and emotional stability, all of which are important for academic success.
• Increased graduation rates: Studies show children who receive SNAP benefits are more likely to graduate from high school.
• Poverty reduction: SNAP benefits can keep families out of poverty and help them pay for other essential items like rent or utilities.

Other program benefits

• Free school meals: If a household is eligible for SNAP, the children are automatically eligible for free school meals.
• Other programs: SNAP eligibility can make it easier to apply for and get other benefits, such as free cell phone service, reduced-cost internet, and utility assistance.
• Adults: Adults can qualify with roughly the same standards.

Obviously, this program helps. How does it function? Read on.

How do you qualify?  Here is your answer.

Eligibility is based on the financial situation of all household members. Everyone who lives together and purchases and prepares food together is considered a member of the same household group. Some household expenses are taken into account when determining your benefit amount. For more information, visit your state’s SNAP website.

Under federal rules, to be eligible for SNAP benefits a household’s income and resources must meet three tests, though income and asset limits are higher for households that are categorically eligible for SNAP, and most states have raised income and asset limits using broad-based categorical eligibility.

Gross monthly income — that is, household income before any of the program’s deductions are applied — generally must be at or below 130% of the poverty line. For a family of three, the poverty line used to calculate SNAP benefits in the federal fiscal year 2026 is $2,221 a month. Thus, 130% of the poverty line for a three-person family is $2,888 a month, or about $34,656 a year. The poverty level is higher for bigger families and lower for smaller families.

Net income, or household income after deductions are applied, must be at or below the poverty line.

Assets must fall below certain limits: households without a member who is aged 60 or older or has a disability must have assets of $3,000 or less; households with such a member must have assets of $4,500 or less.

How many people use SNAP?  Could some people temporarily need SNAP?

Approximately 42 million American citizens, or about one in eight people, are enrolled in SNAP. This number has fluctuated, with participation increasing during the COVID-19 pandemic and remaining high due to factors like inflation and economic conditions.

This figure represents about 1 in every 8 people in the country.

Key statistics about the participants:

• Nearly 90% of SNAP recipients are native-born American citizens; with naturalized citizens included, the percentage of participants who are US citizens is around 96%.
• About 62% of recipients are in families with children.
• Roughly 39% of participants are children under 18.
• Around 20% of participants are adults over the age of 60.

Now you know. These families need this help. Some are just temporary in need due a sudden financial crisis.

Are there cuts in this program? 

Major changes to SNAP took effect on November 1, 2025, primarily expanding work requirements for able-bodied adults without dependents (ABAWDs) as part of the One Big Beautiful Bill Act of 2025. If you become unemployed, you lose SNAP benefits.

These new rules, which have varying state implementation timelines, require more recipients to work, volunteer, or participate in training programs for at least 80 hours per month to continue receiving full benefits beyond a three-month limit within a three-year period. This is a cut in benefits.

Key Changes Effective February 1, 2026

The following changes to the ABAWD criteria went into effect, meaning individuals in these groups are now subject to the work time limit unless another exemption applies:

• Expanded Age Limit: The upper age limit for work requirements increased from 54 to 64.
• Narrowed Child Caregiver Exemption: The exemption for parents or caregivers of dependent children now only applies if the child in the household is under the age of 14 (previously under 18).
• Removed Exemptions: Previous automatic exemptions for the following groups were eliminated:

• Individuals experiencing homelessness
• Veterans of any US military branch
• Young adults under age 25 who aged out of the foster care system (previously exempt until age 25)
• New Exemptions: A new exemption was added for individuals identified as “an Indian,” “Urban Indian,” or “California Indian” as defined in the Indian Healthcare Improvement Act.

Separately, in November 2025, there was a temporary funding crisis and a federal government shutdown that led the USDA to initially instruct states to issue only partial SNAP benefits (some states were told to reduce benefits by 50%, later revised to 35%). There were special reserves for this situation. The federal government didn’t use them.

Following a federal court ruling that required the USDA to release 100% of the funds, the full November SNAP benefits were ultimately issued to eligible households across all states. The USDA instructed states not to count November 2025 as a “countable month” toward the three-month time limit for time-limited participants due to the uncertainty and disruption.

For specific details on how these changes affect you, please contact your state’s SNAP website or a local support organization.

These cuts really hurt. Unfortunately, they are not the only cuts.

Do you need health care for your children? CHIP is a safety net in this area. Read on. Maybe this will help you or a friend. Learn about cuts in this program.

The Children’s Health Insurance Program (CHIP) is a joint federal-state program providing low-cost or free health coverage to uninsured children (up to age 19) and some pregnant women in families earning too much for Medicaid but too little for private insurance. It offers comprehensive benefits, including check-ups, doctor visits, hospital care, and dental/vision services.

Key Aspects of CHIP:

• Eligibility: Based on income (varies by state, often up to 400% of the Federal Poverty Level) and residency.
• Cost: Often free or low-cost, with some options for full-cost premiums in higher-income brackets.
• Coverage: Includes routine check-ups, immunizations, doctor visits, prescriptions, dental, vision, and emergency services.
• Enrollment: Open year-round; not limited to specific enrollment periods.

