Whenever a new president takes office, there’s an air of uncertainty about what lies ahead. This is especially true when it comes to healthcare policy. While it’s still too early to know how Medicare, Medicaid, and insurance regulations may shift under the new administration, some potential changes could impact patients’ ability to afford care. This leaves financial assistance teams wondering how best to prepare.
In these uncertain times, staying informed and adaptable is key to supporting patients. Here are the top policies financial navigators, pharmacy technicians, and other professionals should monitor over the coming months:
1. The Affordable Care Act
The new administration has already announced changes that impact enrollment in insurance plans offered through the Affordable Care Act’s Marketplace. For example, President Trump reversed President Biden’s executive order that extended enrollment periods for ACA plans in most states; Biden’s order also provided extra funding for third-party organizations that helped patients enroll. The rescinded policy gave patients an additional 12 weeks to sign up in 36 states, contributing to significant increases in ACA enrollment.
These changes won’t affect patients this year, since the deadline for ACA open enrollment was December 15. However, navigators should be mindful of this shift for 2026, paying special attention to enrollment periods. Insurance optimization should be the first priority, and navigators should follow up when patients are eligible to enroll. In the interim, they should look to other resources, such as copay assistance, free drugs, and bridge programs to help patients afford the care they need.
Another potential shift to watch: During the Biden administration, we saw enhanced government subsidies that lowered the costs of ACA premiums. These subsidies are set to expire at the end of 2025. We don’t yet know whether Congress will act to extend them.
2. Medicare Reform
The 2022 Inflation Reduction Act (IRA) had major implications for patient affordability. For example, the legislation included a provision adding a $2,000 cap on Medicare Part D out-of-pocket spending. The provision, which took effect this year, has the potential to save Part D beneficiaries with high-cost diagnoses thousands of dollars annually. Another provision imposed a $35 cap on monthly out-of-pocket insulin costs for certain Medicare programs. Medicare beneficiaries make up about half of insulin users in the United States. 37.5% paid more than $35 a month before the IRA cap took effect in 2023.
It’s important to note that the IRA can only be repealed through new legislation, not through an executive order. While President Trump did reverse a previous executive order on prescription drug costs, this reversal does not impact the $35 insulin cap.
The IRA also required the federal government to negotiate prices for some high-cost drugs under Medicare. Although the new administration has not signaled any plans to block this effort, it has communicated possible changes to the negotiating process. It remains to be seen how the process will be revamped—and how this will impact efforts to lower drug prices.
3. Medicaid Coverage
Medicaid provides health and long-term care to one in five low-income Americans. While the situation remains unclear, some policy experts predict changes that could affect Medicaid coverage and access to care. According to the Kaiser Family Foundation (KFF), these potential changes could include federal funding cuts and financing reforms; this may mean imposing work requirements for coverage and repealing incentives for states to adopt Medicaid expansion.
Last month, the Trump administration issued a memo freezing federal financial assistance, causing confusion over whether Medicaid was affected. The White House later clarified that Medicaid was exempt. However, many providers reported being unable to access the Medicaid payment portal. While officials say the portal’s temporary shutdown was unrelated to the spending freeze, uncertainty remains about the future of Medicaid. It’s clear there are many issues at play with potential implications for the more than 70 million Americans who depend on Medicaid for essential healthcare.
Staying Vigilant in Uncertain Times
In these early days of the Trump administration, we don’t yet have a clear picture of how the healthcare landscape will evolve. Effective financial navigation will require staying informed about policy changes, particularly in the areas listed above. It’s worthwhile to sign up for news alerts from health policy organizations like KFF as well as updates from professional groups such as the Academy of Oncology Nurse & Patient Navigators (AONN).
Navigators should also proactively prepare to address patients’ changing needs. Above all, this means keeping an eye on patients’ insurance coverage, steering them toward affordable plans, and matching those in need with relevant cost-saving resources. Now more than ever, financial assistance teams can be a lifeline for patients—helping them afford and access the care every American deserves.
To learn more about how TailorMed can help remove barriers to care for your patients, contact our team.
