Gap Retirees Face Rising Health Care Costs: What You Need to Know

'With rising premiums, shifting federal programs, and mounting medical debt, Gap employees must take a more deliberate approach to budgeting for health care in retirement to help avoid financial pitfalls that could derail long-term plans.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.

'As health care policy continues to evolve, Gap employees should regularly revisit their retirement strategies to account for potential coverage gaps and unexpected medical expenses that could strain fixed budgets.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article we will discuss:

1. How rising health care premiums and shrinking federal support may affect pre-Medicare retirees.

2. The impact of medical debt, weakened consumer protections, and changing credit rules on retirement outcomes.

3. Adjustments to Medicaid and government health care programs that could disrupt early retirement plans.

Health Care Costs Continue to Climb for Retirees

The following article has been revised to reflect recent changes in health care policy and economics for individuals with longstanding corporate careers. Gap retirees and employees preparing for retirement are experiencing higher medical expenses, tighter household budgets, and new health care regulations—an especially relevant concern for those managing fixed incomes or long-term savings goals.

Premiums Rising, Coverage Shrinking

One key factor driving up costs is the anticipated end of Affordable Care Act (ACA) premium subsidies. If these subsidies expire, annual out-of-pocket premiums could increase by an average of $1,247—a 75% jump. ¹  This would affect Gap retirees relying on ACA plans prior to Medicare eligibility. Additionally, the One Big Beautiful Bill Act (OBBBA), passed in July 2025, calls for nearly $1 trillion in cuts to federal health care spending, with Medicaid bearing the brunt over the next ten years. ²

These reductions could result in up to 10.9 million Americans losing health care coverage by 2034, according to the Congressional Budget Office (CBO). ³

Eroding Consumer Protections

Policy changes are also exposing Gap retirees to greater financial stress. A federal ruling overturned a consumer-friendly rule that prevented medical debts over $500 from appearing on credit reports. ⁴  As a result, credit scores for millions could be affected—an issue that carries implications for mortgages, employment applications, and other financial decisions during retirement transitions.

The Weight of Medical Debt

Across the country, medical debt remains a persistent challenge: ⁵

• - 40% of adults report having dental or medical debt.

• - 1 in 6 borrowed money or used credit cards to pay off medical bills.

• - Over 20 million owe $250 or more; 14 million owe over $1,000; and 3 million owe more than $10,000.

• - Adults aged 50–64 carry more debt than those 65–79 due to delayed Medicare access.

These statistics underscore the pressure on Gap employees who retire before reaching Medicare eligibility.

Health Decisions at Risk

According to Tyson Mavar, a financial advisor with Wealth Enhancement, 'Credit scores may not be affected for those who hold medical debt, potentially resulting in delayed treatment.' This concern is amplified for Gap retirees who may have limited health care coverage and rising expenses.

While some households cope with medical debt by cutting back on food and housing, depleting savings, or borrowing more, these approaches only serve to contribute to poorer health and higher stress.

Government Program Adjustments

Medicaid changes under OBBBA bring added burdens, particularly for early retirees in rural areas. Adjustments include stricter eligibility verification, new work requirements, and increased co-pays of up to $35 per visit for those near the poverty line. These revisions may impact millions of rural Americans and bring added stress to rural health care facilities that are already stretched thin.

A $50 billion Rural Hospital Transformation Fund was announced, but it is expected to address just 37% of anticipated losses and is set to expire by 2032. ⁶

Why It Matters for Gap Families

Recent health care changes are reshaping retirement planning. Even though Gap offers a range of employee benefits and retirement options, not all workers transition into Medicare or employer-based retiree coverage without gaps. According to Fidelity, a 65-year-old individual retiring in 2025 may need to spend $172,500 health care throughout retirement—not including long-term care. ⁷

Future policy shifts could add thousands more to that estimate. Keeping an eye on health care policy and evaluating benefit elections are now essential components of retirement planning.

The Bottom Line

Navigating today’s health care system is like taking a road trip with higher tolls, fewer exits, and less reliable maps. Gap employees near or in retirement are encountering a shifting landscape of costs, coverage, and legal rules. If these developments are overlooked, retirement plans may be exposed to financial disruptions that are difficult to recover from.

Being proactive with coverage reviews, medical budgeting, and credit management can help retirees steer clear of costly missteps and adapt to an increasingly complex health care environment.

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Sources:

1. Business Insider. “ Millions of Americans could pay up to $1,247 more for Affordable Care Act health insurance next year ,' by Juliana Kaplan, 23 July 2025.

2. The Guardian. “ Democrats Use New Tactic to Highlight Trump’s Gutting of Medicaid ,” by Stephanie Kirchgaessner, 27 July 2025.

3. USA Today. ' Neary 11 million Americians would lose insurance under Trump's tax bill, analysis says ,' by Ken Alltucker, 4 June 2025. 

4. Medicare Rights Center. ' Federal Court Reverses Federal Medical Debt Protections ,' by Julie Carter, 31 July 2025. 

5. Peterson-KFF, Health System Tracker. ' The burden of medical debt in the United States ,' by S. Rakshit, M. Rae, G. Claxton, K. Amin, and C. Cox, 12 Feb. 2024. 

6. KFF. ' A Closer Look at the $50 Billion Rural Health Fund in the New Reconciliation Law ,' by Zachary Levinson and Tricia Neuman, 4 Aug. 2025. 

7. Fidelity. ' How to plan for rising health care costs ,' Fidelity Viewpoints, 12 Aug. 2024.