Synonyms and Related Terms:

• State Children’s Health Insurance Program (SCHIP): The original name, still used interchangeably.
• Medical Assistance (MA) for Kids: Often used in conjunction with Medicaid.
• CHIP/Medicaid Managed Care Organization (MCO): The insurance plans that administer the benefits.
• Children’s Health Coverage: A general term for these services.

Usage Examples & Benefits:

• Uninsured Due to Job Loss: Helps bridge coverage when parents lose jobs or insurance, or if work insurance is too expensive.
• Preventive Care: Covers regular check-ups, vaccinations, and screenings to keep children healthy.
• Dental and Vision: Covers dental exams, cleanings, fillings, and glasses.
• Chronic Illness Care: Covers management for conditions like asthma or diabetes.
• Emergency & Hospitalization: Covers emergency room visits, surgery, and hospital stays. 

The Children’s Health Insurance Program (CHIP) is a federal and state-funded initiative that provides health insurance to children and, in some states, pregnant women. It is specifically designed for families who earn too much to qualify for Medicaid but cannot afford private insurance.

Core Eligibility Requirements

While each state sets its own specific rules, general requirements include:

• Age: Children must typically be under 19 years old.
• Status: Must be a U.S. citizen or a qualified non-citizen.
• Residency: Applicants must be residents of the state where they are applying.
• Insurance Status: The child must be currently uninsured and ineligible for Medicaid.
• Income: Eligibility is based on household size and income (calculated as Modified Adjusted Gross Income).

Coverage and Benefits

All states are required to provide a comprehensive set of benefits, including: 

• Routine Care: Well-child visits, immunizations, and regular check-ups.
• Specialized Services: Dental and vision care, mental health services, and substance abuse treatment.
• Medical Needs: Emergency services, hospital care (inpatient and outpatient), laboratory tests, X-rays, and prescriptions.

The cost of CHIP depends on your income level. Many families receive coverage for free, while others pay a monthly premium and small co-pays for certain services. Federal law caps total out-of-pocket costs at 5% of a family’s annual income. 

How to Apply

You can apply for CHIP at any time of the year; there is no specific open enrollment period.

• Online: Use the InsureKidsNow.gov locator or apply through the HealthCare.gov Marketplace.
• Phone: Call 1-877-KIDS-NOW (1-877-543-7669) to be connected with your state’s program.
• Automatic Screening: When you apply for Medicaid, your state agency will automatically check if your children qualify for CHIP if they are over the Medicaid income limit. 

The One Big Beautiful Bill Act (OBBBA) significantly impacts the Children’s Health Insurance Program (CHIP) and Medicaid by introducing over $1 trillion in federal funding cuts, leading to an estimated loss of coverage for over 10.5 million people by 2034. Key changes include tighter eligibility, work requirements, and increased re-verification, resulting in reduced benefits.

Impacts on the CHIP/Medicaid Program:

• Eligibility and Enrollment Reductions: The bill mandates stricter, more frequent (every 6 months) eligibility checks for Medicaid and CHIP, reducing the number of people covered.
• Reduced Funding and Enhanced Requirements: OBBBA imposes work-reporting requirements and eliminates pandemic-era rules that made enrollment easier.
• Specific CHIP Cuts: The legislation introduces re-enrollment lockouts for missed premium payments, limits on lifetime or annual benefits, and threatens coverage for lawfully residing immigrant children.
• State Impact: States may be forced to cut optional benefits, such as home- and community-based services (HCBS), due to the reduction in federal funding.

Provider Impact: The legislation reduces the cap on provider taxes from 6% to 3.5% by 2032, leaving states with fewer dollars to support hospitals. 

These changes represent a major shift, with the Congressional Budget Office estimating that the legislation could lead to significant reductions in Medicaid and CHIP coverage.

These cuts affect not only children but also hospitals, which will be forced to reduce services.

CHIP helps a little more than Medicaid. Cutting this benefit will really hurt. Call your representatives.

There are people who can afford to live but, can’t afford medical benefits. This helps them.

Medicaid is a government-funded health insurance program in the United States that provides coverage to millions of low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. It is jointly funded by the federal government and the states, but each state administers its own program within federal guidelines, leading to variations in eligibility and benefits across different states. Medicaid covers a wide range of services, including hospital stays, doctor visits, and long-term care, and typically has minimal or no out-of-pocket costs for enrollees.

Medicaid is essentially medical insurance for poor and vulnerable citizens.

How it works:

• Joint funding: The federal government and each state share the cost of the program.
• State administration: States set their own eligibility rules, determine specific benefits (within federal requirements), and manage the program.
• Coverage: The program provides free or low-cost health coverage and pays providers directly, rather than giving money to the recipient. This is critical to doctors, clinics, and hospitals.
• Eligibility: Eligibility is based on factors like income, household size, disability status, and age, with many states having expanded eligibility to cover more low-income adults.

