The 2026 Trustees Report covers two trust funds with completely different failure modes — and almost every argument about Medicare comes from confusing them. Here is each one, read from the kitchen table and from the committee room.
Two funds, two rules. HI (Hospital Insurance, Part A) is funded by payroll tax and can run out of money. SMI (Supplementary Medical Insurance, Parts B and D) is refilled every year by law from general revenue and beneficiary premiums, so it cannot run out — the cost simply moves onto taxpayers and onto you.
The half with a deadline
2033
Second quarter. That is when the Hospital Insurance trust fund — the part that pays for your hospital stays — is projected to run out of reserves. It moved one quarter earlier than last year's report.
Then 89 % of scheduled benefits are payable — a figure that recovers to 93 % by 2100 rather than sliding further.
Financed by law each year from general revenue and premiums. It cannot deplete — which is not the same as being affordable.
The fund does not meet the Trustees' own 10-year test. They call this “an indication that action is necessary.”
Source: 2026 Medicare Trustees Report, Overview p. 8; §III.B pp. 61–62.
Trust fund ratio: assets at the start of the year as a percent of that year's expenditures. The Trustees' own test wants this at 100 % or above.
Source: Medicare TR2026, table III.B6, p. 62.
At the kitchen table
Part A is the hospital half — inpatient stays, skilled nursing, hospice. If nothing changes, from 2033 it can only cover 89 % of what it owes providers.
You would not be dropped from Medicare. The squeeze would land first on what hospitals are paid, which is a slower and less visible problem than a benefit cut — right up until it affects which facilities take you.
In the committee room
The date moved because of a revenue change, not a spending one. Over 2026–2035 HI income is $51.6 B lower (about 0.8 %) than last year's projection; expenditures are only $4.3 B higher (0.1 %).
The Trustees attribute the income drop to lower taxation of Social Security benefits under the OBBBA. A tax cut scored elsewhere pulled a quarter off Medicare's clock.
The half with no deadline
The Trustees write that SMI — Parts B and D — is adequately financed indefinitely. That is true, and it is not reassurance. It is a description of a mechanism: whatever Parts B and D cost next year, the premium and the government's contribution are simply reset to cover it. There is no trust fund to run dry because the bill is re-sent every year.
Source: Medicare TR2026, “Medicare Data for Calendar Year 2025,” p. 13. Shares are of SMI program cost in 2025.
At the kitchen table
“Medicare can't go bankrupt” is technically true of Parts B and D — because your premium is the shock absorber. When costs rise, the premium rises. That is the design, not a failure of it.
It is deducted from your Social Security payment before you see it, which is why the increase is easy to miss and hard to avoid.
In the committee room
SMI's unfunded obligation is $0 by construction. HI's is $4.2 trillion. Comparing the two as if they measured the same thing is a category error the report itself warns against.
Because 75 % of SMI is general revenue, Part B and Part D growth is a claim on the same appropriations pool as everything else — it shows up in the deficit, not in a depletion date.
The part you feel
The Social Security cost-of-living adjustment for 2026 is 2.8 %. The standard Part B premium — deducted from that same check — rose 9.7 %. Both numbers come from the two Trustees Reports, and together they are the single most consequential fact on either page.
Source: Medicare TR2026, tables V.E1 (p. 206) and V.E2 (p. 207).
Premiums annualised (twelve monthly payments) so both lines are the same unit over the same period. Actual through 2026, projected to 2035.
Source: Medicare TR2026, table V.E2, p. 207. The report publishes the premium monthly; it is multiplied by twelve here. The table view shows both forms.
At the kitchen table
The standard Part B premium is projected to reach $360.60 by 2035 — nearly double the 2025 figure. The deductible roughly doubles too, from $257 to $503.
If your income is above $109,000 filing single or $218,000 jointly, you pay more on top. At the highest tier in 2026 that surcharge is $487.00 a month — on top of the $202.90.
