What Trump Has Done With Medicare So Far

The Trump administration’s second-term policy focuses on deregulation and structural reforms aimed at cost reduction. The stated platform emphasizes protecting core Medicare benefits, with a commitment to maintaining current eligibility ages and premium structures. Throughout his first year in office, Trump has announced several initiatives and changes that impact Medicare and Medicare beneficiaries.

Medicare is the primary health insurance for adults age 65 and older. It also covers those with certain disabilities or illnesses, such as end-stage renal disease or Lou Gehrig’s disease. Over 67 million people were enrolled in Medicare (including both original Medicare and Medicare Advantage plans) in 2025, according to the most recent data from the Centers for Medicare & Medicaid Services (CMS) and the Kaiser Family Foundation (KFF). That number is expected to grow to 68 to 69 million over the next few years, according to current projections.

Medicare spending reached approximately $1.1 trillion in 2024 (the most current data), accounting for about 21% of total national health expenditures and roughly 12-14% of federal spending in recent years, per KFF.

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Some changes in Trump's One Big Beautiful Bill (OBBB) lower costs for seniors, while others raise concerns about privatization and eligibility for certain lawfully present immigrants. However, although Trump promised sweeping changes to the program (some of which were present in the House bill), only one change ultimately made it into the final version.

Here's a look at what has changed for Medicare in the OBBB, as well as other changes the administration has made so far.

A separate story looks at what Trump has done with Social Security so far.

Changes to Medicare in Trump's OBBB

Restrictions on eligibility. Current law excludes anyone in the U.S. from unlawfully receiving Medicare benefits. The law states that to be eligible to enroll in Medicare as a retiree, you must be 65, have worked for 10 years, and be either a U.S. citizen or have been a permanent resident of the U.S. for at least five consecutive years.

Trump's OBBB eliminates Medicare eligibility for some immigrants, including refugees, asylum seekers and those with Temporary Protected Status. The work and age requirements are unchanged.

The Senate version of the bill allowed for certain immigrants from Haiti to be eligible for Medicare; they would join certain Cuban immigrants who have entered the U.S as defined in the Refugee Education Assistance Act of 1980. The Senate bill also terminated Medicare benefits no later than 18 months from enactment (of the legislation) for anyone who is currently receiving benefits but is no longer eligible under these changes. These provisions were included in the bill and signed into law.

Delayed rules for low-income enrollees. The fulfillment of two finalized rules that would have made it easier for very low-income Medicare enrollees to access Medicare Savings Programs (MSPs) has been delayed until October 1, 2034.

Potential future cuts to Medicare are possible. If and when further congressional action is taken, the bill is projected to generate an estimated $490 billion in Medicare cuts between 2027 and 2034 due to a statutory pay-as-you-go (PAYGO) law.

Expansion of drug price negotiation program

In May, the Trump administration announced an expansion of the Inflation Reduction Act's drug price negotiation program to include Medicare Part B drugs for the first time. This action added to Trump's earlier efforts to negotiate drug prices during his first term, which were later rescinded by the Biden administration.

Expanded Medicare and Medicaid coverage for obesity drugs

The Trump administration moved forward with expanding Medicare and Medicaid coverage for obesity treatments, specifically GLP-1 drugs like Wegovy, Zepbound, Ozempic, Mounjaro, and Rybelsus, when used for chronic weight management in obese patients.

This reversed the administration's initial April 2025 decision not to finalize the broad Biden-era proposal in the CY 2026 Medicare Advantage and Part D final rule, which cited prohibitive costs — projected $35 billion added to Medicare from 2026–2034.

The changes emerged through a series of November–December 2025 announcements by the administration, such as negotiated "most-favored-nation" pricing deals with drug manufacturers (slashing costs by up to 80%), enabling coverage under new voluntary payment models like the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) model for Part D and a similar "Weight-Loss Drug Coverage Model" for Medicare and Medicaid.

The stated objective is to initially cover around 10% of Medicare beneficiaries while also controlling federal spending. CMS has begun implementing these through the Medicare Drug Price Negotiation Program (MFP), with negotiated prices recently announced for select GLP-1s.

Read: Medicare to Cover Obesity Drugs Under Trump Deal for as Little as $50. What You Need to Know

Medicare premiums on the rise

In 2026, Medicare beneficiaries will see an increase in their Part B premiums to $202.90, a higher Part D deductible of $615, and a rise in the Part D out-of-pocket cost cap to $2,100. Other changes include potential reductions in negotiated drug prices, stricter rules for extra benefits in Medicare Advantage plans, and the introduction of enhanced security measures.

Part B premium: The premium is $202.90 per month in 2026, up from $185 in 2025.

