Thanks to President Trump’s Big Beautiful Bill, a Biden-era plan to expand access to Medicare assistance has been pushed back to 2034. (1)

The plan, which was finalized in 2023, was created to boost enrollment in state-run Medicaid programs that assist qualified older Americans with paying for out-of-pocket Medicare costs. (2)

The objective was to provide health care to people who are eligible but often deterred by institutional barriers by automating the application process for people who already qualify for Medicare’s Part D Low-Income Subsidy and automatically enrolling some Medicare beneficiaries.

According to the National Council on Aging, nearly 5.8 million low-income older adults are eligible for programs that can help them pay for Medicare costs but are not enrolled. (3)

For many older Americans, especially those on fixed incomes already stretched by rising prices, this could mean the difference between continuing to go without care or getting access to life-preserving help.

“These programs are meant to make it easier for people with very limited incomes to afford health care,” Frederic Riccardi, president of the Medicare Rights Center, shared with the New York Times. “This is a real setback.” (1)

This news also shifts the burden of finding existing federal help back onto those eligible for it, a bureaucratic move to reduce demand by increasing the amount of friction citizens have to endure to get their benefits.

The cost of Medicare is rising at a time when many older Americans can least afford it. In 2025, the standard Medicare Part B premium is $185 a month, up from $174.70 in 2024. Deductibles and cost-sharing amounts are also climbing, adding more pressure to fixed budgets. (4)

Even before these increases, Medicare households already faced heavy financial strain. In 2022, the average Medicare household spent roughly $7,000 on health care, nearly twice what non-Medicare households spent, according to data from KFF. (5)

Many older Americans now delay or skip medical care because they cannot afford their prescriptions, doctor visits or dental work. These higher costs come as older Americans are already battling rising prices for essentials such as food, housing and utilities. Inflation may have eased overall, but retirees on fixed incomes have seen their purchasing power erode over the last five years.

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KFF also found that out-of-pocket health care spending by Medicare beneficiaries in 2022 was 39% of an average person’s Social Security income (6), and proposed premium increases will wipe out most of the cost-of-living increases in retirees’s benefits.

Health care is one of the biggest and most unpredictable expenses retirees face. A 65-year-old retiring today can expect to spend about $172,500 on health care over the course of retirement, not including long-term care. (7)

In 2020, average per-person health care spending for adults 65 and older was more than $22,000, far higher than for younger Americans, according to data from the Centers for Medicare and Medicaid Services. (8)

Costs often rise sharply with age, as long-term care, prescription drugs and hospitalizations become more frequent. As a result, a single health crisis for an older American senior has the potential to wipe out their savings.

For older adults who retired from lower- and middle-income occupations, the financial risk is even greater. Since many couldn’t save enough to absorb unexpected medical bills, even small increases in premiums or co-pays can lead them to skip preventive care or delay necessary treatment.

These pressures can force people to dip into retirement savings, return to the workforce or take on debt just to stay healthy. As the new federal budget rules tighten access to Medicare assistance, the gap between wealthy and struggling retirees is likely to grow.

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Applying for Medicare under the new rules now requires more planning and paperwork. Older Americans must first confirm that they still meet the updated income thresholds for assistance programs and be prepared to provide proof of income and assets more frequently.

The new law also tightens enrollment windows and re-certification periods, meaning there is less flexibility for late applications or missing deadlines. (9)

To avoid costly gaps in coverage, older adults should start the process early and make sure they have all the required documents — like tax returns and income statements — and that these documents are accurate and up to date.

Those seeking help with premiums or prescription costs should continue applying for programs like Extra Help or other low-income subsidies, if eligible. It’s also important to watch for official notices from Medicare or the Social Security Administration and respond promptly to any requests.

Missing a letter or failing to reapply on time could result in losing coverage or having to pay higher costs out of pocket. Even small income changes can trigger a reassessment of eligibility, so retirees need to monitor their finances closely and be ready to appeal decisions through a state health insurance assistance program if necessary.

In this new environment, vigilance and preparation are the best ways to protect access to affordable health care.

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New York Times (1); Federal Register (2); National Council on Aging (3); Centers for Medicare and Medicaid Services (4, 8); KFF (5, 6, 9); Fidelity (7)

This article provides information only and should not be construed as advice. It is provided without warranty of any kind.