Medicare at age 55+?

[DangerousNachos]

I am well aware of the challenges that 55+ face in obtaining health insurance as I am in that group. But, that's not a reason for having lower-income people who can't afford health insurance themselves be the ones to pay for it. If you're working a low-wage job and don't have health insurance but have health problems, you're not really going to feel better about an increase in your taxes because you know that the premiums you can't afford are lower than the premiums older people pay.


You were talking about AI displacing people's jobs. I don't think younger people are going to step into those jobs. Of course, some of the people would retire for other reasons and open up jobs. But, that doesn't seem to be a good reason to limit the access to people over 55 or to make lower income people pay for that. There are all sorts of job implications resulting from health insurance problems. (How many people don't leave their jobs to start their own business because they want the security of their current health insurance?) I don't think the 55+ should be singled out.

I don't question that it is too hard for people 55+ to retire because of the cost of health insurance. But, I don't think solutions to health insurance problems should be limited to that age range or be paid for by people who can't afford to retire or who are younger and can't afford their rent and groceries much less their own health insurance.

@GenXguy Your concern about rising Medicare costs for those already on it is valid, especially if current projections hold and solvency becomes an issue over the next decade. That needs to be part of this conversation.

@NomDeER I understand the concern about who’s paying for this, so let’s look at the mechanics.

The proposal is a 1% total Medicare payroll adjustment:
• 0.5% from the employee
• 0.5% from the employer

For someone earning:
• $25,000/year → about $2.40/week
• $50,000/year → about $4.80/week
• $60,000/year → about $5.75/week

The employer matches that amount.

Across the economy, that’s roughly $100 billion annually going into Medicare, based on estimated U.S. wages and salaries of around $10+ trillion.

So this isn’t one group carrying the burden for another. It’s a broad-based contribution using the same structure Medicare already operates under.

We already have a system where public support exists across income levels, Medicaid, ACA subsidies, and Medicare. This doesn’t introduce that concept. It applies the same funding structure to a defined set of parameters within the proposal.

 

[NomDeER]

So this isn’t one group carrying the burden for another. It’s a broad-based contribution using the same structure Medicare already operates under.

There are some groups carrying the burden for another. And one of those groups is low-income people without affordable insurance. And you are asking them to fund health insurance for more affluent people so that those more affluent people don't have to work.

We already have a system where public support exists across income levels

Yes, but most of the time that support helps lower income people, disabled people, or children. IMO, in general, it should not be the worse off people supporting the more affluent people, especially if it's to ensure that more affluent people have benefits that the poorer people don't have. I think that low-wage workers already are subsidizing the rest of us by providing services for such low wages, whether it's people working at warehouses, in the food industry, etc.

You are primarily concerned that people age 55-64 are not able or willing to stop working due to health insurance. I can understand this concern (though I am generally more concerned with the people who currently can't even access health insurance.) But, you have not provided a reasonable explanation for why the way to address this includes increasing taxes on lower-income people and limiting the benefits to part of the group of people who are age 55-64.

So this isn’t one group carrying the burden for another. It’s a broad-based contribution using the same structure Medicare already operates under.

It's not really the same structure. Almost everyone 65+ gets traditional Medicare. Your proposal for the 55+ provision is not for everyone. And, of course, you are primarily concerned about people 55+ not having to work, so those people wouldn't be paying into the system while other people their age (and younger - or even older) will be paying. And you have suggested no IRMAA corrolary or income eligibility requirements like ACA subsidies and Medicaid have. (Poorer people generally get a better return on their investment with traditional Medicare than rich people do. I have issues with the way that IRMAA is structured, but at least it's not poor people paying more.)

 

[DangerousNachos]

There are some groups carrying the burden for another. And one of those groups is low-income people without affordable insurance. And you are asking them to fund health insurance for more affluent people so that those more affluent people don't have to work.

Yes, but most of the time that support helps lower income people, disabled people, or children. IMO, in general, it should not be the worse off people supporting the more affluent people, especially if it's to ensure that more affluent people have benefits that the poorer people don't have. I think that low-wage workers already are subsidizing the rest of us by providing services for such low wages, whether it's people working at warehouses, in the food industry, etc.

You are primarily concerned that people age 55-64 are not able or willing to stop working due to health insurance. I can understand this concern (though I am generally more concerned with the people who currently can't even access health insurance.) But, you have not provided a reasonable explanation for why the way to address this includes increasing taxes on lower-income people and limiting the benefits to part of the group of people who are age 55-64.


