Seniors Find Medicare Prices Manageable and Enrollment Easy Enough, But Worry Over Congressional Changes

Nearly 80% of the respondents in a July 2025 Caring poll have Medicaid, Medicare, or both. We asked them what the enrollment process was like, as well as their thoughts on H.R.1, the reconciliation bill that President Trump signed into law on July 4. Although many were puzzled over which health insurance coverage options they needed, overall, respondents felt enrollment went smoothly. Parts of H.R.1 gave them pause, and many appear focused on benefits they may not actually receive, while unaware of the way the proposed cuts will impact them.

In July 2025, as the once-titled Big, Beautiful Bill (H.R.1) was making its way through the 119th Congress, Caring used Pollfish to survey 7,000 Americans aged 60 or older about their health insurance coverage and the ways they expected H.R.1 would affect them.

It likely won’t come as a surprise to older adults that of the 7,000 people aged 60+ we surveyed, the majority are enrolled either in Medicare or Medicaid, or both. Both are federal programs, although the states administer Medicaid. Medicare is a health insurance program for older adults that most people pay into when working and benefit from once they turn 65. Medicaid, meanwhile, is health care insurance for low-income families, including children, disabled adults, and seniors.

Most older adults in our survey — a shade over 64% — use Medicare or Medicaid as their primary health insurance. Unexpectedly, 13.8% of respondents’ main health coverage is through a current employer, but this makes sense when you consider that one in three seniors in the workforce work full or part time as of 2024.

Nearly 11% of our respondents are retired or unemployed but still use an insurance plan offered by a former employer, which is common in sectors like state and federal government, and education. A very small subset of respondents uses COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act; COBRA allows employees and their families to temporarily continue employer-sponsored health insurance after a qualifying event, such as job loss. 

Meanwhile, 10.14% of respondents have an individual health plan through the Affordable Care Act (ObamaCare). A few — just over 1% — participate in a health share plan. This type of coverage is unregulated by the government and involves members pooling their money to help cover each other’s medical costs. Many of these groups are church-based.

Medicare and Medicaid are complex, multi-part programs, and the possibility of confusion is high. We’ll talk about that later on, but we found it interesting that more than 88% of seniors polled felt that their insurance coverage, regardless of provider, was covering exactly what they thought it would be. 

This suggests that the website and promotional materials for both these programs and the private insurance our respondents have are doing a good job of outlining what the plans cover.

That sentiment wasn’t universal, however. When we asked seniors what part of being insured by Medicare was harder than they thought it would be, one of the most common replies was some variation of “determining coverage options was difficult.”

“Too often, many new Medicare enrollees ask seniors they know which plan they use, and sign up for the same one without checking if it’s the best fit for them,” said Gene Altaffer, a geriatric care manager with a master’s degree in gerontology. “A better approach is to work with a licensed insurance agent who can identify your needs and custom-tailor a plan for you.”

Despite how many seniors use Medicare and Medicaid, slightly more than 40% of respondents either use private health insurance only (20.39%) or private health insurance in addition to Medicare and/or Medicaid (20.49%). There were multiple motivators for this. 

More than half of those who have private insurance do so to cover out-of-pocket costs. Medicare, for example, has co-pays, coinsurance, and deductibles that can take a bite out of your wallet. One respondent told us, “I stopped getting a treatment as it was costing me $1,600 a year out-of-pocket.” Another said, “My private insurance was primary until I retired, then the roles switched and Medicare became primary, and retirement insurance became secondary. My out-of-pocket never exceeds $25.”

Nearly 35% had a similar concern — that there were gaps in their Medicare coverage that they could fill by also purchasing private insurance. Another 24% qualified for Medicare but were satisfied with having only employer-sponsored coverage. And 7% used private insurance because they were comfortable with their known and familiar policies, and disliked the idea of changing them.

We asked our respondents if they had concerns about H.R. 1, the “big, beautiful bill,” which was, at the time of our survey, still under consideration but has since been signed into law by President Trump.

A top-three concern among respondents was the lower provider tax, which is likely to lead to hospital closures, especially in rural areas. The new law freezes provider taxes at current levels and prohibits new ones. Provider tax, which is currently 6%, is how taxes on hospitals subsidize the state Medicaid budget. 

Reducing the provider tax means less money in the state Medicaid budget. Less Medicaid money in turn leads to rural hospitals — running on thin margins already — to offer fewer services (for example: no more mammograms, no more first responders, etc.) or outright close.

To put it plainly, lowering the provider tax will likely lead to closures or reduced availability of medical services in areas that already have limited capacity to care for residents, including seniors. One report from The Center for Healthcare Quality and Payment Reform suggests that one-third of all rural hospitals are now at risk of closing.

