Medicare at age 55+?

[MBSC]

...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.

In Table 1, the CBO estimated $95.5 billion in nongroup subsidy savings over 6 years, which reduced the deficit to $154.9B. Is this not the ACA subsidy offset?

From the summary:
"Nongroup Coverage: CBO and JCT estimate that premium tax credits (PTCs) for health insurance obtained through the marketplaces established by the ACA would decrease by $95 billion between 2026 and 2031...Most of that effect would result from the loss of subsidy eligibility and the corresponding decrease in enrollment among people newly eligible for Medicare who receive subsidies under current law..."

"An estimated 2.2 percent increase in nongroup premiums over the 2026–2031 period would increase PTCs by $5 billion. That is because premiums in the nongroup market are tied to age: CBO and JCT’s analysis suggests that even though older enrollees spend more, on average, on health care, their premium payments (including individual premium contributions and any applicable PTCs) would exceed insurers’ claims and administrative spending under current law. Since those older enrollees would leave the nongroup market under the policy, premiums would increase. Because premium tax credits are determined by the second-lowest-cost silver plan available in the marketplace in any given area, premium increases result in higher PTCs."

 

[DangerousNachos]

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...

@Cerys, I'm sorry for your loss, and you're right. Disability is a condition that allows individuals to qualify for Medicare before age 65. Getting what you pay for is not a lesson you want to learn when it comes to insurance coverage. By the time you learn the lesson, it's at the time of the claim, and by then, it's too late.

 

[DangerousNachos]

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

@Mike999 Thank you. Your numbers tell the story better than I can. $65,000 for a silver plan for two people is exactly the kind of outcome the Medicare Bridge is trying to address.

Your instinct on the funding is sound. The proposal does envision enrollees paying premiums. This isn't free coverage. And the ACA subsidy question is an interesting one. If someone qualifies for ACA assistance, the mechanics of how that interacts with Bridge premiums would need to be worked out legislatively. But the core idea, that enrollees contribute, and that existing assistance mechanisms could follow them, is directionally consistent with how the proposal is framed.

The fact that Medicare at $30,000 would be a win over your current bronze plan says everything about where the individual market is right now for your age group.

 

[RetiredHappy]

@Mike999 Thank you. Your numbers tell the story better than I can. $65,000 for a silver plan for two people is exactly the kind of outcome the Medicare Bridge is trying to address.

Your instinct on the funding is sound. The proposal does envision enrollees paying premiums. This isn't free coverage. And the ACA subsidy question is an interesting one. If someone qualifies for ACA assistance, the mechanics of how that interacts with Bridge premiums would need to be worked out legislatively. But the core idea, that enrollees contribute, and that existing assistance mechanisms could follow them, is directionally consistent with how the proposal is framed.

The fact that Medicare at $30,000 would be a win over your current bronze plan says everything about where the individual market is right now for your age group.

You don't have to buy a gold or a silver plan. I buy the cheapest Bronze plan, without subsidies.

 

[Mike999]

Thinking about it a little more, I think I’m supporting just adding Medicare as an ACA option for 55-65 group. You apply your subsidy or pay full cost but hopefully by cutting our insurance companies, we get better coverage for less money.

 

[Mike999]

You don't have to buy a gold or a silver plan. I buy the cheapest Bronze plan, without subsidies.

Unfortunately, ACA plans vary by county so I don’t have the same options you see. My rural county in Illinois offers limited options, 30k is the very high deductible bronze plan that includes my doctors( for 2 60 year olds) no other options unless I want different doctors and hospitals. That’s why early Medicare would be better for folks in rural areas, a universal option in ACA.

 

[RetiredHappy]

Unfortunately, ACA plans vary by county so I don’t have the same options you see. My rural county in Illinois offers limited options, 30k is the very high deductible bronze plan that includes my doctors( for 2 60 year olds) no other options unless I want different doctors and hospitals. That’s why early Medicare would be better for folks in rural areas, a universal option in ACA.

I buy a (very) high deductible bronze plan and I pay $14K a year in premiums for 1 person. So far I have paid $3K in OOP expenses for my high deductible plan for 4 specialist visits, an echocardiogram, and several lab tests ($300 per visit for the blood panels). But it still beats buying a silver plan.

