Plain PriceCare Rail · what care actually costs
4% premium inflation · 10% market · to remaining life expectancy

What if they invested the premiums instead?

The big numbers are not wages and not premiums paid. This household put in a few million over a lifetime. The tens of millions are what that cash would be worth at 10% a year. Two columns: cash in vs if invested.

Marry at 30. Kaiser Family Foundation family premium. Not on Medicaid — four residents’ tax share until 65, two after. Two people on Medicare after 65.

Cash they actually paid in (economic)$4,379,250
That same cash, if invested to ~85$115,159,646
From their own check, cash in$1,299,746
From their own check, if invested$24,440,535

Job coverage 30–65, then Medicare to ~85. Family job premium (you + employer) cash-in is about $1,988,095 over 35 years — not $73,111,363. The larger figure is 10% compounding, including 20 years after Medicare starts. Each tab starts from today’s stickers at the start of that clock (26 or 30) — not three households born the same year.

This household’s stack

Line · ages · year-one stickerCash paid inIf invested to ~85
Family job premium (you + employer) · 30–64 · $26,993/yr$1,988,095$73,111,363
Your paycheck premium (part of the family sticker) · 30–64 · $6,850/yr$504,518$18,553,434
Medicare HI tax, employee 1.45% · 30–64 · $1,534/yr$112,983$4,154,886
Medicare HI tax, employer 1.45% · 30–64 · $1,534/yr$112,983$4,154,886
Medicaid tax share, 4 residents (they are not on Medicaid) · 30–64 · $11,200/yr$824,905$30,335,541
Medicaid tax share, 2 residents after 65 · 65–85 · $5,600/yr$658,039$1,670,755
Medicare Part B+D premiums (the check — not full Medicare) · 65–85 · $5,806/yr$682,245$1,732,215
Economic total (paycheck share not added twice)$4,379,250$115,159,646

“Cash paid in” is the running total of that year’s sticker, inflated 4%. “If invested” is that cash at 10% until ~85. The indented paycheck line is already inside the job-premium line — do not add it again.

Medicaid on this page is not this household’s Medicaid bill. It is $2,800 per US resident — this household’s share of a $932B program they are not enrolled in. Medicare in this stack is only the Part B+D premium taken from the check (~$2,903 per person), not Hospital Insurance tax as a “got.” Lifetime pay-in vs pay-out for all three programs is in the cards below. The Medicaid line starts at 30, so it compounds longer than Part B+D premiums that start at 65.

Paid in vs paid out — this year, then a lifetime

Two working-age adults, two children. Job coverage is the working-age insurer. At 65 it stops and Medicare starts — they still write a Part B+D check, and Medicare starts paying claims. Medicaid is different: most people never enroll. This household doesn’t either, but they pay tax for it the whole time. “Got” is stacked median people, inflated 4% like the premium clock — not a claims file.

Job plan · this year

Corporate coverage. Median privately insured adult, MEPS 2021.

Paid in (you + employer)$26,993
Of that, your paycheck$6,850
Median person — what the plan paid$1,369
4 median people stacked (not a family median)$5,476
Net loss per median family$21,517

Job plan · lifetime

Ages 30–64. Same median stacked, every year, 4% inflation. This year $26,993 in vs $5,476 out.

Contributed (you + employer)$1,988,095
Of that, your paycheck$504,518
Paid on their behalf (4 median people)$403,320
They put this much more into the job plan than it paid for their care$1,584,775

After 65 — still pay? Job premiums stop at 65. No more paycheck or employer share.

After 65 — still take out? The job plan pays $0 after 65. Medicare takes over.

Medicare · lifetime

tax 30–64, claims 65–85. HI tax while working prepays Part A. After 65 they still pay Part B+D and Medicare pays the claims. Two adults. HI tax is 1.45% you + 1.45% employer on Census median family income ($105,800).

HI payroll tax (you + employer) while working$225,965
Part B+D premiums after 65 (the check)$682,245
Total contributed$908,210
Medicare paid on their behalf after 65 (median × 2)$856,156
Mean enrollee × 2 adults, after 65$3,943,298
They put this much more into Medicare than Medicare paid for their care$52,054

After 65 — still pay? Still pay Part B+D from the check. Part A premium is $0 with 40 work credits (this household has them).