Part D deductible: The maximum deductible rises to $615. That's up from $590 in 2025.

Part D out-of-pocket cap: The cap on out-of-pocket prescription drug costs will be $2,100 in 2026, up from $2,100 in 2025.

Read: What You Will Pay for Medicare in 2026

Prescription drug costs

Prescription drug coverage will change for some high-cost drugs, while costs for others remain the same in 2026. The $35 monthly cap on insulin costs is expected to continue — capped at the lowest of $35, 25% of the maximum fair price, or 25% of the negotiated price, according to the CMS.

However, prices for some high-cost drugs might be negotiated further, which could lead to lower costs for enrollees. Auto-enrollment into the Medicare Prescription Payment Plan will be available for eligible beneficiaries and recommended vaccines for senior citizens will continue to be covered at no cost.

Medicare Advantage and Part D plans

Stricter rules could mean fewer extra benefits for Medicare beneficiaries as plans face tighter spending restrictions. For instance, the average monthly premium for Medicare Advantage plans is expected to decrease slightly to $14.00 (down from $16.40 in 2025), while perks such as grocery cards and transportation may get cut.

Medicare and Medicaid job cuts

Proposed Medicare and Medicaid budget cuts for 2027 are projected to result in significant job losses, particularly in health care. A recent report (June 25, 2025) estimates that federal cuts could lead to nearly 500,000 health care job losses by 2029, and combined with cuts to other programs like SNAP, the total job losses could exceed one million across various sectors.

“We aren't just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Health and Human Services Secretary Robert F. Kennedy Jr. said. “This department will do more — a lot more — at a lower cost to the taxpayer.”

Read: Trump Buyouts Spread to More Government Agencies: If You're Near Retirement, Should You Take a Buyout?

Medicaid: Taking center stage

Although not directly related to Medicare, it's worth mentioning that Medicaid, the state and federal program that provides health coverage for millions of low-income Americans (about 23% of the U.S. population), is at center stage in Congress’s bid to pass Trump’s sweeping agenda.

In simple terms, Republicans want to reduce the cost of the $909 billion program as part of a long-term plan to cut federal spending and implement Trump’s tax cuts and his border and energy measures. Democrats adamantly oppose cuts to the program.

Major cuts to federal Medicaid spending are planned, notably through the One Big Beautiful Bill Act, which seeks to reduce spending by approximately $900 billion over 10 years. These cuts are being implemented through several provisions, including reductions in provider taxes and state-directed payments, as well as pausing rules for easier enrollment.

Work reporting requirements are also among the changes outlined. These changes could result in millions of people losing health insurance and will disproportionately affect states that previously expanded Medicaid.

Read: What a Federal Grants Pause Could Have Meant for Social Security and Medicare

Increases in Part B Premium and Deductibles

The standard monthly Part B premium rose to $202.90 in 2026 (up $17.90 from $185 in 2025), and the annual deductible increased to $283 (up $26 from $257). CMS credited administration actions, such as cuts to skin substitute spending in the 2026 Physician Fee Schedule, with preventing an even larger premium hike of around $11 per month.

Medicare Advantage payment boost

Per the CMS, government payments to Medicare Advantage plans increased by an average of 5.06% for 2026, higher than initial estimates due to updated fee-for-service data, contributing to stable plan options (approximately 5,600 plans nationally) and declining average premiums.

However, this has drawn criticism for favoring insurers without stronger prior authorization guardrails.

The Inflation Reduction Act's Medicare Drug Price Negotiation program is continued

Beyond GLP-1s, the CMS has continued the Inflation Reduction Act's Medicare Drug Price Negotiation Program, with Maximum Fair Prices for the first ten selected Part D drugs — Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and certain insulins — with projected savings of $6 billion annually for Medicare and $1.5 billion in beneficiary out-of-pocket costs. A second round of negotiations for 15 more drugs was announced in late 2025, with MFPs set for 2027, according to the CMS.

The Trump administration has also advanced Most-Favored-Nation pricing through voluntary models from the Center for Medicare and Medicaid Innovation (CMMI), including the GENEROUS Model, launched in January 2026, for Medicaid supplemental rebates and the proposed GLOBE Model, for certain Part B drugs like cancer therapies, with a proposed launch in October 2026, to impose rebates if U.S. prices exceed global competitors.

These efforts tie into reduced prices via the TrumpRx.gov platform, launched in early 2026. The platform doesn't sell drugs but instead connects patients to discounted most-favored-nation rates from participating manufacturers.

Rural health investments

OBBB created the $50 billion Rural Health Transformation Program. CMS awarded funds in early 2026 to modernize rural care, directly benefiting Medicare beneficiaries in those areas.

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