Big Beautiful Bill: Medicare

November 14, 2025

If you are one of the 68.6 million current beneficiaries of Medicare benefits, the months of discussion on the recently passed “One Big Beautiful Bill” likely filled your news feed with all kinds of information. Now that the legislation is settled, here is a helpful guide to show what did – and didn’t – make it into the final version:

  • Not Included: HSA contributions after enrollment in Medicare Part A
    • If enrolled in Medicare Part A, you are ineligible to contribute to a Health Savings Account (HSA). Provisions to reverse this rule were initially proposed, but do not appear in the signed legislation.
  • Not Included: “Rural Emergency Hospital” registration
    • From 2005 to 2023, over 200 hospitals in rural U.S. counties had to either close or convert to lower standards of care offered. There were initial proposals to receive Medicare designation as a Rural Emergency Hospital in order to receive financial assistance, but these provisions were not included in final legislation.
  • Not Included: AI assistance in recovering payments
    • As part of ongoing efforts to reduce fraud and wasteful spending, a law would have allowed artificial intelligence contractors to investigate Medicare payments. This provision was removed entirely before the bill’s signing.
  • Included: Limited Medicare eligibility
    • Medicare eligibility is being eliminated for illegal immigrants. Specific requirements can result in eligibility for lawful permanent residents and certain immigrants from Cuba, Haiti, and the Pacific island nations of Micronesia, the Marshall Islands, and Palau.
  • Included: Changes to Medicaid
    • Reductions in Medicaid spending and assistance account for over $1 trillion over the next decade. Medicaid enrollees will be required to regularly file paperwork proving employment or other qualified status to maintain enrollment. This requirement is scheduled to be enacted in January of 2027.

New laws and regulations can be better understood with the help of professionals. Contact us and let us help you gain knowledge and confidence about how changing legislation could affect your unique situation.

Source: https://www.kiplinger.com/retirement/medicare/changes-to-medicare-in-the-one-big-beautiful-bill-act