BiggerPockets Money Podcast The 4% Rule Was Never Designed for FIRE’s Healthcare Reality
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Jan 30, 2026 They explain how rising pre-65 healthcare costs break the 4% rule for early retirees. They map predictable ACA premium increases and show a large pre-Medicare spending hump. They explore strategies like geographic arbitrage, part-time income, health shares, catastrophic wraps, and direct primary care to bridge the gap.
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The Healthcare Hump Before Medicare
- ACA premiums structurally rise with age, creating a predictable healthcare "hump" from your 30s to 65.
- Medicare at 65 causes a sharp drop in costs, so the hump is a time-limited bridge, not permanent spending.
Costs Vary By State And Grow Over Time
- Unsubsidized ACA premiums vary widely by state and can already be large at age 35.
- Those premiums then increase with age, pushing a healthy household's healthcare spend from about $18k to near $38–40k by retirement.
Don’t Base FIRE On Permanent ACA Subsidies
- Model FIRE without counting ACA subsidies as a baseline and treat subsidies as a welcome bonus.
- Plan extra savings to bridge rising premiums if you want the same spending power across ages.