In the committee room
6.1 million beneficiaries pay the income-related surcharge in 2026, contributing $18.8 billion. That is a means test already operating inside a universal program.
The $200,000 / $250,000 threshold for the additional 0.9 % Medicare payroll tax has never been indexed. Every year of wage growth quietly widens who pays it — a tax increase that requires no vote.
In today's money
A projection in future dollars always overstates the pain, so here is the same price list with inflation taken out. Between 2026 and 2035 the Trustees project general prices to rise 17.5 %. The Part B premium rises 77.7 %. Deflate one by the other and you are still left with a 51 % real increase — this is not a price-level illusion.
The distance between the two lines is pure inflation. The lower line is what the premium costs in constant 2026 dollars — and it still climbs.
Source: Medicare TR2026 table V.E2 for the premiums; deflated using the Trustees' own CPI projection, OASDI TR2026 table VI.G1 (Selected Economic Variables, adjusted CPI, indexed to 2026 = 100).
Real = the 2035 amount expressed in 2026 dollars. Real Δ = change against the 2026 amount after inflation. General prices rise 17.5 % over the same period.
At the kitchen table
Your Social Security payment rises with consumer prices; that is what the COLA does. So the honest question is never “does my premium go up,” it is does it go up faster than my raise. For Part B the answer is yes, by roughly half again over the next nine years.
The good news is narrower than it looks but it is real: the hospital deductible and the drug cap grow only about 8 to 13 % in real terms. The squeeze is concentrated almost entirely in the Part B premium.
In the committee room
The real growth sits in exactly the half of Medicare that cannot become insolvent. Part A — the half with the 2033 headline — is close to flat once you deflate it. Part B, which never makes a headline because it can never run out, is where the money actually goes.
That inverts the usual framing. The depletion date is the urgent problem; Part B growth is the large one.
The trajectory
This is the chart that reframes the whole argument. Hospital Insurance — the half with the scary depletion date — barely grows as a share of GDP. The half that cannot go insolvent is the half that grows.
Incurred expenditures. Historical through 2025, projected after; five-year intervals beyond 2035.
Source: Medicare TR2026, table V.B2, p. 188. Parts B and D combined; each row cross-checks against the report's printed total.
Source: Medicare TR2026, Overview pp. 7 and 11, “2025 in Review.”
The arithmetic
The report states the two ways to erase the 75-year HI shortfall outright. Compared with Social Security's gap, these are modest — which is exactly why the political economy, not the arithmetic, is the binding constraint.
Under current law
Close the HI gap
If the law's cost controls don't hold
Illustrative alternative
Source: Medicare TR2026 §III.B, p. 33 and footnote 35. The alternative scenario assumes the physician and productivity-adjusted payment updates written into current law are not sustained — the Trustees publish it precisely because they doubt those updates hold.
At the kitchen table
You currently pay 1.45 % of every paycheck to Medicare and your employer pays another 1.45 %. Closing the gap means about 28 cents more per $100 of wages from each of you.
Self-employed? You pay both halves — 2.90 % today, 3.46 % under that fix.
In the committee room
The gap is 0.56 % of taxable payroll — roughly an eighth of Social Security's 4.42 %. It is the cheapest of the entitlement problems to fix and the one closest to its deadline.
The alternative scenario more than doubles it to 1.38 %. The difference between those two columns is entirely a question of whether Congress lets scheduled provider payment restraint actually take effect.
Current info · Moved since the 2025 report
Source: Medicare TR2026, Overview p. 8; §III.B p. 62; §V.B p. 187.
At the kitchen table
Nothing about your coverage changes this year because of any of the above. The dates in this report are forecasts, and they have moved before — in both directions.
What has already changed is the price list further up this page. That part is not a projection.
In the committee room
The Trustees close with an unusually direct line: “The sooner solutions are enacted, the more flexible and gradual they can be.” They recommend Congress and the executive branch “work closely together to quickly address these challenges.”
Seven years remain before the HI date. Social Security's is eight. The two reports are effectively one deadline.