 

[GenXguy]

Unfortunately, ACA plans vary by county so I don’t have the same options you see. My rural county in Illinois offers limited options, 30k is the very high deductible bronze plan that includes my doctors( for 2 60 year olds) no other options unless I want different doctors and hospitals. That’s why early Medicare would be better for folks in rural areas, a universal option in ACA.

I'm in IL also. Only one provider in my county for ACA starting this year - BCBS. My silver plan for just me is $27,000 unsubsidized just for premiums!

 

[DangerousNachos]

Unfortunately, ACA plans vary by county so I don’t have the same options you see. My rural county in Illinois offers limited options, 30k is the very high deductible bronze plan that includes my doctors( for 2 60 year olds) no other options unless I want different doctors and hospitals. That’s why early Medicare would be better for folks in rural areas, a universal option in ACA.

Yes, getcoveredillinois didn't do anyone any favors by replacing healthcare.gov. I also find it interesting that the "HSA" qualified BCBS plan has copays? I might have misread it

 

[plsprius]

Those incredibly high premiums seem like outliers. I'd expect an unsubsidized ACA Bronze premium to be around $1,500 for the years just before Medicare. I'd fix this problem by adjusting the premium cliff issue, e.g., like limiting premiums to 8.5% of income. Fixed and done.

 

[RetiredHappy]

Those incredibly high premiums seem like outliers. I'd expect an unsubsidized ACA Bronze premium to be around $1,500 for the years just before Medicare. I'd fix this problem my adjusting the premium cliff issue, e.g., like limiting premiums to 8.5% of income. Fixed and done.

High premiums are not the outliers because that those are actual costs of the premiums. Many people are paying alot less because of subsidies.

 

[plsprius]

High premiums are not the outliers because that those are actual costs of the premiums. Many people are paying alot less because of subsidies.

Those premiums are outrageous, I agree. Fix the premium cliff.

Nevertheless, in 2026 in California (Bay Area) a 64-yr old can get an unsubsidized bare bones Kaiser HDHP bronze HMO plan for $1,151 per month. A higher end Anthem Silver EPO plan is $1,962 per month.

Yes, truly crazy prices.

However, I'll point out that this year my Medicare + G supplement plan is costing about $934 per month (for one) with the part B deductible and IRMAA surcharges.

So, Medicare eligibility by itself doesn't appear to be an answer.

Health Care Insurance is EXPENSIVE no matter what!

 

[RetiredHappy]

Those premiums are outrageous, I agree. Fix the premium cliff.

Nevertheless, in 2026 in California (Bay Area) a 64-yr old can get an unsubsidized bare bones Kaiser HDHP bronze HMO plan for $1,151 per month. A higher end Anthem Silver EPO plan is $1,962 per month.

Yes, truly crazy prices.

However, I'll point out that this year my Medicare + G supplement plan is costing about $934 per month (for one) with the part B deductible and IRMAA surcharges.

So, Medicare eligibility by itself doesn't appear to be an answer.

Health Care Insurance is EXPENSIVE no matter what!

I will take Medicare + G supplement + IRMAA everyday over my Bronze plan.

 

[MichaelB]

Health Care Insurance is EXPENSIVE no matter what!

Health care is expensive. Unreasonably so, IMHO. No force in the natural world can make health insurance less expensive than underlying product it insures.

 

[Onda]

Health care is expensive. Unreasonably so, IMHO. No force in the natural world can make health insurance less expensive than underlying product it insures.

The U.S. insurance/administrative layer appears to consume about twice the share of health spending that comparable better quality availability European systems do—around 6–7% vs. roughly 3%.

Doctors, hospitals, and their staff also spend enormous time and money dealing with prior authorizations, billing rules, coding, claim denials, and insurer-specific paperwork, and those costs are built into what patients and employers ultimately pay. In other words, Americans pay not only for the insurance industry’s administrative layer, but also for the provider bureaucracy created to cope with it.

Atter all that overhead you pay for actual product.

 

[Semi-Retyrd]

@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​

I am trying to understand your proposal. Are you saying that once a person reaches 55, they could choose to leave their job and retire early (assuming they had enough savings) and join standard Medicare? Would they then be required to buy a Medigap plan or could they choose a Medicare Advantage plan?

In the case of early retirement they would no longer contribute to social security or Medicare through payroll or self employment taxes. This seemingly would exacerbate the revenue shortfall in these systems.

