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Medicare and Medicaid changes, explained

What changes in 2026 and 2027, and what to do. Last reviewed October 12, 2026.

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What’s changing

Four changes worth knowing, and what to do about each.

Medicare open enrollmentOct 15 to Dec 7, 2026

Switch Medicare Advantage plans, or move between Original Medicare and Advantage, for 2027 coverage. More Advantage plans now offer in-home support, often on a prepaid flex card. It is most common in special needs plans and varies by plan and county.

Before you pick a plan, check

  • Whether it lists in-home support services, and how many hours a year
  • Who provides it: the plan, a vendor, or any licensed agency
  • Whether you need a diagnosis, referral or assessment first
  • What the flex card covers, and whether unused money expires

Tell us the plan name and we’ll help you read the benefit. We don’t sell insurance.

Medicaid work requirementsBy Jan 1, 2027

Under the July 2025 federal budget law (Public Law 119-21), Medicaid expansion adults aged 19 to 64 must show 80 hours a month of work, community service, job training or school. States must start by January 1, 2027, and may start earlier. Most people 65 and older are not affected.

Who is exempt

  • People who are medically frail, including people who are blind, living with a disability, or with a serious or complex condition
  • Parents, guardians and family caregivers of a child 13 or younger, or of a person with a disability
  • People who are pregnant or postpartum, and other groups set by the law

If you care for a family member with a disability, make sure your Medicaid case shows it. Update it through ABE (abe.illinois.gov).

Renewals every six monthsFrom Jan 2027

Expansion adults will be rechecked every six months instead of yearly, and retroactive coverage drops to one month. Most people who lose coverage lose it over missed paperwork.

  • Keep your address, phone and email current with the state
  • Answer every Medicaid letter by its due date
  • Put your renewal month on the calendar
Dementia respite through GUIDEJuly 2024 to 2032

GUIDE is an eight-year Medicare program for people living with dementia and their family caregivers. Medicare pays participating programs up to about $2,500 a year for respite, depending on the year and the person’s needs. The money goes to the program, not the family, and doesn’t roll over.

GUIDE is generally for Original Medicare, not Medicare Advantage. Ask the doctor or memory clinic if they take part.

What Original Medicare covers at home

No change here. It is short-term skilled care, not everyday help.

  • Skilled care a doctor ordersShort-term, usually after a hospital stay, for someone mostly homebound.
  • Not ongoing daily helpBathing, dressing, meals and housekeeping aren’t covered. See the other ways to pay.
  • MedicaidVitalTouch doesn’t bill Medicaid yet. If Medicaid is the right route, we’ll point you to an agency that can.
Original Medicare at homeWhat it pays for
No change
  • Short-term skilled care a doctor orders
  • Bathing and dressing
  • Meals
  • Housekeeping
Other ways to paySee all six

If your coverage changes

Care doesn’t have to wait on paperwork.

  • Start now, switch laterPay on your own while a benefit is pending, then switch over.
  • Change hours any timePause, add or cut hours. No long contracts.
Care planSample weekly schedule
Change any time
BathingMealsMedication remindersErrands
14 hrs / weekPaying on your own

Sources

General information, not legal or benefits advice. Rules and dates can change, and states have some choices in how they apply them. Confirm anything important with Medicare or the Illinois Department of Healthcare and Family Services.

Questions about your coverage?

Tell us what you have. We’ll help you read it.

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