Key features

• Low-income focus: Medicaid is the largest source of health coverage for people with low income in the United States.
• Broad services: It covers a wide array of medical and health-related services, from preventive care to hospital stays, prescription drugs, and long-term care.
• Minimal cost-sharing: Unlike Medicare, which has deductibles and coinsurance, Medicaid enrollees typically have minimal or no out-of-pocket costs.
• Varies by state: Because each state runs its own program, the name, benefits, and eligibility rules can differ. For example, it is called Medi-Cal in California and Medical Assistance in Pennsylvania.

You really must help these people. Communicable diseases must be cured to protect the public. Sick and dead people are not productive and do not pay taxes. Call your representatives.

How do you qualify? You might need this at some point in your life.

• Eligibility: Eligibility is primarily based on income and resources, though factors such as age, pregnancy status, or disability also play a role. Many states have expanded their programs under the Affordable Care Act (ACA) to cover nearly all adults below a certain income level (typically 138% of the federal poverty level).
• Comprehensive Coverage: The program covers a wide range of mandatory services, including inpatient and outpatient hospital services, physician services, lab tests, and X-rays. States may also offer optional benefits like prescription drugs, dental care, vision services, and physical therapy.
• Long-Term Care: A significant feature of Medicaid is its coverage of long-term care services, such as nursing home care and home and community-based services, which are generally not covered by Medicare or private insurance.
• Minimal Costs: People with Medicaid usually have few or no out-of-pocket costs for covered medical expenses, though small co-payments may be required for some services depending on the state.
• Medicare & Medicaid Dual Eligibility: Some low-income individuals who are aged 65 or older or have disabilities may qualify for both Medicare and Medicaid. In such cases, Medicaid can help cover Medicare premiums, deductibles, and other cost-sharing expenses.

Medicaid is needed. Is support for these programs continuing or being cut?

Besides citizens’ lower coverage, changes affect hospitals.

Doctors and hospitals will make less money. Hospitals are having trouble financially now. Many are in bankruptcy. Some are being taken over by large, successful hospitals. Rural hospitals are having more difficulty. This is happening now. These changes will accelerate these problems.

As hospitals fail, the trip to the hospital becomes longer. In trauma accidents, some patients may not reach the hospital within 1 hour. This is called the Golden Hour. What research has found is that patients who do not get help within the hour can get temporarily cured. However, the shock to the system creates damages that elsewhere in the body that causes the patient to die a week later. This is only for very critical accidents or certain types of illness.

88.8 million Americans use Medicaid. Cutting this funding cuts funding for hospitals. Hospitals cannot just turn away critical patients.

When a hospital fails due to nonpayment for services, it takes a long time to replace it.

Hospitals are important to all citizens. Call your representatives. 

Changes are coming. They are cuts. You may need this help in the future.

Recent changes to Medicaid include the implementation of a new “community engagement” requirement (work or volunteering) starting in 2027, more frequent eligibility checks (every six months instead of 12) for expansion enrollees, and stricter rules on state-directed payments to providers. Other changes include limitations on retroactive coverage and a reduction in enhanced federal funding incentives for states that expanded Medicaid.

Community engagement and eligibility

• Work requirement: Starting January 1, 2027, many enrollees will have to prove they are working, volunteering, or in school for at least 80 hours a month to maintain coverage.
• More frequent checks: Beginning in January 2027, states must conduct eligibility reviews every six months for those in the Medicaid expansion population, up from the current annual requirement. This increases the risk of coverage gaps due to missed paperwork or deadlines.

Provider and state financing

• State-directed payments: New state-directed payments to providers are limited to what Medicare would pay. Existing payments are “grandfathered” until January 1, 2028, after which they will be incrementally reduced to match Medicare rates. This will affect hospital survivability.
• Provider taxes: A new law restricts states’ ability to use provider taxes to help finance their Medicaid programs. This just hurts people and intrudes on the state’s rights.

Enrollment and coverage

• Retroactive coverage: Limits have been placed on how far back a person can receive retroactive coverage. This will be one month for Medicaid expansion enrollees and two months for traditional Medicaid enrollees, down from the previous 90 days.
• Eligibility for non-citizens: Eligibility will be narrowed for certain non-US citizens, with changes effective October 1, 2026.

Other changes

• Elimination of expansion incentive: The enhanced federal matching funds that incentivized states to expand Medicaid under the Affordable Care Act will be eliminated starting January 1, 2026. This cuts medical benefits to millions of citizens.

Major changes to Medicaid were enacted by the federal One Big Beautiful Bill Act (OBBBA), signed into law in July 2025. These changes include new eligibility requirements, more frequent check-ins, higher potential costs for some enrollees, and significant reductions in federal funding for states. This is cost shifting.