After 65 — still take out? Yes — Medicare is the insurer after 65. While they were working, Medicare paid them $0.

Medicaid · lifetime

Ages 30–85. Most people are not on Medicaid. This household isn’t either — job plan, then Medicare. They still pay tax for the program as residents — four people until 65, two after. This year $11,200 of tax, $0 of care.

Tax contributed ($2,800/resident)$1,482,944
Premium they paid to Medicaid$0
Medicaid paid on their behalf (not enrolled)$0
If they had been median Medicaid enrollees the whole time$872,818
They paid this tax. Medicaid paid them $0$1,482,944

After 65 — still pay? Still pay the resident tax share until ~85. That is not a premium.

After 65 — still take out? No. Most people are not on Medicaid. This household has a job plan, then Medicare — not dual-eligible at this income.

This year’s job plan

Job premium in
$26,993
Job median out
$5,476

Lifetime cash in vs paid on their behalf (4% inflation)

Job in
$1,988,095
Job out (median)
$403,320
Medicare in (HI + B+D)
$908,210
Medicare out (median)
$856,156
Medicaid tax in
$1,482,944
Medicaid out (actual)
$0
Total cash in
$4,379,249
Total paid on their behalf
$1,259,476
Net loss — they put this much more in than was paid for their care
$3,119,773
That net, if invested in the S&P 500 at 10% to ~85
$98,153,961
Median U.S. family retirement accounts (if they have any)
$86,900

Red is contributed. Green is paid on their behalf. Medicaid out is $0 because they are not enrolled. Medicare out is only years 65–85. The net is job + Medicare + Medicaid, same 4% clock. The S&P line is that extra cash, each year, left in the market at 10% until ~85 — the same 10% this page already uses, not a forecast. Median retirement accounts are Federal Reserve SCF 2022: $86,900 among the 54.3% of families who have any (IRAs, 401(k)s). The rest are at $0. The Fed’s “family” includes one-person households.

The $1,369 is the median privately insured adult — what the job plan paid that person in MEPS 2021. Multiplying by 4 is 4 median people stacked. That is not the median family. MEPS does not publish private-insurance payments for families of exactly two adults and two kids. A real family median would likely be higher than the stack (someone in the house used care) and still far below the sticker. Premiums are Kaiser Family Foundation 2025. Lifetime multiplies that same stacked median (and the Medicare / Medicaid medians) by the years on the clock, inflated 4% — a typical year, every year, not one household’s claims.

The mean is not a typical year

Line everyone up from $0 to the highest spender. The person in the middle is the median ($1,361 in 2022). Add everyone up and divide by the headcount and you get the mean ($6,765). The top 5% (~$72,918) pull the mean up — why that group costs so much. Almost nobody sits at the mean. About 14% used $0.

WhoSpending, one personWhat it is
Bottom 50% average (2023)$433Mean of the cheaper half, not the median
Median of everyone (2022)$1,361The middle person. Half spent less.
Survey mean (2022)$6,765All spending ÷ all people. Tail pulls it up.
Top 5% average (2023)$72,918Almost half of all spending lives here
Top 1% average (2023)$150,467The extreme tail

The household survey runs below the national accounts — it skips nursing homes and some bills. Use the median for “what did a typical person get from this plan?” Use the mean for “what did the program spend per enrollee?”

All three, side by side

A single is not family ÷ 4, and married-no-kids is not family minus two kids. Different stickers, different clocks (26 vs 30), different wage bases. Left column is cash in. Right is if invested.

HouseholdJob yearsCash paid inIf invested to ~85
Married, family of four35 yrs$4,379,250$115,159,646
Married, no kids35 yrs$3,391,204$78,824,711
Never married, single for life39 yrs$2,042,738$59,015,598

Kaiser Family Foundation premiums, Census marriage age, CMS Part B/D, NHEA, MEPS sourced 4%/10%, kids at adult median, Medicaid per-capita, family HI wage base modeled See Journey for the year they actually need a knee, and evidence.