It's not really the same structure. Almost everyone 65+ gets traditional Medicare. Your proposal for the 55+ provision is not for everyone. And, of course, you are primarily concerned about people 55+ not having to work, so those people wouldn't be paying into the system while other people their age (and younger - or even older) will be paying. And you have suggested no IRMAA corrolary or income eligibility requirements like ACA subsidies and Medicaid have. (Poorer people generally get a better return on their investment with traditional Medicare than rich people do. I have issues with the way that IRMAA is structured, but at least it's not poor people paying more

@NomDeER You've been consistent on the equity concern and I want to engage it precisely rather than talk past it. Can you give a couple of specific examples of the low-income individuals you're describing? How are they currently insured (or not), and what are they paying today? I want to make sure I'm responding to the actual situation you have in mind.

Just to be clear on my focus, this isn't about people 55+ not working. It's about job lock tied to health benefits. I've seen people slow down or scale back their hours but stay attached to a job primarily for coverage. The idea here is to give them the option to scale back further with a more predictable path to coverage. In some cases, that flexibility can also help employers manage staffing and hours more effectively.

And on IRMAA, you're right to raise it. It doesn't apply to most people, but it is part of how Medicare already adjusts for higher-income participants. In practice, I've seen higher earners make decisions around coverage just like anyone else. Sometimes even choosing to stay on employer plans because the total cost is more favorable than Medicare plus supplemental coverage.

The broader point is that Medicare already has a mechanism to account for income at the higher end. If something like this were ever implemented, I would expect that structure to remain in place for the 55+ group as well.

I appreciate you pushing on this. It’s been helpful to work through.

 

[plsprius]

Trying to keep up with this thread is giving me a headache .

Glad to be already-retired and receiving Medicare.

 

[DangerousNachos]

Trying to keep up with this thread is giving me a headache .

Glad to be already retired and receiving Medicare.

@plsprius Glad to have you aboard and following along. Below is a one-page handout I use when people ask what it is, and the other document is a one-page comparison sheet:

THE MEDICARE BRIDGE

Fixing Job Lock. Freeing Workers. Stabilizing Small Business.​

THE PROBLEM

Millions of Americans aged 55–64 remain in the workforce not because they choose to—but because leaving employment means losing access to affordable health insurance.

Labor mobility is reduced by 20–40% due to employer-sponsored coverage
Older workers face lower reemployment rates and higher labor force exit rates
Employers absorb rising and unpredictable healthcare costs

This is not a coverage gap.
This is a structural bottleneck in the labor market.

THE SOLUTION

A voluntary Medicare pathway beginning at age 55.
No mandates
No disruption to employer-sponsored coverage
Coverage becomes portable
Workers can make employment decisions based on readiness—not insurance dependency.

WHY THIS MATTERS NOW

Artificial intelligence is accelerating workforce disruption
Workers aged 55–64 face the hardest transition back into employment
Employer-based insurance is increasingly misaligned with modern labor markets

WHAT THIS DOES

Removes job lock
Enables voluntary retirement transitions
Reduces employer cost pressure
Opens positions for younger workers
Allows gradual workforce adjustment instead of abrupt layoffs

No American should be forced to remain in a job solely to maintain access to health insurance.
​

---and---
​

CURRENT SYSTEM vs. MEDICARE BRIDGE​

CATEGORY​	CURRENT SYSTEM​	MEDICARE BRIDGE​
Coverage	Tied to employment	Portable — follows the individual
Worker Behavior	Stay for insurance	Work based on readiness and choice
Employer Role	Insurance provider + employer	Employer only
Cost Structure	Volatile, unpredictable premiums	Predictable payroll contribution
Labor Mobility	Restricted by coverage dependency	Flexible — decisions based on fit
Workforce Transitions	Delayed or abrupt	Gradual and voluntary
Small Business Burden	Disproportionate and rising	Reduced — high-cost group moves to Medicare
Benefits Spouse Effect	Hidden and widespread	Directly addressed

KEY INSIGHT
We are forcing people to work for insurance.

This policy restores choice to the labor market.​

WHY THIS IS DIFFERENT FROM PRIOR PROPOSALS

Targeted only to ages 55–64 — not a universal coverage expansion
Voluntary — no mandates, no disruption to existing coverage
Uses existing Medicare infrastructure — no new bureaucracy required
Directly addresses the benefits of the spouse dynamic — a hidden distortion no other proposal tackles
Functions as both a healthcare fix and a workforce transition mechanism

No American should be forced to remain in a job solely to maintain access to health insurance.​

​

 

[REWahoo]

^ How will this Medicare Bridge be funded? Who will pay the toll?

