Medicare at age 55+?

[DangerousNachos]

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.


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.


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.

@GenXguy, thanks for the concern about my brain cells. I waste most of them on my County finances and trying to fix a $500k deficit. Did you know that in the State of Illinois, a County doesn't have to pass a balanced budget? In fact, it appears you can overstate revenues by almost $1million in order for the budget to appear balanced, but you actually didn't even have to go through that trouble. Regardless, I have a bitter taste in my mouth when it comes to fiscal mismanagement, and that particular article from yesterday hit home.

And I apologize for assuming you were referring to something I said about Medicare being free or its coverage level. It never occured that it might have been a comment I missed.

You might be right, and I'm fighting windmills.

 

[DangerousNachos]

@GenXguy, thanks for the concern about my brain cells. I waste most of them on my County finances and trying to fix a $500k deficit. Did you know that in the State of Illinois, a County doesn't have to pass a balanced budget? In fact, it appears you can overstate revenues by almost $1million in order for the budget to appear balanced, but you actually didn't even have to go through that trouble. Regardless, I have a bitter taste in my mouth when it comes to fiscal mismanagement, and that particular article from yesterday hit home.

And I apologize for assuming you were referring to something I said about Medicare being free or its coverage level. It never occured that it might have been a comment I missed.

You might be right, and I'm fighting windmills.

I hit enter too soon. I meant to add, "However, nothing changes if good people sit and do nothing to change it."

It's why I appreciate you all engaging with this topic. I am already having other discussions outside of here, and the comments here have prepared me for what I'm running into.

 

[Just_Steve]

@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.

But everybody knew or should have known that the extended subsidies were temporary from the beginning and prepared for the likely event they wouldn't be extended for a third time.

 

[GenXguy]

@GenXguy, thanks for the concern about my brain cells. I waste most of them on my County finances and trying to fix a $500k deficit. Did you know that in the State of Illinois, a County doesn't have to pass a balanced budget? In fact, it appears you can overstate revenues by almost $1million in order for the budget to appear balanced, but you actually didn't even have to go through that trouble. Regardless, I have a bitter taste in my mouth when it comes to fiscal mismanagement, and that particular article from yesterday hit home.

That doesn't surprise me. This state is terrible with finances while taxing heavily.

I'm hopeful the ACA subsides won't be cut further by the current leadership. They're manageable for me at this point. But, I still have a few more years to go before Medicare age.

 

[Aerides]

But everybody knew or should have known that the extended subsidies were temporary from the beginning and prepared for the likely event they wouldn't be extended for a third time.

As soon as Nov24 happened, that became super clear. We figured we'd be going back to the pre-2020 premium levels, and expected some inflation and were prepared for it to be far worse than it was. But it's very easy to "well they should have..." with hindsight. I'm super in tune with what's happening in politics and the ACA but it can be exhausting and a lot of people just don't want to wade into it, which I understand.

I think a lot of people who ER'd during that period (or were forced to ER as is more often in the world, in which you can't prepare as easily) and didn't really pay that much attention, and then got sticker shock - particularly those who came face to face with the hard cliff which is a bigger impact to many. We went from paying $250 to $500, but if we go over $84k it will be about $2700. The cliff is my biggest concern as we'd like to increase spending since we can.

 

[DangerousNachos]

But everybody knew or should have known that the extended subsidies were temporary from the beginning and prepared for the likely event they wouldn't be extended for a third time.

@Just_Steve, That's fair, and most in this group have probably learned to expect the unexpected.

However, this proposal wasn't meant just for people to retire early. It also helps an older population have an insurance option they hadn't planned to need, before they were ready. Those who suffer from job displacement because of a changing workforce, technology, or their employer's financial distress, or from a small employer that quits offering group insurance altogether, leaving employees to figure it out on their own.

While most in this group have found ways to successfully navigate the gap, the proposal wasn't built just for this room. It was built for the millions who haven't. Sometimes people are put in situations that are not their fault.

So, let me remind the group that the 2025 Trustees Report states that by 2033, the Medicare Hospital Insurance Trust Fund, the fund that primarily covers Part A, will be insolvent, after which incoming revenue will only cover about 89% of scheduled Part A costs. This proposal not only creates a coverage option for the 55-64 cohort, but does so with a dedicated funding mechanism designed to generate revenue in excess of expansion costs, which strengthens rather than strains the Trust Fund.

