Big Changes Are Coming to Medicare — Here’s What You Need to Know

While many headlines focus on Medicaid and Affordable Care Act changes, a quiet but powerful shift is happening behind the scenes with Medicare — and it could have serious consequences for millions of Americans. If you’re a low income senior or someone with a disability who relies on Medicare, these changes could directly impact your access to healthcare, your out-of-pocket costs, and the coverage you count on.

Let’s break it down in simple terms, so you know exactly what’s happening — and what you can do to stay protected.

Medicare Faces Nearly $500 Billion in Cuts Over 10 Years

A report from the Congressional Budget Office reveals that Medicare could be facing automatic funding cuts of nearly $500 billion over the next decade. These cuts are triggered by a law known as the PAYGO Act of 2010, which requires across-the-board cuts when new legislation increases the federal deficit. These cuts were specifically triggered by the passage of the One Big Beautiful Bill Act, which increased the federal deficit and activated automatic spending reductions under PAYGO rules.

Unless Congress acts to stop it, these cuts could begin as early as 2026. Even though 4% per year might not sound like a huge amount, for a program as large and essential as Medicare, it can result in serious reductions in services, payments to providers, and coverage access. These changes won’t just affect new enrollees — they’ll ripple across the system, creating longer wait times, fewer available services, and higher out-of-pocket costs for many.

AI-Based Pre-Approvals Coming to Six States

In addition to funding cuts, Medicare is launching a pilot program that could change how care is approved and delivered in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. This pilot will require prior authorization for certain medical procedures — meaning doctors will need to get approval before providing care.

Traditionally, people on Original Medicare have not needed prior approval for most services. But under this new model, Medicare will use artificial intelligence (AI) tools to assist in reviewing requests before procedures are approved. While final decisions are supposed to be made by licensed clinicians, there’s growing concern that this process could lead to delays in care and increased denials — especially for low income patients.

Some lawmakers argue that calling this pilot “voluntary” is misleading, since doctors in the test states may be required to comply if they want to be paid. This means that even though it’s technically a test program, its impact could be very real for the people living in those areas.

Why This Matters for Low Income Medicare Beneficiaries

If you’re living on a limited income and relying on Medicare, you may be more vulnerable to these changes than most. Research shows that low income patients are more likely to experience denied claims — and less likely to file appeals. When access to care becomes more complicated, it’s the most vulnerable patients who pay the highest price.

That’s why it’s so important to be proactive. If your care is denied, don’t stop there. You have the right to appeal. Make sure to request the denial reasons in writing, gather any medical records or supporting documents, and follow the appeals process step-by-step. Help is available through organizations like the Medicare Rights Center and local legal aid providers, who can walk you through what to do next.

You can also contact your elected representatives in Congress. Ask them to oppose automatic Medicare cuts and demand more transparency in how changes like prior authorization are implemented. It’s essential that low income seniors and people with disabilities are protected from policies that make healthcare harder to access.

Relief Recap

Medicare is going through a wave of changes that could make it harder for many people to get the care they need — especially those with limited incomes. Between funding cuts and new pre-approval rules rolling out in several states, it’s more important than ever to stay informed, review your options, and speak up for your rights.

If you’re affected by these changes, take action now. Appeal denials, reach out for help, and make your voice heard. These changes might be happening quietly, but their impact could be felt loudly — and together, we can push back.