For Enrollees

• Work Requirements: Starting January 1, 2027 (sooner in some states), most non-pregnant adults ages 19-64 without disabilities who qualify through Medicaid expansion must show they work, volunteer, or participate in school/job training for at least 80 hours per month. Those who are exempt must still document their status.
• More Frequent Eligibility Checks: For adults in the Medicaid expansion group, eligibility must be redetermined every six months instead of annually. This increases the risk of losing coverage due to paperwork errors.
• Higher Out-of-Pocket Costs: Beginning October 1, 2028, states must impose cost-sharing (up to a $35 limit per service) for certain non-primary care services for expansion adults with incomes above the federal poverty level.
• Reduced Retroactive Coverage: As of January 1, 2027, Medicaid will only cover medical bills for one month prior to an application for expansion enrollees, and two months for others, down from the previous 90 days.
• Changes to Immigrant Eligibility: As of October 1, 2026, eligibility will be restricted for certain lawfully present immigrant groups, such as some refugees and asylum seekers, who previously qualified for coverage.

For States and Providers

• Federal Funding Cuts: The law is expected to cut nearly $1 trillion in federal Medicaid spending over a decade, which could force states to limit eligibility, reduce benefits, or lower provider payment rates.
• Restrictions on Provider Taxes: States can no longer create new provider taxes or raise existing ones to help fund their share of Medicaid costs. For expansion states, the maximum tax rate will be gradually lowered by 2032.
• Limitations on Provider Payments: The amount states can pay providers through “state-directed payments” is now capped at the Medicare rate, phasing in over time.
• Delayed Biden-Era Rules: The law delays the implementation of several Biden administration rules designed to streamline enrollment processes and improve access to care (including nursing home staffing minimums and simplified Medicare Savings Program applications) until 2034.

If you are a Medicaid recipient, it is important to keep your contact information up to date with your state’s Medicaid office and promptly respond to all communications to avoid potential coverage gaps. You can find more information from official state resources, such as the PA Department of Human Services website for Pennsylvania residents.

To satisfy the Medicaid work requirements under the One Big Beautiful Bill Act (OBBBA), eligible individuals must participate in one or a combination of “community engagement” activities for at least 80 hours per month.

Qualifying activities include:

• Employment: Working in a paid job (including self-employment or seasonal work) for at least 80 hours a month, or earning a monthly income at or above the federal minimum wage multiplied by 80 hours (currently $580).
• Work Programs and Job Training: Participating in a formal work program, such as those that qualify under the SNAP (Supplemental Nutrition Assistance Program) statute, or other job training programs.
• Education: Being enrolled at least half-time in an educational program, which includes institutions of higher education or career/technical education programs.

Community Service/Volunteering: Engaging in structured community service or volunteer activities for a non-profit or other organization. States are responsible for verifying compliance with these requirements, and failure to document sufficient hours or to obtain an exemption can result in the loss of coverage.

These requirements primarily apply to non-pregnant adults aged 19 – 64 who qualify through Medicaid expansion and are not otherwise exempt (e.g., individuals with disabilities, primary caregivers of children under 14, or those in a drug or alcohol treatment program).

Do these changes help people or hurt them? If you were in their shoes, what would you do without health insurance?  Call your representatives.

What happens when you retire?  Your income drops, and you need health care. Medicare is this safety net.

Medicare is the US federal health insurance program for people 65 and older, certain younger people with disabilities, and people of any age with  End-Stage Renal Disease (ESRD). It provides coverage for a range of healthcare costs, but does not cover everything, such as most long-term care. Individuals can get coverage through different parts of Medicare, including the original program (Part A and Part B) or Medicare Advantage (Part C).

Key details about Medicare

• Coverage parts:
• Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home healthcare.
• Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and many preventive services.
• Part C (Medicare Advantage): An alternative to Original Medicare that is offered by private companies approved by Medicare. It bundles Parts A, B, and often Part D (prescription drug coverage) and may include vision, hearing, and dental benefits.
• Part D (Prescription Drug Coverage): Helps with the cost of prescription drugs and can be added to Original Medicare or be part of a Medicare Advantage plan.
• How to get coverage:
• Original Medicare: Consists of Part A and Part B. You can see any doctor or go to any hospital that accepts Medicare.
• Medicare Advantage: You may need to use doctors and hospitals within the plan’s network, though some plans offer out-of-network coverage at a higher cost.
• Costs: You may have to pay a premium, deductibles, and coinsurance. Costs vary depending on your plan and income.
• Enrollment: If you are turning 65 and receiving Social Security, you may be automatically enrolled. Otherwise, there is an initial enrollment period that starts 3 months before you turn 65 and ends 3 months after.

 Now you know generally what happens in health care at retirement.

What happens when you retire?  Your income drops, and you need health care. Medicare is this safety net.

Medicare is the US federal health insurance program for people 65 and older, certain younger people with disabilities, and people of any age with  End-Stage Renal Disease (ESRD). It provides coverage for a range of healthcare costs, but does not cover everything, such as most long-term care. Individuals can get coverage through different parts of Medicare, including the original program (Part A and Part B) or Medicare Advantage (Part C).

