Our August Office Hours call was packed with insightful information. Ronnie’s main focus was the Big Beautiful Bill – legislation significantly impacting your clients on ACA and Medicare plans, but he also shared the latest Medicare news you need to stay ahead.
If you’re an insurance agent committed to staying up to date on industry trends and providing top-notch service to your clients, our office hours are just for you. Continue reading to stay informed.
Main Points Covered
The main topics Ronnie covered during August’s call include:
- The Big Beautiful Bill
- Medicare News
One Big Beautiful Bill Act
“There is so much packed into the Big Beautiful Bill“, Ronnie said.
The bill is one of the most significant pieces of legislation in years, and is reshaping how older generations access and pay for healthcare. The bill impacts both ACA and Medicare plans, but ACA is taking a greater hit. Some of the benefits and regulations will not take effect for several years (some as late as 2034), and it could be a long time before we see the full extent of the bill.
Ronnie shared the immediate effects the bill will have as we go into plan year 2026 and 2027.
Immediate Effects of the Big Beautiful Bill:
- Roughly 10.5 million people are expected to lose Medicaid
- Enhanced premium tax credits will expire in 2026 if they are not extended by President Trump
- If eliminated, enrollees who receive credits will see premiums increase 75%
- As monthly out of pocket costs increase, plans become more unaffordable…we could see a lot of people cancel their ACA plans (because they are too expensive or the value for their dollar doesn’t seem to be there if they are a healthy individual)
- Some lawful immigrants will no longer qualify for tax credits on the ACA side
- Client’s with income above 400% of the federal poverty level will be responsible for paying 100% of all the premiums on their plans
- Individuals who qualified for a 0 premium plan in the past must update their income information on healthcare.gov during enrollment or they will be charged a $5 monthly fee
- If not paid, the carrier could terminate their coverage
- Special enrollment periods will no longer be allowed on the basis of income
- Currently, if someone falls below 150% of the federal poverty level, they can enroll using an SEP into a marketplace plan throughout the year – this will be ending
- To collect Medicaid, individuals will be required to work 80 hours per month (this will not take affect until 2027 at the earliest for states that expanded Medicaid)
- Individuals do not have to meet the requirement if they have a condition fitting the waiver (such as caring for sick child, being enrolled in school, or volunteers)
- Able-bodied individuals who choose not to work will lose Medicaid
- If they elect to enroll in ACA as a result, they will not be eligible for premium tax credits
- States will be required to obtain enrollee addresses using reliable data sources
- States will be required to review a master death file at least once a quarter and disenroll anyone who has passed away
- States who did expand Medicaid benefits are now going to have to conduct eligibility redeterminations every 6 months
- New proof of income requirements
- Individuals who delay or have not filed taxes will not be eligible for premium tax credits
- In 2027, there is going to be tighter restrictions on who can qualify for Medicare
- Congress passed a one year update for 2026 to provide a temporary 2.5% increase in Medicare physician fees for services between January 1 and December 31st
- Primary care doctors will experience an increase in pay
Remember, legislation is constantly changing…for now, that’s all we have for the Big Beautiful Bill. Ronnie and the entire Tidewater team are here to help you navigate changes and keep you informed as updates come.
Medicare News
- Experts are predicting a 2.7% COLA (Cost of Living Adjustment)
- Social Security beneficiaries (Medicare clients primarily) are going to see a 2.7% pay raise
- Although a pay raise sounds nice, Part B projections are expected to see the largest increase in premiums since 2022 (11.6%)
- Current premium is $185 per month…the predicted jump is $206.50
- Although a pay raise sounds nice, Part B projections are expected to see the largest increase in premiums since 2022 (11.6%)
- Social Security beneficiaries (Medicare clients primarily) are going to see a 2.7% pay raise
- In 2026, Medicare plans will cover more than 1,000 new procedures in outpatient settings
- 2025 was the first year the Mid-Year Enrollee Notification of Unused Supplemental Benefits CMS requirement was active
- Carriers are required to mail their Medicare Advantage members a customized notice (by July 31st) detailing any unused benefits and provide an explanation of how they can be used by the end of the year
- SNP products in addition to MA plans continue to gain popularity
- 1 in 5 people that are on a Medicare Advantage plan are on a SNP product
Other Reminders and Knowledge from Ronnie
AEP Updates
Tidewater’s AEP Roadshows are here! Make sure you register for your local Roadshow so you’re prepared and ready to take on the Annual Enrollment Period.
As we approach 2026, remember to look at smaller carriers, they typically have great benefits.
Join a Professional Organization
With legislation like the Big Beautiful Bill, and other bills on the horizon, it’s really important that you join NABIP or another type of professional agent organization where your voice can be heard.
Wrap Up
Ronnie reminded us that August is mental health month…he stressed the importance of taking care of yourself first and foremost. Prioritizing yourself will prepare you to better serve clients and adapt to industry changes. Check out How to Achieve Work-Life Balance as an Insurance Agent for some self care tips.
Stay tuned for our September Office Hours date and registration. We hope you’ll join us for the call to stay ahead, informed, and knowledgeable about the latest industry trends and updates.