 

[MBSC]

A couple of recent posts are similar to the latest Medicare Buy-in bill.

HR 7909 - March 12, 2026
"To amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization..."

1) Eliminates the 400% FPL subsidy cliff and permanently codifies the 8.5% MAGI threshold into the Internal Revenue Code.

2) Allows 50-64 year olds to buy in to original Medicare or Medicare Advantage plans. Enrollment periods would match ACA Marketplace enrollment periods. Premiums would be adjusted for geographic differences and announced in Sept of the prior year. It would be treated as having a qualified Silver plan from the ACA exchange for tax purposes.

2b) The bill leaves it up to HHS/CMS to determine if premiums should be based on age.

3) Creates a new "Medicare Buy-In Trust Fund" for premium receipts and to apply PTC subsidies as determined by the ACA exchanges. Reduces Medicare cost-sharing if the individual is eligible for ACA CSR.

4) Part D drug plan enrollment is optional. Directs CMS to negotiate lower drug prices.

5) Medigap plans would be guaranteed-issue for 30 days after the annual enrollment period and special enrollment periods for those 50-64. Similar to those under 65 on SSDI today, they would still get the age 65 Medigap Open Enrollment Period. For all ages enrolled in original Medicare A & B, creates a "direct supplement" run by CMS as a voluntary alternative to insurance company plans that covers all Medicare Part A & B cost sharing except the first $100. It would have a single, nationwide premium and a late enrollment penalty (10% per year with 100% cap) if not enrolled when first eligible.

6) Creates an "Individual Market Re-insurance Fund" should these changes disrupt the ACA Marketplace. Funded by a new fee in addition to those already included in exchange plan premiums.

 

[DangerousNachos]

A couple of recent posts are similar to the latest Medicare Buy-in bill.

HR 7909 - March 12, 2026
"To amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization..."

1) Eliminates the 400% FPL subsidy cliff and permanently codifies the 8.5% MAGI threshold into the Internal Revenue Code.

2) Allows 50-64 year olds to buy in to original Medicare or Medicare Advantage plans. Enrollment periods would match ACA Marketplace enrollment periods. Premiums would be adjusted for geographic differences and announced in Sept of the prior year. It would be treated as having a qualified Silver plan from the ACA exchange for tax purposes.

2b) The bill leaves it up to HHS/CMS to determine if premiums should be based on age.

3) Creates a new "Medicare Buy-In Trust Fund" for premium receipts and to apply PTC subsidies as determined by the ACA exchanges. Reduces Medicare cost-sharing if the individual is eligible for ACA CSR.

4) Part D drug plan enrollment is optional. Directs CMS to negotiate lower drug prices.

5) Medigap plans would be guaranteed-issue for 30 days after the annual enrollment period and special enrollment periods for those 50-64. Similar to those under 65 on SSDI today, they would still get the age 65 Medigap Open Enrollment Period. For all ages enrolled in original Medicare A & B, creates a "direct supplement" run by CMS as a voluntary alternative to insurance company plans that covers all Medicare Part A & B cost sharing except the first $100. It would have a single, nationwide premium and a late enrollment penalty (10% per year with 100% cap) if not enrolled when first eligible.

6) Creates an "Individual Market Re-insurance Fund" should these changes disrupt the ACA Marketplace. Funded by a new fee in addition to those already included in exchange plan premiums.

@MBSC, this is an EXCELLENT find. There are more similarities than not to what I have proposed. I'm also afraid it will die for lack of sufficient funding, and it adds another layer of complexity, like the ACA, that I don't believe is needed. Plus, it's a Chicago Democrat, so I'm not sure it will get the serious look it deserves.

@MBSC, you obviously follow the Federal Government closely. The bill appears to be stalled and hasn't moved since its introduction. I was working on my proposal from the Senate side with Senator Duckworth, but she's also a (D). If you're involved as much as I think you may be, you know how this works, and it's all political to get anything looked at and passed.