Key details about Medicare

• Coverage parts:
• Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home healthcare.
• Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and many preventive services.
• Part C (Medicare Advantage): An alternative to Original Medicare that is offered by private companies approved by Medicare. It bundles Parts A, B, and often Part D (prescription drug coverage) and may include vision, hearing, and dental benefits.
• Part D (Prescription Drug Coverage): Helps with the cost of prescription drugs and can be added to Original Medicare or be part of a Medicare Advantage plan.
• How to get coverage:
• Original Medicare: Consists of Part A and Part B. You can see any doctor or go to any hospital that accepts Medicare.
• Medicare Advantage: You may need to use doctors and hospitals within the plan’s network, though some plans offer out-of-network coverage at a higher cost.
• Costs: You may have to pay a premium, deductibles, and coinsurance. Costs vary depending on your plan and income.
• Enrollment: If you are turning 65 and receiving Social Security, you may be automatically enrolled. Otherwise, there is an initial enrollment period that starts 3 months before you turn 65 and ends 3 months after.

 Now you know generally what happens in health care at retirement.

For 2025, the standard monthly premium for Medicare Part B is $185, and the annual deductible is $257. Most people pay the standard Part B premium, but those with higher incomes will pay more through an Income-Related Monthly Adjustment Amount (IRMAA). Part A has no premium for most people who paid into the system through payroll taxes, but the 2025 deductible is $1,676 per benefit period.

Part A (Hospital Insurance)

• Monthly Premium: Most people don’t pay a premium.
• Those with 7.5 to 10 years of Medicare-covered employment pay $285/month.
• Those with less than 7.5 years of work history pay $518/month.
• Annual Deductible: $1,676 per benefit period.
• Daily Copayments:
• Days 61-90: $419 per day.
• Lifetime reserve days: $838 per day.

Part B (Medical Insurance)

• Standard Monthly Premium: $185.
• Annual Deductible: $257.
• IRMAA (Income-Related Monthly Adjustment Amount): Higher-income earners pay more based on their income from two years prior.
• Coinsurance: 20% of the Medicare-approved amount for most services after the deductible is met.

Part C (Medicare Advantage) and Part D (Prescription Drugs)

The average premium is around $17/month in 2025, though costs vary by plan. Many plans have no premium beyond the Part B premium.

Part D (Prescription Drugs):

The average premium is about $38/month, but costs vary significantly based on the specific plan you choose.

Most people have a lower income in retirement. They need help in health care.

Do you know the changes in Medicare?  If you are not using it, you eventually will.

PART 3 CHANGES IN MEDICARE

In 2025, Medicare changes include a new $2,000 annual cap on out-of-pocket prescription drug costs for Part D, the standard Part B premium increasing to $185, and the Part A inpatient hospital deductible rising to $1,676. Other changes focus on improving access to behavioral health, streamlining enrollment for dual-eligibles, and creating new rules for broker marketing and plan compensation.

Medicare costs

• Part B premium: The standard monthly premium increases to $185 from $174.70 in 2024.
• Part A deductible: The inpatient hospital deductible will be $1,676, an increase of $44 from 2024.
• Part A coinsurance: The daily coinsurance for the 61st through 90th day of a hospital stay rises to $419, and the lifetime reserve day coinsurance increases to $838.
• Part D premiums: The projected average Part D premium is decreasing slightly, and many enrollees are in plans that opted into a premium stabilization program.

Prescription drug benefits (Part D)

1. Out-of-pocket cap: There is a new $2,000 cap on annual out-of-pocket spending for covered drugs.
2. Coverage gap: The “donut hole” is eliminated. Beneficiaries now pay 25% of the cost of drugs until they hit the out-of-pocket cap, at which point they pay nothing for the rest of the year.
3. Premium stabilization: A voluntary program is helping to keep Part D premiums lower for most enrollees.

Medicare Advantage and Part D plan rules

• Behavioral health: CMS is working to improve access to behavioral healthcare for enrollees.
• Broker marketing: Stricter rules are in place for third-party marketing organizations, including limitations on distributing personal beneficiary data.

Plan compensation: Supplemental benefits: Plans are required to offer appropriate supplemental benefits and will be required to provide mid-year notifications of newly available benefits.

Dual eligibility: Enrollment for individuals dually eligible for Medicare and Medicaid is being streamlined.

Other changes

• Health equity: Plans must conduct annual health equity analyses of their utilization management policies.
• Appeals: Enrollees have enhanced rights to appeal a Medicare Advantage plan’s decision to terminate coverage for non-hospital provider services.
• Telehealth: Some telehealth flexibilities are extended, but there are also reinstatement of pre-COVID-19 restrictions for some services, say Elation Health.

We are all living longer. This is important. These changes affect those people who will eventually be on Medicare.

10 Medicare Change for 2026 that Will Impact All Retirees

Story by Stacy Garrels   Markets Today   Net   Finance Buzz

Big changes are coming for the roughly 69 million Americans receiving Medicare coverage, in particular, the 91% of plan participants enrolled in Part A and Part B.

Policy watchers anticipate a series of cost and coverage changes in 2026, with some of the biggest shifts impacting deductible amounts, prescription drug costs, and eligibility requirements.

Staying informed is one of the best ways to avoid wasting money in retirement, so here’s a breakdown of what we know so far about the most far-reaching changes ahead.

1. Prepare for a significant Medicare Part B premium increase
   The standard Medicare Part B premium is expected to rise from $185 per month in 2025 to $206.50 in 2026, an 11.6% jump, or more than double last year’s increase.

