Health Insurance for 55 and Older: What It Costs Before 65

Health insurance for 55 and older usually comes from the ACA Marketplace, COBRA, a spouse’s job, or a part-time job. Those options bridge the years until Medicare starts at 65. Without a subsidy, an average benchmark silver plan cost about $1,091 a month at 55 and $1,467 at 64 in 2026.

Ten years is a long time to pay that bill. Early retirees have more control over it than most people. The subsidies that cut premiums depend on income, and much of your income in early retirement is yours to plan. Open enrollment for 2027 coverage runs Nov. 1, 2026 to Jan. 15, 2027 on HealthCare.gov. Enroll by Dec. 15 for coverage that starts Jan. 1.

How Much Does Health Insurance Cost at 55 and Older?

Health insurance gets more expensive every year between 55 and 64. Insurers can charge a 64-year-old up to three times what they charge a 21-year-old, and prices step up with each birthday.

Source: KFF, average benchmark premiums for a 40-year-old and benchmark premiums for older adults, 2026; CMS default age curve. Figures are the national average for the second-lowest-cost silver plan, before subsidies. Boldin calculated the 55 and 64 figures from KFF’s age-40 average and the CMS curve.

Your price depends on where you live. The same plan can cost far more in one county than in the next. A few states use their own age curves. New York and Vermont don’t price by age at all.

Insurers can’t charge women and men different prices for Marketplace plans. Age, location, tobacco use, and whether the plan covers a family are the only factors allowed. Smokers can pay up to 50% more.

Expect higher prices in 2027. Insurers proposed a median increase of about 15%, according to KFF. That follows a 26% average increase in what insurers charged for 2026. Final 2027 prices show up on HealthCare.gov when open enrollment starts.

Can You Get Medicare at 55?

Most people can’t get Medicare until 65. The exceptions are based on disability. You qualify after 24 months of Social Security disability benefits, or right away if you have ALS. End-stage renal disease also qualifies, on a timeline tied to dialysis or a transplant.

Without one of those, coverage at 55 has to come from somewhere else for up to 10 years. Plan to sign up for Medicare on time at 65, even if you have a Marketplace plan. If you’re on an ACA plan, “you need to enroll at 65,” Social Security and Medicare writer Mark Miller said on the Boldin podcast. Missing that window brings a Part B late penalty that lasts for life.

If your spouse is already on Medicare, their plan choices come up each fall in Medicare’s own open enrollment, Oct. 15 to Dec. 7.

What Are Your Health Insurance Options Before Medicare?

Most people between 55 and 65 choose among seven options. The right one depends on your income, your health, and whether anyone in the household is still working.

Source: U.S. Department of Labor, An Employee’s Guide to Health Benefits Under COBRA; KFF, Medicaid expansion decisions; Michigan Department of Insurance and Financial Services, health care sharing ministries.

COBRA keeps the plan you had at work, but you pay the whole premium yourself. For most people under the subsidy cliff, a Marketplace plan costs less than COBRA.

In states that expanded Medicaid, adults qualify with income up to 138% of the poverty line. That’s about $22,025 for one person or $29,863 for two in 2026. Medicaid for these adults has no asset test, so savings don’t count. The Medicaid eligibility rules vary by state.

Health care sharing ministries cost less because they aren’t insurance. They don’t follow ACA rules, they can turn down claims tied to pre-existing conditions, and no state guarantees payment.

How Do ACA Subsidies Work for Early Retirees in 2027?

ACA subsidies cap what you pay for a benchmark silver plan at a share of your income. They apply as long as your income stays at or below 400% of the federal poverty line. Above that line, you pay full price.

Boldin Advisor Andy Barton, a CFP® professional, described the change during a session on Roth conversions and ACA costs: “There’s two tiers of the ACA subsidies. There’s the standard subsidies, which are still in place, and then there were higher COVID subsidies that were in place for a number of years.” Those enhanced subsidies expired at the end of 2025.

Source: HealthCare.gov, federal poverty level; IRS Revenue Procedure 2026-26 for 2027. Marketplace subsidies use the prior year’s poverty guidelines.

Starting with 2026 tax returns, there’s also no cap on paying back excess subsidies. If your income ends up higher than you estimated, you repay the full difference at tax time.