Now that I know a similar concept is already out there, I'll attempt to package it, rebrand it, and see where I can get with the Republicans. Any insight you can provide would be greatly appreciated. You're definitely catching more than I am.

Thank you very much for this. I hope the group continues to stay engaged, as invaluable discussion has occurred, and I'll continue to keep everyone posted on the journey.

 

[TripleLindy]

We went from paying $250 to $500, but if we go over $84k it will be about $2700. The cliff is my biggest concern as we'd like to increase spending since we can.

Ditto. While I wasn’t thrilled with the unsubsidized premiums we paid prior to the enhanced subsidies, they increased more than 100% for us - from ~$15k/yr to $34k/yr. And the deductible and out of pocket max also increased.

 

[DangerousNachos]

It would have been nice if they had brought back the pre-cliff premiums and coverages with the pre-cliff rules.

 

[plsprius]

It seems to me that this proposal raises everyone's earned income Medicare taxes from 1.45%/1.45% to 1.95%/1.95% employee/employer.

That's a total change from 2.9% to 3.9%, or a 35% increase in Medicare taxes.

That's not going to work, I don't believe, because of the unpopularity of significantly increased taxes.

 

[Onda]

It seems to me that this proposal raises everyone's earned income Medicare taxes from 1.45%/1.45% to 1.95%/1.95% employee/employer.

That's a total change from 2.9% to 3.9%, or a 35% increase in Medicare taxes.

That's not going to work, I don't believe, because of the unpopularity of significantly increased taxes.

Honestly, a more effective path may be to tax employer-sponsored health insurance plans at, say, 10%-20% rather than sharply raising payroll Medicare taxes. That would likely generate far more revenue because employer health benefits represent a massive untaxed compensation pool, and at the same time it would make a public option look more attractive by removing some of the tax advantage that employer plans currently enjoy. Right now the tax code heavily favors employer coverage, which quietly distorts the whole system.

 

[DangerousNachos]

It seems to me that this proposal raises everyone's earned income Medicare taxes from 1.45%/1.45% to 1.95%/1.95% employee/employer.

That's a total change from 2.9% to 3.9%, or a 35% increase in Medicare taxes.

That's not going to work, I don't believe, because of the unpopularity of significantly increased taxes.

@plsprius, of course, it's all about how it's presented.

I have a dear friend whom I've tried for years to help with his finances. Tried to get his credit score fixed, budget, etc. He finally went on Medicare disability and gets a fixed income that he has to budget from truly. We broke things down again, by percentage of income, of his expenses. It finally clicked with him that 30% of his monthly income was being spent on chewing tobacco. He was at one time making $50k a year, and he realized, on his own, "that would be like spending $15k on chew, back then? That's crazy!"

So yes, your math is correct, and Medicare would get a 35% funding increase under my proposal. Some increase in funding will have to happen eventually.

However, I believe that if presented in this way, for every $100 earned, an extra $ 0.50 will go toward Medicare, BUT you will now be eligible to get it 10 years earlier if you choose. And, it helps make Medicare more financially solvent, so it might actually be there when you need it. People might view the very minor increase differently.

 

[DangerousNachos]

Honestly, a more effective path may be to tax employer-sponsored health insurance plans at, say, 10%-20% rather than sharply raising payroll Medicare taxes. That would likely generate far more revenue because employer health benefits represent a massive untaxed compensation pool, and at the same time it would make a public option look more attractive by removing some of the tax advantage that employer plans currently enjoy. Right now the tax code heavily favors employer coverage, which quietly distorts the whole system.

@odan, speaking from experience with enrolling employees in pre-tax spending under Flex Plans (Section 125), that would be a huge hit to employers and employees alike. I always enjoyed showing employees that if they put their day care through the flex pre-tax, the savings per paycheck would almost fund their 401(k), get the company match, and keep their take-home check the same. Health Insurance premiums were the next most expensive pre-tax item

A softer approach could be to disallow FICA and Medicare exclusions for flex-plan contributions. But again, that targets more specifically those who already have expenses, as opposed to the additional 0.5% charged on all employees' earned income.

Also, I don't see paying an additional $0.50 per $100 as "sharply raising Medicare." However, $0.50 is $0.50

I may not have followed your math as you intended, so please feel free to correct me if I'm not seeing something clearly.