The annual Part B deductible is projected to grow as well, from $257 to $288, a 12% bump.

2. Plan for higher prescription drug costs before coverage kicks in
   Prescription drug costs under Medicare Part D will shift in 2026. The federal cap on the standard Part D deductible will rise to $615, up from $590 in 2025.

While some plans may still offer lower deductibles or $0 premiums, Medicare.gov warns that drug costs and coverage details vary by plan, so enrollees may see different out-of-pocket amounts depending on the coverage they choose.

3. Expect a higher catastrophic threshold under Part D
   Medicare Part D’s catastrophic spending limit (the point where your out-of-pocket drug costs stop) will increase from $2,000 to $2,100 in 2026.

Once you hit that threshold, Medicare covers 100% of your covered prescription costs. Even with the small increase, the Inflation Reduction Act maintains strong protections for seniors with chronic or high-cost medication needs.

4. Don’t expect the hold-harmless rule to shield you
   Medicare’s “hold-harmless” provision protects many beneficiaries from seeing their Social Security checks drop when Medicare Part B premiums rise.

Under this rule, a beneficiary’s Social Security payment can’t go down if the dollar amount of their Part B premium increase is larger than the dollar amount of their annual Social Security cost-of-living adjustment (COLA).

Because the rule ties protection to the size of a person’s COLA, it mainly helps beneficiaries with smaller Social Security payments. Those receiving larger monthly benefits typically experience full Part B premium increases.

5. Your IRMAA could go up
   Higher-income seniors may also face paying for IRMAA, or the Income-Related Monthly Adjustment Amount.

The IRMAA is a surcharge that higher-income participants may pay if their modified adjusted gross income (MAGI) exceeds IRS thresholds. These added charges apply to both Part B and Part D.

If you do pay IRMAA charges, the amount is calculated on a sliding scale with five income brackets. Figures are updated yearly with inflation and have a two-year lag time. To date, many policy insiders expect an increase in 2026 IRMAA amounts, but no hard figures are yet known.

6. Auto-renewal is coming for the MPPP
   The Medicare Prescription Payment Plan (MPPP) allows enrollees to spread out their prescription drug costs across the year rather than paying large upfront amounts at the pharmacy.

In 2026, a new rule makes participating easier. If you opt in, you’ll be automatically re-enrolled in future years unless you choose to leave.

You’ll receive an annual notice of updated terms. If you do decide to exit the program, providers must process your request within the outlined timeframe.

7. Supplemental benefits curtailed
   Medicare Advantage plans have increasingly offered “extras” like meal deliveries, OTC benefits, transportation, and non-medical supports for chronic illness. But starting in 2026, new rules restrict services previously covered.

Plans will no longer be allowed to offer:

• Non-healthy foods
• Alcohol
• Tobacco
• Life insurance

These changes don’t overhaul Medicare Advantage, but they do trim the perks, which may shift seniors’ focus back to networks, drug coverage, and core benefits. 

8. Prior authorization requirements are expanding
   While historically Original Medicare requires prior authorization only for a small set of services, that’s changing.

In 2026, Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington will pilot a new model expanding prior authorization requirements for several outpatient procedures.

These include:

• Skin and tissue substitutes
• Electrical nerve stimulator implants
• Knee arthroscopy for osteoarthritis

Emergency and inpatient services remain excluded.

Prior authorization is already common in Medicare Advantage, but this is the first meaningful test of expanding it under Original Medicare.

9. Some dual-eligible seniors could lose Medicaid coverage
   Medicaid requires states to verify enrollees’ eligibility on a recurring basis, including reconfirming income and financial resources.

These verification checks can create administrative challenges, especially for people with complex health needs.

For Medicare-Medicaid “dual eligibles,” losing Medicaid coverage can be especially harmful as Medicaid covers critical services such as long-term care and certain home- and community-based supports.

10. Some prescription drugs will see lower prices
    For the first time, Medicare will enforce negotiated prices on a group of high-cost, single-source drugs starting in 2026.

The initial list includes Eliquis, Enbrel, Entresto, Farmiga, Imbruvica, Januvia, Jardiance, Fiasp/NovoLog, Stelara, and Xarelto.

Savings may be modest at first because the list is short, but more drugs will follow, including Ozempic, Rybelsus, and Wegovy in 2027.

Bottom line

Medicare beneficiaries face rising costs in 2026, especially under Part B.

Although Medicare trustees’ projections haven’t always been perfect, the broader trend is clear: healthcare costs are rising, and retirees will need to plan for greater out-of-pocket expenses to avoid medical debt.

If you rely on Medicare, 2026 is a year to review your situation carefully, check for IRMAA exposure, and budget for these changes if you want to continue to enjoy a stress-free retirement.

The Affordable Care Act, ACA, is a comprehensive healthcare reform law that aims to increase the number of Americans with healthcare insurance and improve the quality of healthcare. It expands coverage by expanding Medicaid eligibility for low-income adults, creating health insurance marketplaces where people can purchase plans with financial assistance, and allowing adults to stay on their parents’ plans until they are 26. The law also includes consumer protections such as prohibiting insurers from denying coverage based on pre-existing conditions and eliminating lifetime and annual limits on essential benefits.

