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By Jasmine Laws
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In 2026, there are a number of changes coming to the two federal health insurance programs, Medicare and Medicaid, after the Trump administration brought in various policies and bills this year that will shape the future of the programs.
Why It Matters
Medicaid, the federal program for low-income Americans, provides health care coverage for over 70 million people, while Medicare, the federal program for those older than 65 or potentially those younger if they have certain health conditions, provides health coverage for around 68 million Americans.
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The upcoming changes have prompted significant concern among recipients, lawmakers and experts, who have warned that millions of Americans will lose access to health care coverage, which they say would have implications on health outcomes nationwide.
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2026 Changes To Medicaid
Following the passage of President Donald Trump's One Big Beautiful Bill (OBBB), there will be almost $1 trillion worth of cuts to Medicaid, as part of the administration's bid to strip the program of "waste, fraud and abuse" and, as the White House said, to protect Medicaid for the "truly vulnerable."
The cuts clamp down on expansions of the program brought in under former President Joe Biden, and under former President Barack Obama via the Affordable Care Act (ACA), in order to generate funds so that Trump could bring in his sweeping tax cuts.
The 40 states that expanded Medicaid under the ACA will now face a reduced federal match rate forcing states to shoulder a greater share of the costs—which Julie Donohue, a professor and chair of health policy and management at the University of Pittsburgh, told Newsweek will primarily affect people eligible through the ACA Medicaid expansion "who make less than $21,000 a year."
The Congressional Budget Office (CBO) predicted the cuts would see 1.3 million more Americans left uninsured in 2026, and that the total number of uninsured Americans could continue to rise over the coming years.
Donohue said that the changes to Medicaid overall in the OBBB will result in "approximately 10 million low-income people losing insurance coverage."
She said that there are about 15 separate provisions in the law that "limit in some way who can be covered by Medicaid, or reduce the amount of federal spending on Medicaid, or both."
In another bid to cut "waste, fraud and abuse" from Medicaid, the Trump administration is bringing in new requirements for Medicaid eligibility.
The new requirements mandate all recipients, unless exempt, to complete 80 hours a month of verified community engagement—which could include education, volunteering, working and more—and to report these hours worked to keep access to the program.
Those between 19 and 65 have to complete the hours, unless they have caring responsibilities for very young children, have a disability, are in drug or alcohol rehabilitation, are pregnant and a few other exceptions.
The work completed has to be easy for states for verify, and experts have warned that the measure will push many Americans off the program, purely because of the administrative burden of reporting and proving worked hours.
States are required to implement these measures by January 1, 2027, but in order to check eligibility prior to that date, they will need to review hours worked by recipients in the run up to the new year, so Medicaid enrollees will have to prove they complete the 80 hours a month up to three months beforehand.
Additionally, the OBBB also determines that any states providing Medicaid services to undocumented immigrants will face financial penalties, by losing enhanced federal matching funds.
Reflecting on the upcoming changes, Paul Shafer, a professor of health law, policy, and management and co-director of the Medicaid Policy Lab at Boston University, told Newsweek that "in short, we are going to make it harder for people to get and stay enrolled in Medicaid, while at the same time also making it harder to get access to the health care providers that patients need."
He said that those "who are least able to navigate the system, from struggles with confusing work reporting requirements and more frequent renewal paperwork, and those who have unstable housing, who may be more likely to miss an important notice from their state Medicaid agency, will probably struggle the most." Although, he added that all Medicaid recipients will be impacted in some way.
"Medicaid also can serve as a front door to other benefits, like nutrition assistance, so for many families the changes to both Medicaid and SNAP in the OBBB may end up being a double whammy for their budget and their health," he said.
2026 Changes to Medicare
The Trump administration is also bringing in changes to the Medicare program, which includes increases to premium costs, coinsurance amounts, and deductibles for those using Part A and B plans.
In the case of Medicare Part B plans, the average premiums are increasing by around 10 percent, or nearly $18 a month, Allison Hoffman, a professor of law, and of medical ethics and health policy at the University of Pennsylvania, told Newsweek.
"For retirees on a fixed income, this increase can be a lot," she said.
While there are some increases for other plans, the changes are more "variable," she added. "For example, in Medicare Part D drug plans, some plans are increasing prices, although many are staying the same or decreasing."
The Centers for Medicare and Medicaid Services (CMS) also announced cost cuts for 15 more commonly used prescription drugs that treat chronic diseases including cancer, diabetes and asthma.
These cost cuts were shaped by the Inflation Reduction Act, brought in under the Biden administration, and will mean in 2026, a total of 25 drugs will have new negotiated Maximum Fair Prices (MFPs).
It is thought that the drug negotiations "will save money," Hoffman said. Also, enrollees "might experience some savings in cost sharing, but those savings won’t be dramatic for most people," she added.
Telehealth flexibilities—which allow Americans to access health care while still at home, a crucial benefit for those in rural areas and who find traveling difficult—are also set to end after January 30, 2026.
Some states are also testing a new Medicare model next year—including New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—not by choice, but as part of an experiment.
The model involves bringing in a prior authorization process relative to Medicare's existing processes, meaning recipients will either have to submit prior authorization requests for selected services, or their claim will be subject to pre-payment medical review, but it does not change Medicare coverage or payment criteria.
It will also involve "testing the use of [artificial intelligence (AI)] to review and reject inappropriate use of certain care that is considered low value," Hoffman said.
"Prior authorization and denials have been contentious in Medicare Advantage, and it might receive a similar reception in traditional Medicare," she said.
Hoffman said there is also going to be a decrease in the number of private Medicare Advantage plans and prescription drug plans being offered in some areas.
"This decrease might leave some areas of the country with no or few options in Medicare Advantage, and some people will lose their current coverage and have had to find an alternative," she said. "For some of these people, they are facing either higher premiums than they paid before, or less comprehensive coverage."
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