I think you are saying the extra cost of this "bridge" would be borne by all those still working by paying an extra 1% for Medicare tax (half by employee and half by employer). Is this correct?

Please help me to understand your proposal more clearly.

Thanks, Dennis

 

[DangerousNachos]

In Table 1, the CBO estimated $95.5 billion in nongroup subsidy savings over 6 years, which reduced the deficit to $154.9B. Is this not the ACA subsidy offset?

From the summary:
"Nongroup Coverage: CBO and JCT estimate that premium tax credits (PTCs) for health insurance obtained through the marketplaces established by the ACA would decrease by $95 billion between 2026 and 2031...Most of that effect would result from the loss of subsidy eligibility and the corresponding decrease in enrollment among people newly eligible for Medicare who receive subsidies under current law..."

"An estimated 2.2 percent increase in nongroup premiums over the 2026–2031 period would increase PTCs by $5 billion. That is because premiums in the nongroup market are tied to age: CBO and JCT’s analysis suggests that even though older enrollees spend more, on average, on health care, their premium payments (including individual premium contributions and any applicable PTCs) would exceed insurers’ claims and administrative spending under current law. Since those older enrollees would leave the nongroup market under the policy, premiums would increase. Because premium tax credits are determined by the second-lowest-cost silver plan available in the marketplace in any given area, premium increases result in higher PTCs."

View attachment 63071

@MBSC, you caught a major error in my wording, and that is exactly the kind of feedback needed for corrections that can help make this proposal more credible.

I'm working on using the table you provided to see if I can plug in the projected revenue from the additional 1% and do some "guessing" based on the full CBO report.

I still stand by the concept and proposal I am making, but saying ACA subsidies were not considered in the CBO report was not accurate.

Thank you for doing your homework.

 

[DangerousNachos]

I am trying to understand your proposal. Are you saying that once a person reaches 55, they could choose to leave their job and retire early (assuming they had enough savings) and join standard Medicare? Would they then be required to buy a Medigap plan or could they choose a Medicare Advantage plan?

In the case of early retirement they would no longer contribute to social security or Medicare through payroll or self employment taxes. This seemingly would exacerbate the revenue shortfall in these systems.

I think you are saying the extra cost of this "bridge" would be borne by all those still working by paying an extra 1% for Medicare tax (half by employee and half by employer). Is this correct?

Please help me to understand your proposal more clearly.

Thanks, Dennis

@Semi-Retyrd your first question is exactly correct.

The second question is no different than the current Medicare guidelines. No one is being forced to do anything differently at 55 than they are at 65. I'm not trying to reinvent the wheel or confuse the issue.

As for early retirement, if someone has no "earned" income, they would not contribute to SS or Medicare. But if they scale back their hours to go part-time, or start a new small venture that is self-employment, they continue to contribute.

Yes, the .5% from employees and .5% on employers comes from all earned wages.

Thank you for asking for additional clarity.

 

[Semi-Retyrd]

@Semi-Retyrd your first question is exactly correct.

The second question is no different than the current Medicare guidelines. No one is being forced to do anything differently at 55 than they are at 65. I'm not trying to reinvent the wheel or confuse the issue.

As for early retirement, if someone has no "earned" income, they would not contribute to SS or Medicare. But if they scale back their hours to go part-time, or start a new small venture that is self-employment, they continue to contribute.

Yes, the .5% from employees and .5% on employers comes from all earned wages.

Thank you for asking for additional clarity.

Got it. Thanks for your reply.

I have a counter proposal as follows.

CMS the provider for Medicare should be added as an additional option in the ACA with no subsidies from the federal government. This would not require an additional Medicare tax increase.

Example - In 2024 the cost per beneficiary for Medicare was around $17.8K. The cost per beneficiary to cover a younger cohort (eg 45-64) would be less given their age. The average cost over the whole cohort could be calculated each year and applied with an inflator to the coming year as a charge for this insurance. This would become the "public option" that was lobbied out of the original ACA.

My guess about the cost would be something on the order of $12K/yr or $1K/mo. This should result in cost savings for many individuals and small businesses based on the fact that Medicare negotiates better deals with hospitals and doctors, has lower admin expenses than insurance companies and pays no shareholders.

