Written and medically reviewed by Dorcas Morak, Pharm.D
A major transformation in U.S. healthcare policy is underway. Signed into law on July 4, 2025, the One Big Beautiful Bill Act (Public Law 119-21) significantly reshapes Medicaid and Affordable Care Act (ACA) programs. With stricter eligibility rules, reduced federal incentives, and fewer prescription drug protections, this law may affect coverage and affordability for millions—especially immigrants, low-income individuals, and the uninsured.
Here’s a breakdown of what’s changing, when it will take effect, and how you can still save on your medications using the RxLess® Assurance Plan.
What’s Changing with Medicaid Eligibility? Effective Immediately (July 2025):
- States must reintroduce full eligibility documentation and stop using automatic redetermination processes.
January 1, 2026:
- Federal incentives for Medicaid expansion will end. States that have expanded under the ACA may slow or reverse expansion efforts due to funding loss.
October 1, 2026:
- Medicaid eligibility will be limited to:
- U.S. citizens
- Lawful permanent residents
- Select humanitarian categories
- This change excludes individuals with Temporary Protected Status (TPS), refugees, and DACA recipients.
- Work requirements (80 hours/month) will be enforced for non-disabled adults without dependents, with penalties for non-compliance.
These changes may result in more than 10.3 million people losing Medicaid coverage by 2034, according to the Congressional Budget Office.
How Will ACA Marketplace Plans Be Affected?
Beginning December 31, 2026, additional ACA restrictions will take effect:
- The open enrollment period will be shortened by one month, ending December 15.
- Special enrollment periods will require stricter documentation and income verification.
- ACA subsidies will be revoked for:
- DACA recipients
- Individuals earning below 100% of the Federal Poverty Level (FPL)
These changes may cause a "subsidy cliff," where some individuals no longer qualify for assistance and can no longer afford coverage. Approximately 4.2 million more people may become uninsured by 2034 if enhanced ACA subsidies expire.
Prescription Costs Are Likely to Rise
Without Medicaid or ACA subsidies, many Americans will pay significantly more for vital medications, including:
- Specialty medications: Ozempic, ,Humira, Eliquis, Lantus
- Common generics: Metformin, Amlodipine, Amoxicillin
The law also expands the number of drugs excluded from Medicare price negotiations, reducing access to lower-cost alternatives and contributing to overall price increases.
Other Key Impacts
Planned Parenthood & Reproductive Care The law places funding restrictions on Planned Parenthood and similar providers, removing Medicaid reimbursements when annual thresholds are exceeded. However, a federal injunction in July 2025 restored access to preventive care and contraception services at these clinics nationwide—at least temporarily.
Supreme Court Decision Limits Enforcement
In Medina v. Planned Parenthood, the U.S. Supreme Court ruled that private individuals and providers can no longer sue states for failing to uphold Medicaid obligations. This further limits legal avenues to challenge reduced access.
What Can You Do If You Lose Coverage or Face High Drug Costs?
Use a Prescription Savings Program: The RxLess® Assurance Plan offers free, no-obligation discount cards accepted at over 70,000 pharmacies nationwide. You can search for the lowest real-time prices on medications like:
Ask About Affordable Alternatives: If prescribed an expensive brand-name drug like Eliquis or Ozempic, ask your pharmacist or doctor about generic or therapeutic equivalents such as warfarin or metformin.
Compare Pharmacy Prices: Drug prices vary widely between pharmacies—even within the same ZIP code. The RxLess® Assurance Plan helps you locate the lowest price in your area with no login required.
Stay on Top of Deadlines: Avoid losing coverage due to paperwork delays or missed enrollment dates. Set calendar alerts and maintain digital or paper copies of all verification documents.
What If You’re Uninsured?
Even if you are uninsured due to immigration status or affordability, you can still save. The RxLess® Assurance Plan is:
- Free to use
- No sign-up or personal information required
- Accepted at major chains (CVS, Rite Aid, Walgreens, Walmart) and thousands of independents
Final Thoughts
The One Big Beautiful Bill Act brings profound changes to American healthcare, with millions potentially losing access to Medicaid or subsidized insurance. But you still have control over how you manage your prescription costs. By using the RxLess® Assurance Plan, you can access discounts, compare prices, and avoid paying more than you need to—no matter your insurance status. Download the free app and start saving.
