Healthcare in Early Retirement
What coverage costs between the day you stop working and the day Medicare starts.
2025 program data · ACA rules through 2025
Premiums, Federal Poverty Levels, Medicare Part B and D, and IRMAA brackets are 2025 figures. The enhanced subsidy caps used here were legislated through 2025 and are not guaranteed to continue. In particular, they remove the old 400%-of-poverty-level subsidy cliff. If those credits have lapsed, a household above 400% FPL would pay the full unsubsidised premium rather than the 8.5% cap shown here. Treat every number on this page as a rough order of magnitude, not a quote.
Your situation
2025 tables · not adjusted for future rule changes
- Healthcare gap: 10 years between early retirement and Medicare eligibility at 65
- At 236% of Federal Poverty Level, you qualify for ACA subsidies. Managing income (MAGI) is key.
- Potential ACA subsidies: $116,180 over 20 pre-Medicare years
- Healthcare inflation impact: peak year costs 191% above average
You are projected to spend $87,171 on healthcare across 20 years before Medicare. An HSA is the only account that is tax-free going in and coming out for medical costs — add one to your plan →
Bridging healthcare for early retirement
Medicare begins at 65. Retire at 50 and you buy your own coverage for fifteen years first, at a point in life when premiums are rising with age. It is routinely the largest expense missing from a FIRE plan, and unlike most expenses it is only loosely under your control.
What is under your control is the income you report. ACA subsidies are calculated from modified adjusted gross income, and in early retirement that is mostly portfolio withdrawals. Drawing from a Roth or an HSA instead of a traditional IRA or 401(k) lowers your MAGI, which raises your subsidy: the same dollar of spending, a smaller premium. That is the lever this page exists to show you.
The projection on the main calculator treats healthcare as an ordinary living expense. Use the peak and average figures here to set that number honestly, and read how account types are taxed for the withdrawal side.
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