The One Big Beautiful Bill: What Health Insurance Agents Should Know

We’re sure you’re familiar with the One Big Beautiful Bill, if not in depth, at least by name. It’s been a frequent topic among news outlets for weeks. After being passed for final approval by the House of Representatives, President Trump signed the 330-page bill into law on July 4.

We’ve reviewed details of the One Big Beautiful Bill and highlighted what’s important for insurance agents to know.

What Is the One Big Beautiful Bill Act?

The Big Beautiful Bill, at its core, is a continuation of President Trump’s Tax Cuts and Jobs Act from 2017, which was set to end at the close of this year. This bill makes most tax cuts permanent, while also increasing spending for border security, defense, and production of energy, at the cost of health care and nutrition programs, specifically Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

Big Beautiful Bill Changes Health Insurance Agents Should Note

The impact of the Big Beautiful Bill on your Medicaid-eligible, ACA, and Medicare clients will be significant. It’s essential now more than ever that you do your research and equip yourself with knowledge for not only yourself, but also your clients, both present and future.

Medicaid

Americans see more stringent parameters on Medicaid eligibility, including work requirements for able-bodied adults ages 18 to 64.

Per the legislation, “able-bodied” is defined as those not medically certified as physically or mentally unfit for employment. As such, under the bill, able-bodied Medicaid recipients must work 80 hours a month or qualify for an exemption, such as being a student, caregiver, having a disability, or parents of children older than 13.

States will be required to check Medicaid eligibility twice a year instead of just once.

By January 1, 2027, states will need to set up systems to verify an individual’s employment and exemption statuses. Additionally, they will be required to check Medicaid eligibility twice a year, instead of just once. States may be able to launch their programs before the enactment deadline with approval from Centers for Medicare & Medicaid Services (CMS).

ACA

Tax credits within the ACA market are set to shrink.

Starting in 2026, in cases where an enrollee’s estimated income was lower than their actual income, the excess of premium tax credits will be reclaimed in full no matter their household income. Also, consumers who enroll in a plan using a non-qualifying life event (QLE) Special Enrollment Period (SEP) won’t receive premium tax credits or Cost Sharing Reductions (CSRs) starting in Plan Year 2026.

Additionally, the legislation restricts eligibility for subsidized ACA coverage to certain, lawfully present immigrants, with some exceptions, effective January 1, 2027. Beginning in 2028, exchanges must complete pre-enrollment verification of eligibility for the premium tax credit.

Telehealth and direct primary care will permanently be HSA-qualified expenses.

In exciting news, all individual market bronze and catastrophic plans will be treated as high-deductible health plans (HDHP) that can be paired with a health savings account (HSA), starting 2026. In further regard to HSAs, telehealth and direct primary care will permanently be HSA-qualified expenses.

Medicare

Medicare qualification criteria are changing for individuals residing in the U.S.

Most notably, eligibility will be eliminated for those with temporary protected status, refugees, and asylees. The government will terminate the benefits of those receiving Medicare who no longer qualify within 18 months of the bill’s enactment.

Eligibility will be eliminated for those with temporary protected status, refugees, and asylees.

The legislation also delays the implementation of the Medicare Savings Program (MSP) eligibility and enrollment adjustments in the September 2023 CMS Final Rule until October 1, 2034, save for provisions that have already taken effect.

Finally, the orphan drug exclusion has been expanded to include drugs designated for one or more rare diseases or conditions. The time that a drug is on the market as an orphan drug will not count toward the seven- to 11-year market duration standard used to determine eligibility for selection in the Medicare Drug Price Negotiation Program. These changes will be effective for drug price selection starting in 2026 for negotiated prices available on or after January 1, 2028.

What the Big Beautiful Bill Means for the ACA Marketplace

Millions of individuals losing Medicaid benefits will be looking for new health coverage and may benefit from an ACA plan. An influx of ACA enrollments is likely, which means the efforts of ACA insurance agents are paramount. Now’s the time to certify to sell ACA insurance and set yourself up as a helpful resource in the community.

Enrollees will need to put in more work to remain in an ACA plan, as auto-renewals of coverage will be discontinued due to pre-enrollment verification. Fewer enrollees will be eligible for subsidies, especially since Inflation Reduction Act-era subsidy enhancements expire at the end of 2025.

An influx of ACA enrollments stands to occur, which means the efforts of ACA insurance agents are paramount.

With bronze and catastrophic plans soon becoming compatible with an HSA, ACA clients will be able to enjoy those tax benefits and more tax savings! Also, employers will be able to offer more health plan options while maintaining HSA eligibility.

What the Big Beautiful Bill Means for Medicare

While all Medicare-eligibles will likely be impacted by the changes of the Big Beautiful Bill, immigrants and dual-eligibles will face the most disruption.

Some immigrants will lose their Medicare eligibility and coverage altogether, while it will be harder for duals to maintain coverage due to the more frequent Medicaid eligibility requirements. Also, states will be given more freedom to disenroll individuals who don’t respond to redetermination requests promptly.

In addition, enrollment for Medicare beneficiaries in Medicare Savings Programs will not be as streamlined as it could be due to the halt on the September 2023 Final Rule. Your clients who rely on these programs could feel frustration and despair, so make sure you’re an empathetic and proactive resource to help them navigate through the enrollment process.

How Insurance Agents Can Adapt

We advise that you reach out to your immigrant and dual-eligible clients and make sure they’re supported and understand what’s happening to their health coverage.

It’s also your duty as your clients’ insurance agent to educate them on these changes and assist them through it. Ways you can do so can include:

• Sharing articles about the changes on your social accounts
• Writing and publishing a blog post about it
• Including facts in your upcoming email newsletter
• For ACA clients, ensuring they properly estimate/report household income
• Inform bronze/catastrophic coverage clients about their new HSA capability
• For dual-eligible clients, making sure they respond to verification requests promptly
• Stress the importance of updating contact info to your clients so their state/health plan can reach them and your clients aren’t missing communications

And as always, be a listening ear and offer your support whenever you can. Not everything you do as an agent will result in financial gain, but trust and loyalty should help your business go far.

President Trump’s One Big Beautiful Bill is certainly something to behold. As you support your clients, do your best to stay neutral and bring facts and solutions to the table rather than fuel emotions. Remember, you set the tone and are the role model for clients during this time of uncertainty and change.

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