Trump’s $90 Medicare and $500 ACA checks are going out. Here’s why healthcare costs could still hit seniors

A $90 Medicare payment is on the way for millions of beneficiaries, while nearly 1 million Affordable Care Act enrollees are receiving $500 refunds. But those payments are arriving as the cost of health coverage continues to rise.

More than 20 million Medicare participants enrolled in Part B are expected to receive the one-time $90 payment and about 1 million people who enrolled in ACA plans through federal exchanges are getting $500 checks.

The amounts may sound helpful, but the increases in healthcare costs reported in the same period are larger.

Medicare Part B Premiums Have Already Risen

The $90 payment is available to certain people enrolled in Original Medicare Part B. The Centers for Medicare and Medicaid Services has estimated that 20.8 million Americans are eligible for the rebate.

So for that, beneficiaries must have Original Medicare Part B, live in the US and not receive premium assistance from Medicaid or pay an Income-Related Monthly Adjustment Amount (IRMAA) to qualify.

People enrolled in Medicare Advantage are not eligible. Most eligible beneficiaries are expected to receive the $90 through direct deposit from the Social Security Administration on or around October 8, as per a Forbes report. Those without direct deposit will receive a paper check later in October.

The payment is intended to help eligible beneficiaries pay their Part B premiums.

Why $90 May Not Cover the Increase

The size of the payment becomes more important when compared with the change in Part B premiums.

Part B premiums rose by more than $200 annually in 2026. The Medicare trustees' latest annual report also projects another $79 increase in 2027.

That means the one-time $90 payment is smaller than the increase in the annual Part B premium that took effect in 2026.

About 40 million Medicare Part B recipients do not qualify for the payment.

The $500 ACA Refund Is Also Smaller Than the Premium Increase

The ACA payment is larger, at $500, but the increase in average premiums is larger still.

Nearly 1 million people enrolled in ACA plans through federal exchanges are receiving the refunds. The payments are for people who did not receive ACA insurance subsidies and are described as refunds for overcharges.

The checks are being sent to ACA enrollees across 30 states.

Average ACA premiums increased by $780 in 2026, or 58% from 2025, as per a KFF analysis cited by CBS News report. So that means the $780 increase is larger than the $500 refund.

Higher ACA Costs Add to the Pressure

The increase in ACA premiums came after enhanced premium tax credits expired.

About 18 million ACA enrollees will not receive the $500 payment and the administration began sending the ACA refund checks on September 30.

Who Gets the Medicare Payment

The Medicare rebate is not available to everyone with Part B as eligible beneficiaries must have Original Medicare Part B, live in the US and not receive premium assistance from Medicaid or pay IRMAA. Medicare Advantage enrollees are excluded. The payment is a one-time $90 rebate for those who qualify.

Why the Payments May Not Be Enough

The key issue is that both payments are one-time amounts, while the higher premiums represent an ongoing cost.

For people receiving the Medicare rebate, the payment comes alongside higher Part B costs that continue into the following year, when another increase is projected.

The same issue applies to the ACA refunds. The $500 payment is being sent to eligible enrollees, but higher average premiums mean the refund does not necessarily make up for the full increase in what coverage costs.

That leaves the payments offering a limited offset rather than covering the entire rise in premiums.