Here are the most important changes to Medicare in the One Big Beautiful Bill

Sweeping changes to Medicare may soon be on the horizon, thanks to new legislation advanced by House Republicans. Dubbed the "One Big Beautiful Bill," this massive legislative package-while primarily focused on tax reforms-includes major overhauls that could significantly reshape Medicare coverage, access, and benefits for millions of older Americans and low-income beneficiaries.

ed in the U.S. House of Representatives, the bill has sparked concern among healthcare advocates and senior citizens' groups, who warn that the proposed changes could roll back critical protections and increase financial pressures on already vulnerable populations.

The implications stretch beyond simple program tweaks, potentially leading to automatic funding cuts, stricter eligibility rules, and diminished access to long-term care .

How the GOP-backed bill could reshape Medicare for years to come

One of the most consequential aspects of the bill is its projected impact on the federal deficit. According to estimates, the legislation would add roughly $2.3 trillion to the deficit over the next 10 years. Under current PAYGO (Pay-As-You-Go) budget rules, this would automatically trigger spending cuts across various federal programs-including a 4 percent cut to Medicare funding starting in 2026.

If these automatic cuts take effect, they could reduce provider payments, limit services covered under Medicare, or increase wait times and out-of-pocket costs for enrollees. Health systems that rely heavily on Medicare reimbursements may also scale back services in response to decreased funding.

Another provision of the bill targets Medicare eligibility for certain immigrant groups. Current policy allows many lawful permanent residents-particularly those who have contributed to Medicare through payroll taxes-to qualify for benefits after meeting residency and work requirements. The new bill would revoke eligibility for many of these individuals, creating a new healthcare access gap among seniors who have spent decades contributing to the system.

This shift could leave thousands of older legal immigrants without coverage, forcing them to rely on emergency care or private insurance markets where s are often unaffordable.

Also under fire are proposed rollbacks to rules designed to simplify enrollment into Medicare Savings Programs (MSPs) and Medicaid-linked services. The Streamlining Medicaid Eligibility & Enrollment Rules, intended to improve access for low-income seniors, would be eliminated under the bill. This move could increase bureaucratic hurdles, making it more difficult for vulnerable populations to access assistance with s, deductibles, and co-pays.

In addition to changes directly tied to Medicare, cuts to Medicaid included in the bill could also hit seniors hard-especially those who rely on long-term care such as nursing home placement or in-home assistance.