The only losers in this proposal might be the insurance companies who would lobby furiously against in congress. Their might be enough wealthy individuals and philanthropic foundations to match or exceed their lobby spend to counter this.

Comments?

 

[DangerousNachos]

Got it. Thanks for your reply.

I have a counter proposal as follows.

CMS the provider for Medicare should be added as an additional option in the ACA with no subsidies from the federal government. This would not require an additional Medicare tax increase.

Example - In 2024 the cost per beneficiary for Medicare was around $17.8K. The cost per beneficiary to cover a younger cohort (eg 45-64) would be less given their age. The average cost over the whole cohort could be calculated each year and applied with an inflator to the coming year as a charge for this insurance. This would become the "public option" that was lobbied out of the original ACA.

My guess about the cost would be something on the order of $12K/yr or $1K/mo. This should result in cost savings for many individuals and small businesses based on the fact that Medicare negotiates better deals with hospitals and doctors, has lower admin expenses than insurance companies and pays no shareholders.

The only losers in this proposal might be the insurance companies who would lobby furiously against in congress. Their might be enough wealthy individuals and philanthropic foundations to match or exceed their lobby spend to counter this.

Comments?

@Semi-Retyrd This is a thoughtful counter-proposal, and the underlying logic is sound. Medicare's negotiating power, lower administrative costs, and the absence of shareholders make it a structurally cheaper form of coverage.

A few observations from my years of group and individual enrollments:

In the group market, Medicare competing alongside traditional carriers introduces a composite-rating dynamic that doesn't exist in Medicare today. Group insurance rates are built around the demographics of the specific group. Medicare premiums are currently flat-rated regardless of age. That's a mechanical difference that would need to be worked through.

On the ACA market: This could work, but it faces a similar issue to the one above. Medicare coverage aligns more closely with a Gold plan than with Silver or Bronze, which suggests the $12,000 estimate may be low when you factor in what it covers.

Adverse selection is a key concern for any health care plan: healthy individuals will weigh costs and benefits and opt out once costs exceed a certain threshold. The less healthy will gravitate toward whatever covers the most at the lowest cost. Without a broader funding base beyond enrollee premiums, that dynamic tends to drive per-capita costs upward over time. I've seen it play out in both group and individual markets throughout my career.

I completely agree with you that Medicare's purchasing power and lower administrative costs are real structural advantages. The loudest opposition would likely come from provider lobbyists, not insurers. More people on Medicare reimbursement schedules means lower provider revenue.

Your proposal has merit. Mine is anchored in existing retirement plan provisions, specifically the Rule of 55 and 72(t) distributions, and has CBO benchmark data supporting the age-60 version as a reference point. I'll respectfully stay the course on what I've built, but I sincerely appreciate your engagement in the conversation.

 

[GenXguy]

This should result in cost savings for many individuals and small businesses based on the fact that Medicare negotiates better deals with hospitals and doctors, has lower admin expenses than insurance companies and pays no shareholders.

The only losers in this proposal might be the insurance companies who would lobby furiously against in congress.

Comments?

Losers would be the healthcare facilities taking the big cuts in payments when many are struggling to survive as it is. Someone has to make up the costs, the other losers, or the healthcare facility starts reducing services or shuts down. It's already happened, and the current OBBB is expected to accelerate that as it is. So, if suddenly 44 to 64 year olds using services results in much smaller Medicare rates, that's going to add fuel to the fire.

Also note, that Medicare doesn't cover everything. Most people still purchase supplementals to cover what A/B won't cover, plus the prescription drug plans that have high deductibles.

After seeing all these comments in this thread, the easiest and most logical thing is to restore the enhanced subsides that were in place prior to this year. No point in trying to complicate things with some plan that is even less likely to happen.

 

[DangerousNachos]

Losers would be the healthcare facilities taking the big cuts in payments when many are struggling to survive as it is. Someone has to make up the costs, the other losers, or the healthcare facility starts reducing services or shuts down. It's already happened, and the current OBBB is expected to accelerate that as it is. So, if suddenly 44 to 64 year olds using services results in much smaller Medicare rates, that's going to add fuel to the fire.

Also note, that Medicare doesn't cover everything. Most people still purchase supplementals to cover what A/B won't cover, plus the prescription drug plans that have high deductibles.

