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Healthcare expert Jae Oh is cautioning others about sweeping disruptions to health coverage now that the One Big Beautiful Bill Act has become law.
Oh, an education fellow at the Alliance for Lifetime Income and author of “Maximize Your Medicare,” outlined how the legislation could reshape access to Medicaid, Affordable Care Act (ACA) coverage, and Medicare Advantage plans — potentially creating new financial burdens for millions of Americans, especially retirees and those without employer-based insurance.
“I do not lose sleep over changes, for example, to the [Medicare] eligibility rules,” Oh said on a recent episode of the Decoding Retirement podcast recorded before President Trump signed the bill into law. “That said, I would say that enrolling correctly, in a timely fashion, not overpaying, not underpaying, not having lapses in coverage, that entire process has become more complicated through time.”
17 million could lose Medicaid coverage
The most immediate concern centers on Medicaid work requirements, which now require recipients to prove they’ve worked at least 80 hours per month to maintain eligibility.
According to the Congressional Budget Office (CBO) and KFF, an estimated 17 million Americans could go without health insurance due to Medicaid cuts and changes to the Affordable Care Act.
This change follows the unwinding of pandemic-era Medicaid, which has already led to widespread disenrollment — sometimes without recipients knowing.
“What was already complicated looks to become even more so,” Oh warned. “People are being ejected today and aren’t necessarily aware.”
His advice? Check your status monthly. Oh recommended that current Medicaid enrollees contact their state’s Department of Health and Human Services regularly to verify eligibility, as the verification process has become increasingly burdensome.
Millions could lose ACA subsidies — and face a premium shock
For those who buy health insurance through the ACA marketplace, the looming expiration of enhanced Advanced Premium Tax Credits (APTC) at the end of 2025 presents a serious financial threat.
“Without [the credits], this is, in effect, inflationary,” Oh said.
Thanks to these subsidies, the average ACA marketplace enrollee paid just $113 per month in 2025, according to KFF data.
But without them? “If you thought that the average adult health insurance premium would be $500 a month higher, that’s now $6,000 [per year],” Oh explained. “And a married couple — that’s $12,000 a year as far as the cost of living. Well, that by definition is inflation.”
Households already spend 8% of their total annual expenditures on healthcare, per the Bureau of Labor Statistics. If the Advanced Premium Tax Credits subsidies vanish, that share could climb substantially, particularly for middle-income families.
Premium-setting for ACA plans is already a complex and unpredictable process. But increased utilization, combined with the loss of subsidies, could destabilize the marketplace further.
Oh noted that declining enrollment would only compound the challenge.
“The carriers depend on the people who do not require healthcare services to pay for those who do,” he said. “So, to the degree that the total pool declines, could that make it even more challenging? I think that is safe as far as a prediction goes.”
Some projections suggest that 4 million to 8 million people could lose access to ACA subsidies if the enhanced APTC ends. But Oh believes even that may understate the risk.
“I think, if anything, that sounds too low to me,” he said. “And this is raising my concern for people who are not covered by their employer. They have to fend for themselves and choose an individual or a family plan using HealthCare.gov or their state-specific health insurance portal.”
If you rely on ACA coverage, now is the time to prepare. Use the KFF ACA Marketplace Premium Calculator to estimate what your premiums could look like in 2026 — with or without subsidies.
“You’ve got to run the numbers,” Oh said. “If subsidies disappear, people will need to reassess everything— from coverage levels to savings goals.”
Medicare Advantage plans may see cuts
Current Medicare beneficiaries also face growing uncertainty. Oh pointed to worrisome trends in Medicare Advantage (MA) plans, where insurers are reporting elevated medical utilization, leading to higher costs that could soon be passed on to enrollees.
“The question is whether or not you are going to have the same quality of packages of benefits,” Oh said. “That is an open question.”
This could mean reduced benefits, narrower networks, or higher out-of-pocket costs for the 30 million-plus Americans enrolled in MA plans.
With that in mind, Oh stressed that this year’s Medicare Annual Election Period — running from October 15 to December 7 — will be more important than ever.
“Don’t let inertia guide your decisions,” Oh advised. “This year, more than ever, it will be essential to actively compare plans rather than automatically reenrolling in the same coverage.”
For recently laid-off workers, the decision between continuing coverage through COBRA or using an ACA marketplace plan is becoming even harder.
COBRA provides continuity: the same doctors, networks, and benefits. But it’s costly. Former employees are responsible for the full monthly premium — often more than $800 for individual coverage and even more for families — since employer contributions disappear.
ACA marketplace plans may offer cheaper options, for now. But if APTC subsidies expire, those plans could quickly become unaffordable too.
“Comparing benefits, provider networks, and total costs between COBRA and ACA plans is complex,” Oh said. “It’s a burden that usually falls on the individual, not HR departments.”
Read more Yahoo Finance coverage on the Big Beautiful Bill Act:
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How the big, new tax law affects your money
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How Trump’s tax bill could affect the healthcare industry
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Have a mortgage? Trump’s tax law might give you new deductions.
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How Trump accounts work — and why financial experts don’t love them
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What does “no tax on tips” really mean?
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Trump bill brings big changes to 529 plans
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HSA changes in Trump’s tax bill
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How 2 business world changes to Trump’s megabill helped push the price tag $1 trillion higher
Got questions about retirement? Email Robert Powell at yfpodcast@yahooinc.com, and we’ll do our best to answer it in a future episode of Decoding Retirement.
Each Tuesday, retirement expert and financial educator Robert Powell gives you the tools to plan for your future on Decoding Retirement. You can find more episodes on our video hub or watch on your preferred streaming service.
