What's New

Medicare continues to fully cover updated COVID-19 vaccines at no cost to beneficiaries, provided they’re administered by Medicare-approved providers. This includes the latest 2024–2025 vaccines targeting Omicron variants like KP.2 and JN.1 from Pfizer-BioNTech, Moderna, and Novavax. In-home vaccination support also remains in place, offering additional payments to providers to reach homebound individuals—a key benefit for seniors with limited mobility or in long-term care.

Although CMS ended its vaccine mandate for healthcare staff in Medicare- and Medicaid-certified facilities in mid-2023, facilities are still required to educate and offer COVID-19 vaccines. A new reporting requirement, item O0350 in the Minimum Data Set (MDS), helps track whether long-term care residents are “up-to-date” on COVID-19 vaccines as per CDC guidelines, reinforcing ongoing efforts to monitor vaccine uptake.

Vaccine policy has shifted under Health Secretary Robert F. Kennedy Jr., who has prompted the withdrawal of CDC booster recommendations for certain groups. While Medicare coverage remains unchanged for now, beneficiaries should stay alert to future policy changes and consult healthcare providers for the most current guidance.

Many people are well aware of the benefits of telehealth, including convenience and flexibility, as well as access to a broader range of specialists. Under Medicare’s original rules, telehealth services were intended mainly for rural residents , with the aim of connecting patients with remote specialists from an approved medical facility, like a local clinic. During the COVID-19 pandemic, Medicare temporarily made it easier for people to get care from home through telehealth, no matter where they lived. This change allowed beneficiaries to have video or phone visits with their doctors right from their living rooms — a huge help for people with mobility challenges or those living in urban or suburban areas.

Starting October 1, 2025, unless new laws are passed, this pandemic-era home access will end for many services under Original Medicare. The guidelines will revert back to the original rule, meaning in most cases, you will need to be at an approved medical site in a rural area to use telehealth. There are a few notable exceptions, including mental health counseling, substance use disorder treatments, dialysis visits, and a few other services, which will still be covered from your home, wherever you live. If you rely on telehealth, it’s smart to ask your provider now what services you can still get from home, and whether they offer extra telehealth benefits beyond basic Medicare. Some Medicare Advantage Plans may offer more telehealth benefits than the basic coverage in Original Medicare. Stay informed and consult with your licensed insurance agent to help you plan ahead for any changes to your care routine in the coming months.

On July 4, 2025, lawmakers in Washington passed the “One Big Beautiful Bill Act” (OBBBA) , which includes several changes to the Affordable Care Act (ACA). While the legislation is now official, many of the details are still being shaped through rulemaking, guidance, and state-level decisions. That means real-world impacts may shift as the law is rolled out. Here's a look at what the law includes so far and how it could affect individuals and families in the months ahead.

Key ACA Changes

1. Expiration of Subsidies

Enhanced premium tax credits, expanded under the American Rescue Plan and extended by the Inflation Reduction Act, are set to end in late 2025. Without renewal, premiums may rise — by up to 75% in some states.

The Congressional Budget Office (CBO) estimates around 4.2 million people could lose coverage.

2. Enrollment Policy Changes

The bill proposes adjustments that could affect ACA sign-ups:

• A shorter enrollment window
• Ending automatic re-enrollment (affecting ~11 million people)
• Annual income and eligibility checks
• Revised access rules for certain legal immigrants

The CBO projects these changes could result in 3.1 million more people becoming uninsured.

3. Medicaid Reforms

Proposed changes to Medicaid include:

• Work requirements for some able-bodied adults
• Higher cost-sharing for those above the poverty line
• Tighter eligibility verification
• Reduced federal support for states covering undocumented immigrants
• Limits on funding for certain services, including gender-affirming care

The CBO projects these changes could lead to 7.8 million losing Medicaid coverage.