 

[DangerousNachos]

^ How will this Medicare Bridge be funded? Who will pay the toll?

The proposal is a 1% total Medicare payroll adjustment:
• 0.5% from the employee
• 0.5% from the employer

For someone earning:
• $25,000/year → about $2.40/week
• $50,000/year → about $4.80/week
• $60,000/year → about $5.75/week

The employer matches that amount.

Across the economy, that’s roughly $100 billion annually going into Medicare, based on estimated U.S. wages and salaries of around $10+ trillion.

 

[statsman]

Just another reason to loathe AI, beyond its demand for resources. But that's a discussion for another topic.

 

[DangerousNachos]

@statsman AI should be required to develop solutions to the problems it causes. But until it does, humans need to stay engaged to find solutions, and this proposal is mine.

 

[plsprius]

This proposal looks very much like what the ACA offers today. I recognize that for anyone not receiving subsidies the costs are high. But those costs are the same in the pre-65 employer market. It's just that the employer is subsidizing it for the employee as a non-taxable benefit. So, the problem is costs, not access...

 

[DangerousNachos]

@plsprius yes. I see Medicare as the post-"employer" that has negotiated its "group" benefits and discounts and also subsidizes the premiums. The proposal is to allow 55+ to that plan sooner. I would submit that one's health care is still the same, a doctor visit is a doctor visit, and a prescription is a prescription. The amount charged to and is covered by "insurance" for that health care differs by negotiated contracts.

Sorry for the quotes. It's my brain trying to imply comparisons to the coverages (insurances).

 

[pb4uski]

The proposal is a 1% total Medicare payroll adjustment:
• 0.5% from the employee
• 0.5% from the employer

For someone earning:
• $25,000/year → about $2.40/week
• $50,000/year → about $4.80/week
• $60,000/year → about $5.75/week

The employer matches that amount.

Across the economy, that’s roughly $100 billion annually going into Medicare, based on estimated U.S. wages and salaries of around $10+ trillion.

There are 42.6 million US citizens between 55 and 65. $100 billion divided by 42.6 million is a whopping $2,347 per person per year in additional taxes annually.

Medicare will spent $7,000-$8,000 for each beneficiary 65 years old in 2026. So the per person cost for 55-65 would be less but not that much less.

It seems to me that this proposal makes the Medicare funding problem much worse and would increase the federal deficit. Correct?

 

[Aerides]

There are 42.6 million US citizens between 55 and 65. $100 billion divided by 42.6 million is a whopping $2,347 per person per year in additional taxes annually.

I think he means everyone, all taxpayers, pay the nominal fee, including those older and younger. Still, that continues the issue of people paying for someone else, which many are loathe to do, even in tiny amounts.

My question would be, what happens to the ACA under this proposal? Remove most of the 55-65's (not all, many are happy with their plans) and you have a smaller younger group, but maybe not enough for some providers to continue to offer exchange plans.

The proposal also needs to state why this is needed when the ACA already exists. Other than "it's expensive" I haven't seen that argument made super clear.

 

[DangerousNachos]

@pb4uski The math appears correct, but the framing matters significantly.

First, the $100 billion in revenue is divided among all workers and employers who are required to pay the tax, not just the 42.6 million in that age group.

Second, it appears your assumption is that all 42.6 million sign up for Medicare at once. If the assumption is also that they all retire and stop working, their lack of contribution to Medicare really skews the $100 billion in additional funding.

Third, I'm not sure what supporting data is available to estimate Medicare spending for the 55-65 age group. I would appreciate it if you could share what you have found. It seems there may be data showing certain procedures, medications, and costs by age group that would be useful here.

Fourth, and I believe most important, this is a voluntary enrollment proposal. A more realistic enrollment estimate is not 42 million, but somewhere between 4 and 6 million, roughly 10 to 15 percent. The additional $100 billion in dedicated revenue to cover those enrollees makes a significant impact on the current Medicare funding shortfall.

This proposal has never been presented as a finished product. The CBO scored lowering eligibility to age 60 at roughly $26 billion net annually, with no additional revenue mechanism. This proposal adds approximately $100 billion in dedicated funding and introduces an ACA subsidy offset, from those currently covered by ACA going to Medicare, that no previous proposal has accounted for. That combination materially changes the fiscal picture and would need to be included in any formal scoring.

You've raised excellent points that need to be worked through, and I appreciate the engagement.

