The One Big Beautiful Bill Act changes are set to bring sweeping shifts to U.S. health coverage—some happening immediately, and others rolling out over the next few years. While many of the most dramatic changes, like large Medicaid cuts, won’t take effect until 2027, important adjustments to Medicaid, Marketplace coverage, and subsidies will hit much sooner.
If you’re enrolled in Medicaid, purchase coverage through the ACA Marketplace, or are a low-income immigrant relying on subsidies, these changes could affect your eligibility, premiums, and coverage options. Understanding these shifts now can help you prepare before the new rules take hold.
You can read more about the law’s full scope here.
1. More Complex Medicaid Applications and Renewals
One of the earliest One Big Beautiful Bill Act changes impacts how people apply for and keep Medicaid coverage. Beginning July 4, 2025, the Act halts new federal rules that aimed to simplify Medicaid enrollment—such as removing in-person interviews for older adults and people with disabilities.
Without these simplifications, Medicaid and CHIP enrollees may face extra paperwork and stricter eligibility verification. This could lead to coverage losses if people miss deadlines or can’t meet new documentation requirements.
Tip: Make sure your state Medicaid agency has your current contact information and respond quickly to any renewal notices.
2. Planned Parenthood Medicaid Funding Restrictions
The Act also includes a provision to block Medicaid reimbursement for care provided at Planned Parenthood and similar providers offering abortion services (outside the federal exceptions for rape, incest, or danger to the mother’s life).
Although this rule was scheduled to begin July 4, 2025, it’s currently paused by a court injunction. If it eventually takes effect, Medicaid patients could lose access to preventive and reproductive health services at certain clinics.
Tip: If you rely on Planned Parenthood for care, watch for updates on this court case so you can plan ahead for alternative providers if needed.
3. Loss of Marketplace Subsidies for Some Immigrants
Starting January 1, 2026, one of the most significant One Big Beautiful Bill Act changes for immigrants will remove Marketplace subsidies for lawfully present individuals in their first five years in the U.S. if their income falls below the federal poverty level (FPL).
Previously, these subsidies filled a coverage gap for immigrants not yet eligible for Medicaid. Without them, an estimated 300,000 people could lose health coverage.
Tip: Recent immigrants should aim to project a 2026 household income at or above the FPL ($15,650 for an individual, $32,150 for a family of four in most states) when applying for Marketplace coverage during 2025 open enrollment.
4. Full Repayment of Excess Marketplace Subsidies
Currently, if your income ends up higher than you estimated when applying for Marketplace coverage, there’s a cap on how much of the excess advance premium tax credit (APTC) you must repay. Beginning with 2026 coverage, those caps disappear.
This means if your income increases unexpectedly, you could be on the hook for the entire subsidy amount you received—potentially thousands of dollars.
Tip: Track your income during the year and update your Marketplace account immediately if it changes to avoid large repayments.
5. Expanded Access to Health Savings Accounts (HSAs)
Starting in 2026, all Bronze and Catastrophic Marketplace plans will qualify as high-deductible health plans (HDHPs) for HSA purposes. This is another major One Big Beautiful Bill Act change—millions more consumers will be able to open or contribute to HSAs, even if their plan didn’t previously qualify.
Additionally, direct primary care (DPC) memberships will no longer disqualify you from contributing to an HSA, and DPC fees can be paid with pre-tax HSA funds.
Tip: Using an HSA can lower your taxable income and possibly help you qualify for Marketplace subsidies—especially important if the ACA subsidy cliff returns in 2026.
Preparing for the Road Ahead
While some One Big Beautiful Bill Act changes won’t arrive for years, the adjustments coming in late 2025 and early 2026 could significantly affect coverage and costs for millions. By understanding these changes now, you can take steps to protect your coverage and manage expenses.
At ICT Insurance Group, we’re here to help you:
Review your health coverage before open enrollment
Project your income accurately to protect against subsidy loss
Compare plans to find the most cost-effective coverage
Navigate complex changes in Medicaid and Marketplace rules
Get expert guidance before these changes take effect.
Call (316) 440-6111
Request a free quote online
Connect with a licensed agent in your state
Don’t wait until these changes hit—plan now to secure the best possible health coverage for you and your family.