Key Provisions of the ACA

1. Expands coverage.
1. Medical expansion: Extends Medicaid to cover low-income adults.
2. Health Insurance Market Place: Creates online marketplaces where individuals and families can compare and purchase health plans, with some receiving subsidies to lower costs.
3. Young Adults: Allow young adults to remain on parents’ health insurance to age 26.
2. Consumer Protections
1. Pre-existing conditions: Prohibits insurers from denying coverage or charging more on a person’s health status or pre-existing condition.
2. Essential health benefits: Requires all plans to cover a set of 10 essential health benefits, such as doctor visits, prescription drugs, and emergency services.
3. Coverage Limits: Elimination of lifetime and annual limits on the amount of coverage an individual can receive for essential health benefits.
3. Other provisions:
1. Employer requirements: Requires employers with a certain number of employees to offer affordable health coverage or face penalties.
2. Tax Credits: Provides premium tax credits to make insurance more affordable for those whose income is between 100% and 400% of the federal poverty level (FPL).
3. No more individual penalty for not having individual health insurance was eliminated in 2019.

The Trump administration is eliminating ACA piecemeal. He hopes to complete this by the end of 2026. Cutting ACA in parts denies benefits to citizens who previously received health care because of ACA.

If ACA originally made you receive medical benefits, being cut off is very serious. Call your congressman.

What would you do if your medical benefits were cut because of eliminating ACA?

Trump is eliminating the ACA in pieces. He as stated that he hopes to complete this task by the end of 2026. This will cut medical benefits for millions of citizens. People will die. Hospitals will lose more money dealing with patients without medical benefits.

The financial state of US hospitals is mixed, with some recent reports showing improved margins for 2024 due to rising revenue and slower expense growth, while other long-term challenges, such as surging labor costs, underpayment for certain services, and increased bad debt, persist. Although margins have rebounded from their 2022 low, they remain below pre-pandemic levels, and hospitals are struggling to achieve full financial sustainability. Factors like the end of pandemic-era Medicaid eligibility expansions and high inflation continue to put pressure on hospitals, especially rural facilities. (AHA American Hospital Association Report)

Financial performance

• Improved but fragile margins: After a significant dip in 2022, hospital margins saw a rebound in 2023 and 2024. However, average margins are still lower than in 2021 and are not in a “fully sustainable position”.

• Revenue growth: Hospitals experienced a rise in net patient revenue in 2024, driven by an increase in outpatient services.
• Slower expense growth: While expenses still grew in 2024, they did so at a rate lower than inflation, a positive sign compared to previous years.
• Increased bad debt: Despite overall revenue growth, hospitals saw a significant increase in bad debt and charity care in 2024, likely due to the end of pandemic-related Medicaid eligibility expansions.

Major challenges

• Labor costs: Labor is a major expense for hospitals, and costs increased significantly between 2021 and 2023. Many are still dealing with a competitive and tight labor market.
• Inflation and underpayment: The cost of supplies and other non-labor expenses is rising due to inflation. This is happening at a rate that outpaces growth in Medicare reimbursement, and many essential services are paid below cost.
• Administrative burden: Insurer practices like prior authorization and claim denials add to a hospital’s administrative burden.

Impact of financial pressure

• Varying impact: The financial health of hospitals is not uniform. Rural hospitals and those with a higher share of Medicaid patients have been more vulnerable.
• Risk to access: Persistent financial pressure could threaten a hospital’s ability to invest in technology and maintain access to care for patients.

Hospitals are closing. It is more difficult to pay for their services. People without medical benefits often cannot pay even a fraction of the cost of a stay. Hospitals cannot turn away seriously ill patients. Frequently, the hospital must eat the loss.

The ACA and Medicaid help hospitals in this area. Still, hospitals are closing. This is more critical in rural areas.

When hospitals go bankrupt, it takes longer for people to get to a hospital for treatment. This delay is critical in severe trauma problems. In a severe, total blockage heart attack, you have roughly 30 minutes to 2 hours to receive treatment before it is irreversible. If you can’t breathe, you have 4 – 6 minutes before permanent brain damage. Six to 10 minutes will almost certainly cause some brain damage. Strokes need to be attended to within 60 minutes. The Golden our is an overly simple explanation of severe Trauma. People in a car accident can have combinations of these events.

Trauma hospitals and helicopters exist to handle these severe medical events.

Fewer hospitals and fewer trauma centers mean that help for a severe trauma event is less likely to occur. Rich or poor, having medical benefits or not, severe trauma events require help quickly. Every citizen has this concern about hospitals being eliminated.

A requirement for trauma is to have neurosurgery at the hospital.

This is a detailed report on the current effects of hospital problems. Most citizens are unaware of these problems. This report is done by professionals in American health care. This will help you understand the problems of a place you will visit during your lifetime.