 

[DangerousNachos]

I think he means everyone, all taxpayers, pay the nominal fee, including those older and younger. Still, that continues the issue of people paying for someone else, which many are loathe to do, even in tiny amounts.

My question would be, what happens to the ACA under this proposal? Remove most of the 55-65's (not all, many are happy with their plans) and you have a smaller younger group, but maybe not enough for some providers to continue to offer exchange plans.

The proposal also needs to state why this is needed when the ACA already exists. Other than "it's expensive" I haven't seen that argument made super clear.

@Aerides, I'll answer that personally. As a self-employed person, I'm currently on an ACA plan and just lost $20,000 in subsidies due to the reimplementation of the ACA cliff effective January 1, 2026.

A couple my age earning $80,000 could qualify for roughly $25,000 in subsidies, effectively covering their full premium. The same couple earning $90,000 qualifies for nothing and owes the full $25,000 in premiums. Their net spendable income drops to $65,000. One dollar over the line costs them $25,000. That's not a coverage gap. That's a broken system.

Now compound that with the possibility of job displacement and the influx of others who could have been okay with ACA coverage and subsidies, but without those subsidies, ACA becomes COBRA essentially, and we all know how that goes.

The Medicare Bridge addresses this directly. It extends existing Medicare infrastructure to a defined cohort without dramatically changing the underlying law. Without it, people in the situation above are effectively taking a $25,000 income reduction for doing nothing different from the year before. Can you imagine someone in their 70s taking a $10,000 cut in their Social Security income, just because the rules changed?

While not perfect, Medicare offers greater financial certainty than the ACA. A certainty that most would appreciate when retired, on a fixed income, and out of the full-time workforce.

 

[RetiredHappy]

I retired at 53 and have been buying health insurance without subsidies since the age of 54. I have 1.5 years go to before reaching Medicare age-eligible. It is the price that I pay for retiring early. I don't expect other taxpayers to subsidize my health care when I chose to retire early and could afford to support myself. The issue is the high cost of health care in the US. Instead of fixing the issue of high health care costs, the issue becomes that people are trying to get others to subsidize their health care.

 

[plsprius]

From a practical standpoint, I'd say it would be easier to fix the ACA cliff than to extend Medicare to 55+.

The question is who pays for it? Overall, I'm OK with the current approach--and I also lost the subsidy in the year before going on Medicare. Before Medicare I was on an ACA plan for 10 (?) years, and it worked fine.

 

[Aerides]

A couple my age earning $80,000 could qualify for roughly $25,000 in subsidies, effectively covering their full premium. The same couple earning $90,000 qualifies for nothing and owes the full $25,000 in premiums. Their net spendable income drops to $65,000. One dollar over the line costs them $25,000. That's not a coverage gap. That's a broken system.

But with any understanding of the US political system, saying "but people making over $84k don't get subsidies" does not exactly invoke empathy and a driver to act. As many of us well know...

Because as well, that $90k isn't their gross either. Self employed folks have some ways to reduce magi via HSA and IRA contributions, so the gross is going to be over 100k. Yes, I fully understand $25k in premiums is too high, but the sympathy from the general voting public and their congressional representatives is not going to result in a groundswell of support for this relatively small group.

Those that are not working at all have a much easier time managing to the cap, albeit still many of us have to carefully manage our capital gains.

Remove the hard cap or slide it out a bit and you solve most of the problem, for a wider age group too. Why not just aggressively pursue that instead of the far heavier lift of expanding medicare access?

 

[DangerousNachos]

@RetiredHappy, I congratulate you on your ability to retire at 53 and pay for health insurance without assistance from a subsidy. I believe the key statement you made is that you chose to retire. Not all will have that choice, especially with the coming changes in the workforce.

As for asking others to subsidize one's health care, I would say that subsidies are available to those who qualify. No different than tax credits for those who install solar, buy electric cars, or received PPP loans during the pandemic. I believe the term subsidy is somewhat subjective.

I would also submit that someone who makes $1 million a year and spends $1,000 on dinner is equivalent to someone who makes $50k a year and spends $50 on dinner. My point is simply that a fixed-cost item is viewed differently depending on income.

Good luck with your upcoming milestone. I'm sure you're aware, but make sure to pay attention to the IRMAA limits, if applicable.

 

[RetiredHappy]

@RetiredHappy, I congratulate you on your ability to retire at 53 and pay for health insurance without assistance from a subsidy. I believe the key statement you made is that you chose to retire. Not all will have that choice, especially with the coming changes in the workforce.

