Issue #3 · August 4, 2026
Big changes are coming to Medicaid and insurance costs. Here's what families need to hear.
If you've been following the news about Medicaid this summer, you already know something big is on the horizon. The 2025 budget reconciliation law requires states to implement Medicaid work requirements starting in January 2027. That means millions of Medicaid enrollees will soon need to prove they are working, volunteering, or participating in approved activities to keep their coverage. KFF is now tracking how each state plans to roll this out, including which states are seeking waivers and how renewal processes might change. For families who rely on Medicaid to help cover home health aides, nursing facility stays, or other elder care services, this is not an abstract policy debate. It is personal.
At the same time, insurers across the country are proposing a median premium increase of about 15% for ACA Marketplace plans in 2027. KFF analyzed filings from 276 insurers in all 50 states, and the trend is clear: coverage is getting more expensive. While most older adults on Medicare won't feel this directly, many family caregivers in their 50s and early 60s who buy their own insurance absolutely will. When a caregiver's own healthcare costs spike, it puts pressure on the entire family system. We've seen this pattern before, and it deserves attention now rather than in January when the bills start arriving.
Here's the thing about the Medicaid work requirements: they don't just affect the person whose name is on the Medicaid card. If your aging parent receives Medicaid-funded home health services, and the home health aide workforce in your state shrinks because workers lose their own Medicaid coverage, that affects your parent's care too. States have some flexibility in how they implement these rules, and several are already pursuing 1115 waivers that could exempt certain populations or modify the requirements. It is worth checking what your state is doing right now, because the details vary enormously.
If your family member is currently enrolled in Medicaid or dual-eligible for both Medicare and Medicaid, make sure their paperwork is current and their contact information with the state Medicaid office is up to date. During past Medicaid changes, huge numbers of people lost coverage simply because renewal notices went to old addresses. Don't let that happen to someone you love. You can check your state's Medicaid agency website or call them directly to confirm everything is in order.
Let's talk about what a 15% premium increase actually looks like in real dollars. If a 60-year-old caregiver is currently paying $800 a month for a silver-tier ACA Marketplace plan, a 15% hike means roughly $120 more per month, or about $1,440 more per year. Subsidies will absorb some of that cost for people who qualify, but not everyone does, and the subsidy calculations themselves may shift depending on what Congress does with the enhanced premium tax credits. For sandwich generation caregivers who are simultaneously paying for a parent's care and their own insurance, this kind of increase can be the thing that forces impossible choices.
If you're in this situation, now is a good time to review whether your family member's care costs could be covered differently. Medicare covers home health services when they are medically necessary and ordered by a physician, and the Medicare hospice benefit covers nearly all costs related to a terminal illness with little to no out-of-pocket expense for the patient. Many families we talk to are surprised to learn how comprehensive the hospice benefit actually is. If your loved one qualifies, it can free up significant financial breathing room for the whole family.
We know that keeping up with policy changes while also caring for someone you love is exhausting. That's exactly why we're here. Best Hospice and Home Health is a completely free service for families, and our only job is to connect you with verified hospice and home care providers in your area. If someone in your life is starting to ask hard questions about care options, please share this newsletter or send them to our website. No one should have to figure this out alone.