Respondents were also wary of the ways H.R.1 would take away staffing regulations for nursing homes. The new law blocks the federal government from enacting new rules that would have increased staffing limits at nursing homes. Nursing home understaffing can lead to neglected residents and overburdened employees.

Altaffer points out other factors beyond H.R.1 endanger the quality of nursing home care. “Making matters worse, many foreign-born nursing home aides are at risk of deportation,” Altaffer said. “In addition, some janitorial, housekeeping, and food service personnel are concerned about potential ICE raids due to their immigration status.”

The majority of the older adults we surveyed — nearly 3,000 — were interested in the bill’s expanded senior deduction, and felt this part of the law would have the most impact on them. H.R.1 extends the standard deduction that was a feature of the expiring 2017 Tax Cuts and Jobs Act (TCJA), and provides an extra inflation adjustment to the standard deduction of $2,000 for single taxpayers and $1,600 per spouse for married couples. 

In addition, there’s a $6,000 deduction for taxpayers over the age of 65, whether they itemize or not, but this lasts only until 2028. The senior deduction may translate into money that can pay health insurance costs, such as copays and coinsurance costs — but not everyone will benefit from it.

The senior deduction reduced taxes on earned income. Social Security benefits are not considered taxable, earned income. Lower-income seniors, who already pay no federal income tax on Social Security because of their income threshold, will not benefit from the senior deduction in H.R.1.

To put it another way, if you are over 65 and are not working, but instead rely on Social Security and have a household taxable income below the enhanced standard deduction, the increased deduction will not benefit you because Social Security is not counted as taxable income for you and about half its beneficiaries, and thus your income won’t be high enough to benefit.

Since a good handful of respondents (nearly 15%) use either Medicaid alone or a combination of Medicaid and Medicare, it’s not surprising that Medicaid concerns placed high in our poll. 

The proposed $35 Medicaid copay, effective October 2028, was the second most-concerning part of H.R.1 for our respondents. Adults enrolled in Medicaid with household incomes above 100% of the federal poverty level will now face copays for most services, which are capped at $35 and cannot exceed 5% of a family’s total yearly income. 

Other cuts may far exceed this, however, with H.R.1 mandating gross cuts of $863.4 billion in Medicaid and CHIP (the Children’s Health Insurance Program) over the next 10 years. Projections suggest that this will increase the number of uninsured individuals by 7.8 million by 2034, many of them seniors. 

Another top concern for the seniors we polled related to Medicaid recipients who use the program to help cover Medicare’s significant costs, such as premiums and cost-sharing. Section 44101 of H.R.1 is a moratorium on a rule that would have simplified enrollment and potentially increased the number of Medicare recipients who could benefit from Medicaid coverage. This practice, called a Medicare Savings Program or MSP, is administered by state Medicaid programs. The new law delays implementation of the streamlining process until 2035. 

A work requirement for Medicaid recipients also generated concern for our respondents. The new law states that adults ages 19-64 must work or be involved in community engagement at least 80 hours per month to remain eligible for Medicaid. Although there are exemptions for “medically frail individuals,” Urban Institute research reports  that a significant number of people could lose coverage because they are unable to work.

Although it placed lowest on our survey, suggesting that it’s not a great cause for alarm, another of H.R.1’s measures may hit low-income seniors. H.R.1 states that Medicaid enrollees who qualify for Medicaid because they need long-term care have home equity limits. Meaning a state can deny a senior Medicaid coverage if their home is worth too much. 

With the passage of H.R.1, asset-based Medicaid disqualification could affect more seniors. Depending on the state, a senior’s home equity must be limited to between $730,000 and $1,097,000 in order for that senior to receive Medicaid coverage.

H.R.1 lowers the home equity limits to $1,000,000, meaning seniors who have low income levels but own a property with a higher value, such as a farm or larger home, or even a home or land deemed valuable by their county of residence can be denied Medicaid coverage. 

Private insurance covers a broad range of policy types, from ACA plans to employer-sponsored coverage, and slightly more than 40% of our respondents use private insurance, either alone or in combination with Medicaid/Medicare. Around 32% of our respondents are still working at least part time, with the majority (24.13%) covered by their employer’s plans. 

Two out of three respondents qualified for Medicare. In fact, only 17% of those surveyed don’t qualify for either Medicaid or Medicare. Which means some respondents who do qualify for one or both of the federal programs are not making use of them. 

Around a quarter of respondents are waiving Medicare because their employer-sponsored health plans are robust enough to provide the necessary coverage. For those who qualify but fail to sign up when they reach 65 years of age, however, there may be penalties that apply if and when they sign up later.

No matter where they get their insurance, 45.39% of our respondents pay between $0 and $100 a month for coverage. Another 47% pay between $101-$500 a month. Only a small handful — less than 8% — pay more than this. 