As for asking others to subsidize one's health care, I would say that subsidies are available to those who qualify. No different than tax credits for those who install solar, buy electric cars, or received PPP loans during the pandemic. I believe the term subsidy is somewhat subjective.

I would also submit that someone who makes $1 million a year and spends $1,000 on dinner is equivalent to someone who makes $50k a year and spends $50 on dinner. My point is simply that a fixed-cost item is viewed differently depending on income.

Good luck with your upcoming milestone. I'm sure you're aware, but make sure to pay attention to the IRMAA limits, if applicable.

We are already hit with IRMAA (spouse) and I will be when I reach 65 as our income in 2025 was "too" high.

 

[DangerousNachos]

@Aerides and @plsprius, you both make good points, but let me go a bit off-topic to make an observation. ACA and the subsidies exist, but have a very serious political stigma to them. And as was just proven this year, changes to funding for the plans can be made on a whim. I did a quick Google search and found the following:

Approximately 92% of the 23 million enrollees in the Affordable Care Act (ACA) receive federal subsidies to help lower the cost of premiums and out-of-pocket expenses. Additionally, the federal government subsidizes health insurance for over 150 million Americans through various programs and tax benefits, with costs and subsidies totaling $1.6 trillion in 2023.
Forbes+1

Now, does anyone recall any increase in our personal taxes to pay for this? Payroll taxes? Yeah, there were penalties to be paid by those who didn't participate, but they weren't really enforced. So, a $1.6 trillion price tag, and what are the funding sources? Where is the additional money going to come from to make it... better?

I don't have an answer to any of that, but I do have an answer to an identifiable group, some of which may be part of that $1.6 trillion cost, and a way to fund alternative coverage for them. That's it. That's the proposal. I'm suggesting eating this pizza a slice at a time. I'm happy to help anyone work on the next slice, but I'm focused on this one first. Aside from the evident personal reasons, I am truly concerned that this specific age group is more vulnerable to the coming changes in the workforce than others.

 

[DangerousNachos]

We are already hit with IRMAA (spouse) and I will be when I reach 65 as our income in 2025 was "too" high.

I guess that's a good problem to have? I remember a mentor of mine, when I was in my twenties and owned a bungee-jumping company, complaining that he had to pay six figures in income tax, even though I was lucky if I made $15k for the year. I suggested we trade professions and income. He politely declined.

 

[GenXguy]

It seems to me that simply restoring ACA enhanced subsidies would address the example you pointed out without a whole new program. And they couldn't even get that done!

Also note, that the ACA law actually includes the Medicaid Expansion. That's over 20 million people, but many are going to be kicked off next year due to massive cuts to Medicaid under the guise of fraud and abuse (actually mostly making it impossible for many disabled people to get coverage because they don't meet the stiff legal requirements for eligibility). So, we seem to be going in the opposite direction of providing coverage.

I would prefer to see Medicaid, Medicare, and everything go away and replaced with a Universal Healthcare system that provides 100% coverage, even if it means higher taxes. Yeah, that's not going to happen anytime soon.

 

[Cerys]

So here's the deal. I recently read an article about AI displacing workers. I've been in the employee benefits business for over 30 years and I have personally spoken with employees that continue to work, just for the health insurance.

I believe the older work force are more vulnerable to the AI displacement, and some older employees would retire sooner, if they had health insurance coverage. So, with some help from AI, I wrote a policy proposal to lower Medicare eligibility to age 55. I am happy to share it with anyone that is interested, but I am looking to see if this is something the public would support. I've found policy can change more easily when the people want it. Any feedback or ideas on how to push this forward is greatly appreciated.

There is actually certain cases in which someone can get Medicare before age 65. My husband would've qualified but he died before any of the stuff that he qualified for took affect. If you have a serious illness or a life ending illness, you qualify very quickly for disability and then Medicare. Now we had insurance and we were using the insurance but I think after he was on disability he may have qualified for Medicare.

After him getting a brain tumor, I made sure that I was covered by quality insurance and not just the cheapest thing I could find. That was a hard lesson to learn about false economies...

 

[Mike999]

I like this idea, I’d be happy to pay a fair rate to get on the plan, probably not fair to ask current workers to pay more. Just give me an option to get on at cost, then maybe other folks could bring ACA subsidies with them to subsidize full cost. I was able to manage to the subsidies from 50-59 and aca was great. Now I’m unsubidized , silver plan went to $65k for 2 of us, we landed on bronze for $30k. Having Medicare for 30k would be a win for me.