How Can You Keep Your Income Under the Subsidy Cliff?

You keep your income under the cliff by choosing which accounts pay your bills. Marketplace subsidies use modified adjusted gross income (MAGI), and in early retirement much of that number is up to you.

• Adds little or nothing to MAGI: spending cash savings, selling taxable investments at little gain, withdrawals of Roth IRA contributions, and HSA money used for medical bills.
• Counts in full: traditional IRA and 401(k) withdrawals, Roth conversions, realized capital gains, interest (tax-exempt interest too), dividends, and all Social Security benefits, including the untaxed part.

The stakes are large. Take a couple, both 60, with 2026 average premiums of about $2,654 a month for two benchmark plans. Under 2027 rules, income of $86,000 caps their share at about $8,790 a year, so a subsidy covers the other $23,000 or so. At $87,000, they pay the full $31,848. Going a few hundred dollars over the line costs them about $23,000, and the gap grows with 2027 prices.

The catch is that staying low for 10 years can work against Roth conversions, which often make the most sense in these same years. Boldin Advisors Andy Barton and Brie Black see the same tradeoff with clients. A conversion can raise Medicare costs or erase ACA subsidies in the same tax year. Planning the order of withdrawals across the bridge years, and sizing conversions around the cliff, helps you keep both.

When Can You Switch From COBRA to a Marketplace Plan?

You can switch from COBRA to a Marketplace plan during open enrollment, or when your COBRA coverage runs out. Losing job-based coverage also opens a 60-day special enrollment period, even if you’re offered COBRA.

Dropping COBRA early, or stopping payments, doesn’t open a special enrollment period. You’d wait for the next open enrollment. HealthCare.gov may ask for proof that your coverage ended, so keep the letter.

COBRA can last longer for family members. When the former employee’s Medicare entitlement ends a spouse’s or child’s coverage, those dependents can qualify for up to 36 months in certain circumstances.

How Do You Shop for a Marketplace Plan at 55 or Older?

Start at HealthCare.gov, which sends you to your state’s exchange if it runs one. Lead-generation sites that look official are common in this market, so enter your information only on the official exchange. Several state exchanges stay open longer. California, New Jersey, New York, and DC close Jan. 31.

Plans come in four metal levels: bronze, silver, gold, and platinum. If you rarely see a doctor, bronze keeps premiums low. If you have ongoing care, gold or platinum lowers what you pay at each visit. Starting in 2026, bronze and catastrophic Marketplace plans also count as HSA-eligible, so you can keep funding a health savings account.

Check the network type, too:

• HMO: you use the plan’s doctors and need referrals for specialists.
• EPO: you use the plan’s network, and most plans don’t require referrals.
• POS: you pick a primary doctor and can go out of network at a higher cost.
• PPO: you can see doctors outside the network, which costs more.

Not every type is sold in every county.

Coverage for Full-Time RVers

RVers do best with a PPO and a broad network, since HMO and EPO plans cover little outside their service area beyond emergencies. Plans are sold by state, so no Marketplace plan follows you nationwide. Before you enroll, check the plan’s out-of-area rules and its doctors in the states where you’ll spend the most time.

Coverage if You Retire Abroad

Marketplace plans and Medicare cover little outside the U.S., so most people retiring abroad buy international health insurance. Prices and quality vary by country, and many expats keep a plan that also covers trips home.

How Do You Budget for Health Insurance From 55 to 65?

To plan for healthcare costs before 65, budget for a decade of premiums that rise with age, plus deductibles and out-of-pocket costs. Ten years of unsubsidized benchmark premiums, from 55 through 64, add up to about $155,000 per person at 2026 prices. That’s a Boldin estimate from the KFF and CMS figures above, before any price increases.

Health costs weigh on early retirement decisions. In a September 2025 Boldin survey of 509 subscribers 64 and under, 75% said affordable healthcare options mattered to them. More than half said losing subsidies would force them to adjust or delay retirement.

In the Boldin Planner, you can enter what you expect to pay for health coverage before Medicare. The plan then shows how those costs change what you can spend each year until 65.

Health Insurance for 55 and Older: FAQ