Medicare Changes Under HR-1: What You Need to Know
5 min read
If you're one of the 65 million Americans on Medicare, you might be wondering how the new One Big Beautiful Bill Act (HR-1) will affect your healthcare. The good news? Medicare faces far fewer changes than other government programs.
The not-so-good news? The changes that are happening could significantly impact the quality of care in nursing homes.
Here's what you need to know about how HR-1 affects Medicare, broken down in plain language.
And to stay up-to-date on all things benefits, subscribe (for free) to BenefitKarma.
The Big Picture: Medicare Stays Mostly the Same
The One Big Beautiful Bill Act (HR-1) brings a major overhaul to government benefits, but unlike the big changes coming to Medicaid and the widespread SNAP cuts, Medicare's core structure remains untouched. Your eligibility requirements, benefits, premiums, and coverage options aren't changing. What is changing involves nursing home care quality and some behind-the-scenes administrative stuff.
What About Medicare Part E?
You might have heard about a proposed "Medicare Part E" – that's a separate piece of legislation called the Choose Medicare Act, reintroduced in June 2025 by House Reps. Jimmy Gomez and Don Beyer. This bill is completely separate from HR-1 and would need to pass Congress on its own. It's worth keeping an eye on if you're interested in more Medicare options, but it's not part of the current changes we're discussing.
The Major Problem: Nursing Home Care Gets Pushed to the Back Burner
Back in 2024, the government put new rules in place to fix chronic understaffing problems in nursing homes. These rules required:
Minimum numbers of registered nurses and nursing assistants
Better staff-to-resident ratios around the clock
More training for nursing staff
Better oversight to make sure facilities actually follow the rules
What's Happening Instead
HR-1 hits the pause button on these improvements until 2035 (a decade away). This means nursing homes can keep operating with whatever staffing levels they have now, even if those levels put residents at risk.
Why This Matters to You
Most people in nursing homes are on Medicare, either getting short-term care after a hospital stay or long-term care where Medicare covers medical services. With staffing requirements on hold, you might face:
Longer waits when you press your call button
Less one-on-one attention from staff
Higher risk of medical errors because staff are rushing
Less time for physical therapy and rehabilitation
If you have a loved one in a nursing home or might need nursing home care yourself, this delay means you'll need to be extra careful about researching facilities and advocating for good care.
Administrative Changes: Mostly Behind the Scenes
HR-1 also makes some administrative changes that shouldn't affect your day-to-day Medicare experience much:
Better tracking of deceased enrollees: Medicare will check death records every three months and remove people who have died from the rolls. This should reduce fraud, though there's always a small chance of computer errors that might temporarily affect living people.
Stricter oversight: The law introduces more thorough verification processes and fraud prevention measures. You might experience minor delays in claims processing during the transition, but your coverage shouldn't be affected.
Changes for low-income Medicare help: The bill makes it harder for low-income Medicare beneficiaries to sign up for programs that help pay their premiums. This could affect people who qualify for extra help with Medicare costs.
Changes for immigrants: The law also limits Medicare benefits for immigrants in certain groups, restricting eligibility to green card holders and other specific categories rather than all who are "lawfully present" in the U.S.
Provider payment changes: The law also limits how much healthcare providers can be paid when they serve both Medicare and Medicaid patients, which could indirectly affect Medicare beneficiaries if providers become less willing to accept Medicare patients.
What You Should Do Now
The best way to deal with the myriad of changes associated with HR-1, your best bet is to stay vigilant and get your house in order.
If You're in a Nursing Home
Since federal staffing standards are on hold, you need to be your own advocate:
Keep detailed records of any care problems you experience
Don't hesitate to speak up if you're not getting the attention you need
Know that you have rights as a nursing home resident, including the right to file complaints
Contact your state's nursing home ombudsman if you have serious concerns
If You're Planning for Future Long-Term Care
With federal standards delayed, you'll need to do more homework:
Research nursing homes thoroughly before you need them – look for facilities that maintain good staffing levels voluntarily
Consider alternatives like home-based care or assisted living
Understand how Medicare and Medicaid work together to pay for long-term care
Consider talking to an elder law attorney about your options
For Everyone on Medicare
Keep your contact information updated with Medicare so you don't miss important notices
Continue doing your annual Medicare plan review – that hasn't changed
Keep good records of your Medicare coverage and healthcare documents
Stay informed about any changes that might affect you
When These Changes Happen
2025: The administrative changes take effect
2035: Nursing home staffing requirements finally kick in (assuming they don't get delayed again)
Getting Help When You Need It
For general Medicare questions:
Medicare.gov or call 1-800-MEDICARE
Your State Health Insurance Assistance Program (SHIP) offers free local help
For nursing home issues:
Medicare.gov has a nursing home comparison tool
Your state's Long-Term Care Ombudsman advocates for nursing home residents
Your state health department investigates nursing home complaints
The Bottom Line
HR-1's impact on Medicare is much smaller than its effects on other programs, but the nursing home staffing delay is a big deal if you or a loved one might need that level of care. The key is staying informed and being proactive about advocating for quality care, since you can't count on federal standards to do that job for the next decade.
Your Medicare benefits, coverage options, and eligibility requirements remain the same. The administrative changes happening behind the scenes should have minimal impact on your actual healthcare experience. But when it comes to nursing home care, you'll need to be extra vigilant about quality until those federal standards finally take effect in 2035.