After seeing all these comments in this thread, the easiest and most logical thing is to restore the enhanced subsides that were in place prior to this year. No point in trying to complicate things with some plan that is even less likely to happen.

@GenXguy, I agree that providers and healthcare facilities operating on thin margins would feel the impact of more participants being covered under Medicare's reimbursement schedule. However, their failures aren't necessarily tied to reimbursement schedules, as this audit of a recently shuttered facility illustrates. Scathing audit performed on shuttered Oak Park hospital thousands relied on

On supplements and Part D, I agree. Medicare isn't free or complete coverage. I don't believe anyone throughout this conversation has implied that it is.

While restoring enhanced subsidies is easy, and I was overly optimistic that it would still happen, I would submit the following. I just lost $20,000 in subsidies when the political wind shifted. Subsidies that exist by legislative grace can be removed the same way. The Medicare Bridge isn't dependent on subsidy levels that change when someone introduces a new OBBB. That's not a small distinction for anyone trying to plan retirement around healthcare costs.

The easiest solution and the most durable solution aren't always the same thing.

 

[Just_Steve]

@GenXguy, I agree that providers and healthcare facilities operating on thin margins would feel the impact of more participants being covered under Medicare's reimbursement schedule. However, their failures aren't necessarily tied to reimbursement schedules, as this audit of a recently shuttered facility illustrates. Scathing audit performed on shuttered Oak Park hospital thousands relied on

On supplements and Part D, I agree. Medicare isn't free or complete coverage. I don't believe anyone throughout this conversation has implied that it is.

While restoring enhanced subsidies is easy, and I was overly optimistic that it would still happen, I would submit the following. I just lost $20,000 in subsidies when the political wind shifted. Subsidies that exist by legislative grace can be removed the same way. The Medicare Bridge isn't dependent on subsidy levels that change when someone introduces a new OBBB. That's not a small distinction for anyone trying to plan retirement around healthcare costs.

The easiest solution and the most durable solution aren't always the same thing.

If someone can't afford healthcare in early retirement then they are not prepared for nor deserve to ER. Pretty simple concept.

 

[DangerousNachos]

@Just_Steve, following that line of thinking, I hope Congress doesn't decide tomorrow that Roth IRA distributions are now taxable income. Not your principal contribution, but all the deferred gains. Similar to distributions from non-qualified annuities. All those who planned for early retirement on tax-free income, and the rules changed... Silly people.

 

[GenXguy]

@GenXguy, I agree that providers and healthcare facilities operating on thin margins would feel the impact of more participants being covered under Medicare's reimbursement schedule. However, their failures aren't necessarily tied to reimbursement schedules, as this audit of a recently shuttered facility illustrates. Scathing audit performed on shuttered Oak Park hospital thousands relied on

First, I did not say the reimbursement rates alone were the reason, but when you already have many in trouble with the OBBB making things even more concerning for many of them, reimbursing them less for services on top of that, only worsens things.

You can't review an audit of a single hospital that is temporarily shut down and make assumptions about all of them. When I looked into the reason for hospitals shutting down, the number #2 reason on the list was:

2) Low or inadequate reimbursement rates

I will add that I had worked at a hospital and had another hospital in my home town shut down, so there's only one remaining. But that's anecdotal, like the article you linked to. That hospital in Oak Park is actually in my region.

On supplements and Part D, I agree. Medicare isn't free or complete coverage. I don't believe anyone throughout this conversation has implied that it is.

It seems implied in the post I was responding to, talking about replacing the originally proposed public option in the ACA with Medicare. The public option was supposed to be an alternative for a full ACA plan, meeting the same standards, which is more than Medicare A & B.

While restoring enhanced subsidies is easy, and I was overly optimistic that it would still happen, I would submit the following. I just lost $20,000 in subsidies when the political wind shifted. Subsidies that exist by legislative grace can be removed the same way. The Medicare Bridge isn't dependent on subsidy levels that change when someone introduces a new OBBB. That's not a small distinction for anyone trying to plan retirement around healthcare costs.

The easiest solution and the most durable solution aren't always the same thing.

Durable, but it’s a major structural expansion of entitlement coverage with real downstream effects. I think it's way too heavy of a life considering we already have the ACA, despite the cliff being back in effect. Anyway, good luck. I hope you aren't spending too many brain cell hours on this.