This is the No. 1 thing Americans worry about being able to afford in retirement - and it's not food or housing

By Alessandra Malito

Some say these worries will impact how they vote in the midterm elections

Healthcare spending tops other financial concerns for those nearly and currently retired - and some polled respondents have said those worries will impact how they vote this fall.

Retirement savers are more concerned about medical spending than any other financial stressor, a new survey found - and for good reason.

The rising cost of healthcare, including insurance premiums and drugs, will pressure older Americans, particularly more vulnerable populations. This is on top of other financial-related anxieties, such as the rising cost of living, as well as the fact that so many Americans have not saved enough for retirement.

Healthcare costs were the top financial concern for retirement investors in 2026, according to an Oath Money & Meaning Institute survey released this month. More than 81% of respondents said they were worried about the cost of premiums, prescriptions and long-term care - more than the two-thirds of people who said they were concerned with not having enough money to maintain their lifestyles, or the more than half who were most stressed about the cost of housing.

"That's just the facts of the reality of healthcare spending," said Jack Hoadley, research professor emeritus at the Health Policy Institute at Georgetown University's McCourt School of Public Policy.

The findings underscore Americans' financial worries about medical expenses. Three-quarters of respondents in a KFF poll released Thursday said healthcare expenses will impact how they vote in midterm elections this fall, more than those who were concerned about how to pay for utilities, groceries or housing.

More than half of KFF's respondents said they expect healthcare expenses for them and their families will become less affordable in the year ahead, the nonpartisan health-policy think tank found.

Studies throughout the years show healthcare spending, especially for retirees, often rises year after year. A 65-year-old retiring in 2025 could expect to spend an average of $172,500 on healthcare in retirement, up 4% from the year before, according to Fidelity Investments, which has tracked retiree healthcare costs since 2002. That figure includes out-of-pocket drug costs and usual medical spending like premiums, copays and deductibles, but does not include long-term care.

Medicare, which has nearly 63 million beneficiaries covered under parts A and B, highlights these rising costs and the impacts they have on retirees.

Beneficiaries of Medicare Part B - which pays for doctor visits and other medical expenses outside hospital stays and prescriptions - saw a 10% increase in their monthly Part B premiums in 2026, going from $185 a month to about $203 a month, and the most recent trustees report suggests program spending will continue to rise. Premium hikes are linked to the program's spending, as is the income-related monthly adjustment amount higher earners must pay when they exceed certain income thresholds.

According to the trustees report, that surcharge, known as IRMAA, could jump by a double-digit percentage over the next few years.

Where Medicare and future premium hikes fit in

Medicare premium hikes affect all beneficiaries who pay for their premiums (though there are some lower-income individuals who do not have to pay, such as if they qualify for Medicare Savings Programs).

"The reality is that while people with higher income might be concerned about an increase in IRMAA, they end up translating to a much less substantial burden overall," said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF.

For example, individuals in the highest IRMAA bracket, with incomes of $500,000 or more, may pay the most in Part B premiums when including the surcharge - but their premiums represents a much smaller percentage of their monthly income compared to lower-income individuals whose Part B premiums could take 10% or more of their annual income.

"The burden falls much more heavily on people with relatively modest incomes even though, in dollar terms, people with higher incomes are required to pay larger numbers," Cubanski said.

Still, more than 5 million beneficiaries were impacted by IRMAA in 2025, and the trustees estimate more than 7 million will be affected by it in 2030.

IRMAA fees are broken into tiers, and people pay a percentage of Part B costs based on their tax-filing status and earnings over the modified adjusted gross income. The tiers are: 35%, 50%, 65%, 80% and 85% of total Part B costs.

The lowest tier of beneficiaries required to pay IRMAA - who were either single with income between $106,000 and $133,000, or married filing jointly with income between $212,000 and $266,000 - paid an additional $74 a month for their Part B premiums in 2025, according to the Centers for Medicare and Medicaid Services. In 2030, this tier's IRMAA could be $106 per month. The beneficiaries in the highest bracket - single filers with income of $500,000 or more, or those married filing jointly with income equal or more than $750,000 - paid an additional $444 a month in 2025, but could possibly pay $635 more per month in 2030, according to the trustees' estimates. These fees are on top of whatever the Part B premium will be at the time.

So, someone in the first tier of IRMAA's thresholds in 2025 would have paid a monthly total premium of $259, which is the $185 monthly Part B premium plus the additional $74 surcharge.

Source: Centers for Medicare & Medicaid Services

There are also IRMAA-related fees for Medicare Part D premiums, as shown below.

Source: Centers for Medicare & Medicaid Services

These surcharges are based on income from two years prior, so someone paying IRMAA in 2026 is doing so because of his or her 2024 tax return.

The tiers are adjusted for inflation, which means beneficiaries won't necessarily jump from one bracket to another in the years ahead. "You may not go up to the next level because the thresholds go up too," Georgetown's Hoadley noted. Some beneficiaries may also be able to appeal the IRMAA if they had a major life-changing event, such as a retirement, marriage or the death of a spouse, he said.

Medicare premium increases, and the estimates the trustees put out, are tied to the inflation of healthcare spending. That spending includes doctor visits, new technologies, outpatient drugs such as injectables, and other medical expenses, said Gretchen Jacobson, vice president of Medicare, expanding coverage and access at the Commonwealth Fund, a nonpartisan healthcare think tank.

"As all of that rises in costs, that is going to affect how much Medicare beneficiaries have to pay for premiums," she said.

-Alessandra Malito

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01-31-26 1409ET