Those on Medicare have fixed premiums: Part A, hospital insurance, has no upfront cost for most people. Part B, medical insurance, has a standard monthly premium in 2025 of $185 for most people. So why are some people paying $1,000 or more? 

For some, it may be a function of having to pay the costs of a secondary private insurer in addition to Medicare. For others, especially those with serious medical conditions, high costs may come from copays, coinsurance, and deductibles, which are common with insurance plans, including Medicare.

A study from the Employee Benefit Research Institute found that single payers had significantly higher medical expenses than couples, which suggests that couples can benefit from having a partner who is able to provide care. They may also have lower per-person costs when living in a nursing home or other facility. 

Those with a higher income will also pay more for their Medicare benefits. The cost of Medicare Part B coverage, for example, may be as high as $628.90/month, if your income is $500,000 or above annually. Only seniors with an income of $106,000 or less pay the $185/month rate.

Other factors that may play into premium rates, especially for private insurance, include age, health status, location, and the type of coverage chosen. 

“Once you're covered,” said Altaffer, “your insurance company can’t raise your premiums because of worsening health. Medicare regulates its plans and oversees the insurance companies that offer them.”  

Altaffer said that in 2025, Medicare introduced a $2,000 annual out-of-pocket cap on drug costs. “After a policyholder reaches that amount for covered medications, the insurance company pays 100% of those costs for the rest of the calendar year.”

For those who have not yet applied for Medicare, the good news is that most of the people we surveyed — 83.73% — found the enrollment process easy, sometimes to their own surprise. “Online enrollment was easier than expected,” was one typical comment. 

For some people, having another person assist them — whether it was an insurance company rep, an employer, or a member of their family — made the process go smoothly. One respondent, for example, told us, “Enrollment was done with a broker who took care of details. I find Medicare, thus far, has been very straightforward and easy to deal with. I like the Medicare website also for getting answers.”

Most seniors sign up for Medicare Part A and Part B when they reach the age of 65. That process is straightforward. Deciding on whether to get your Medicare services through a Part C program (also called Medicare Advantage), or a Medicare supplement plan can be more challenging. Advantage plans include drug coverage. Supplement plans require a separate Part D plan, so you will also need to decide if you wish to have that optional Part D, or prescription drug coverage. 

It was in determining the right options for their own needs that our respondents faced challenges. “Filling out the enrollment form was straightforward. It was more difficult to determine which was the best coverage for my specific health situation,” said one, echoing a common response. “It was easy to sign up, but hard to figure out which plan was the best for me and my husband,” said another.

A few respondents noted that when you turn 65, insurance companies sit up and take notice of you. They want your business. “Once you start searching for Medicare, the calls start flowing in from so many different companies to get you signed up,” one senior noted. 

Those who chose a Medicare Advantage program, which is supplied by a private insurer rather than the government, seemed to be reasonably happy with their choice. One told us, “Finding a provider was easy. The costs were low and getting lower annually, which is a nice surprise. I am back with my preferred healthcare provider after having been forced to change providers while I was under 65.”

Altaffer offered extra context that those who choose a Medicare supplement plan “like the ability to see any medical provider that takes Medicare nationwide, and enjoy no pre-authorization from the insurance company prior to many medical procedures.”

Others complimented the government’s Medicare website, which allows seniors to see plan details and do a comparison of multiple plans. “The ability to compare plan features across companies and plans was much easier than I expected,” said one, while another commented, “The website allowed me to see three plan options side by side for easy comparison.”

Of our respondents, 16.3% found Medicare enrollment difficult. By far, the most common drawback for people was the difficulty in determining what coverage options best suited their situation. For many of our respondents, working with an insurance broker or other professional was necessary to ensure that they chose the right option for their needs.

The differences between Medicare and Medicaid were tough for more than a few respondents to parse. One told us, “How Medicare and Medicaid worked together was not as straightforward as I thought, but I think it was the way the person explained it or did not explain it that was the problem.” Another added that “medical jargon and legalese is impossible to understand.”

Others reflected on the genuine complexity of programs that are designed to handle the needs of millions of Americans. “It is pretty much impossible to predict what will and won't be covered and at what rate because Medicare rules are so incredibly complicated,” one told us. Another said that they found it difficult “understanding that the same plan can have differences each year.”

Cost was a consideration for some seniors. One mentioned that “Having to pay for Medicare after paying into it for my entire working life was unexpected and disappointing, especially at over $2,000.00 per year, and the coverage is not that great considering all the co-pays and non-covered care costs.” 

One respondent shared cost details that made their coverage challenging: “The cost of the various Medicare plans can be high, especially for basic retirees. Part B is now close to $200/month, Part D is $64/month, Part G (Medigap) is over $200/mo. Based on this, the monthly cost is [approximately] $460. Medicare is not free as many think it is.”

For more information about Medicare, Medicaid, and Social Security, check out our Finance and Legal Resources Hub.

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