New AHA, American Hospital Association Report:

Economic Challenges

WASHINGTON (April 30, 2025) — The American Hospital Association (AHA) today released a new report showing that hospitals and health systems continue to experience significant financial headwinds that can challenge their ability to provide always-there, essential care to their patients and communities. The report outlines the significant financial burden of the heightened expenses that hospitals have faced in recent years in caring for patients, as well as the increasing strain on the field.

Key findings from the report include:

• Having the right care team available for patients has long been the single largest category of hospital spending, accounting for 56% of total costs in 2024. Amid ongoing workforce shortages, hospitals have raised wages to recruit and retain staff, adding financial pressure even as these investments are essential to maintaining care.
• Medicare and Medicaid continue to underpay hospitals for patient care. Hospitals absorbed $130 billion in underpayments from Medicare and Medicaid in 2023 alone, and these shortfalls are worsening — growing on average 14% annually between 2019 and 2023.
• Medicare reimbursed just 83 cents for every dollar hospitals spent caring for patients in 2023. From 2022 to 2024, general inflation rose by 14.1%, while Medicare inpatient payment rates increased by only 5.1% — amounting to an effective payment cut over the past three years.
• The practices of certain Medicare Advantage (MA) plans — including increased delays, denials and underpayments — are exacerbating the financial burden faced by hospitals. This has happened while hospital reimbursement from MA plans fell by 8.8% on a cost basis between 2019 and 2024.
• Tariffs on medical imports could significantly raise costs for hospitals as nearly 70% of medical devices marketed in the US are manufactured exclusively overseas. A recent survey found that 82% of healthcare experts expect tariff-related expenses to raise hospital expenses by at least 15% over the next six months, and 94% of healthcare administrators expect to delay equipment upgrades to manage financial strain.
• At the same time, Congress is considering proposals that would cut Medicaid, Medicare and other programs that support the 24/7 care and services that hospitals provide to patients in every community across America.
• “This report should serve as an alarm bell that a perfect storm of rising costs, inadequate reimbursement, and certain corporate insurer practices are jeopardizing the ability of hospitals to deliver high-quality, timely care to their communities,” said AHA President and CEO Rick Pollack. “With so much at stake, policymakers must recommit to making preserving access to hospital care a national priority.”
• View the full report. See the AHA’s advocacy agenda for more information on the AHA’s efforts to support hospitals and health systems.

About the American Hospital Association (AHA)

The American Hospital Association (AHA) is a not-for-profit association of healthcare provider organizations and individuals committed to improving the health of their communities. The AHA advocates on behalf of our nearly 5,000 member hospitals, health systems, and other healthcare organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 healthcare leaders who belong to our professional membership groups. Founded in 1898, the AHA provides insights and education for healthcare leaders and serves as a source of information on healthcare issues and trends. For more information, visit the AHA website at www.aha.org.

The federal budget and its safety net programs significantly affect hospitals. Politicians determine how much support hospitals get. Contact you representatives and express your concerns.

Medicine is important for you, your family, friends, and fellow citizens. This is the total of all upcoming changes.

The changes coming to healthcare are significant. Most of these changes are due to cost shifting from the federal government to the states. They will affect every citizen in the country. Below is a summary list of the basic changes:

1. There will be cuts in SNAP payments. This hurts the absolute bottom of the country’s economic scale. This cuts food from the desperate.
2. There will be cuts in MEDICAID. This will hinder access to medical benefits for the poor. Medical care will be delayed and, in some cases, not be given.
3. Hospitals depend on Medicaid to be financially solvent. Hospitals are already having difficulties. Some are going bankrupt. These cuts will make their problems worse. Rural hospitals are the most at risk. Getting to a hospital will take longer in Trauma accidents or emergencies.
4. Social Security will have some cuts. The cuts are not yet determined. They affect people on a fixed income. Some are on a very low income. Every year, inflation eats away at their finances.
5. The total of these cuts will make US medicine worse. There are already delays to see specialist doctors. This delay can be deadly. Doctors and hospitals are already highly dependent on insurance companies for covering medical benefits.
6. Medicine in the US is already too high. Many critical medicines created in the US are more expensive to US citizens than to people in foreign countries. WHY?

There is no way to be nice, politically correct, or sugarcoat the realities. The Republicans control all three branches of the federal government: the Executive Branch (President), the Legislative Branch (House of Representatives majority and Senate majority), and a majority of the Supreme Court. Citizens need to change this.

Historically, Republicans and Democrats are polar opposites in their perspectives at the extreme. This is not true for everyone in either party. Both function to compromise and move legislation toward the middle. Both extremes are dangerous. This is not happening now. The President bullies his party to do what he wants. Many Republicans are afraid to vote against President Trump. This is what can happen if America becomes a one-party dominant country.

Many citizens must work more hours to survive. They are too busy to keep up with politics. Much of the news media is afraid to confront our President. Many citizens only get news from a single source.

This website is to help people with critical news that is not being published. The bottom line with democracies is that the citizens have a responsibility to be informed and vote. If they don’t, the wealthy will rule as an oligarchy, when the super-rich run the country.

VOTE because medical care, hospitals, and YOUR LIFE depend on it.