Medicare premiums rose during the Trump administration, not fell
Medicare Part B premiums — the monthly charge for doctor visits and outpatient care — increased every year from 2017 through 2020. The premium went from $134 per month in 2017 to $148.50 in 2020. Part D premiums, which cover prescription drugs, also rose during this period, though the amount varied by plan.
The increases were driven by the same factors that push premiums up most years: rising healthcare costs, more people enrolling in Medicare, and changes in how much beneficiaries used medical services. The administration did not reverse these trends or introduce policies that lowered what seniors paid each month.
What sometimes gets confused with premium changes is the annual cost-of-living adjustment, or COLA. In 2020, Medicare beneficiaries received a COLA increase of 1.3 percent — a raise to Social Security that affects how much income is available to pay premiums. This is not the same as the government lowering premiums. The COLA is set by law based on inflation and does not depend on which administration is in office.
Key Takeaways
- Medicare Part B premiums rose from $134 in 2017 to $148.50 in 2020 during the Trump administration.
- Part D prescription drug premiums also increased during these years, though the amount varied by individual plan.
- Premium increases are driven by healthcare costs and enrollment changes, not by presidential policy decisions in most cases.
- A cost-of-living adjustment to Social Security is different from a premium decrease and is set by law, not by the administration in power.
How Medicare premiums are actually set
Medicare premiums are not set by the President or Congress on a year-to-year basis. Instead, they are calculated by the Centers for Medicare and Medicaid Services (CMS), a federal agency, based on projected costs for the coming year. CMS looks at how much it expects to spend on claims, administrative costs, and reserves, then divides that by the number of people enrolled to arrive at the premium amount.
For Part B, Congress does have the power to change the formula or cap increases, but this rarely happens. The last time Congress significantly altered Part B premiums was in 2008, when it froze them for certain beneficiaries. Day-to-day premium-setting follows a technical process, not a political one.
Part D premiums are set by private insurance companies that offer the plans, not by Medicare itself. Each company decides what to charge based on their own claims experience and business decisions. This is why Part D premiums vary widely from plan to plan and from year to year.
What the Trump administration actually did regarding Medicare costs
The Trump administration pursued several policies aimed at reducing healthcare costs broadly, though their effect on Medicare premiums specifically was limited. One example was promoting price transparency — requiring hospitals and insurers to publish what they charge for procedures. The theory was that if patients could see prices, competition would lower costs.
The administration also worked to reduce drug prices through executive orders and negotiations with pharmaceutical companies. In 2020, it announced a plan to tie Medicare drug prices to what other countries pay, though this was not fully implemented before the administration left office.
None of these policies directly lowered the monthly premiums seniors pay. Reducing overall healthcare costs takes years to show up in premium calculations, and the effect is often small. The premiums that seniors saw on their bills each month continued to rise as they had in previous administrations.
Why premiums go up almost every year
Healthcare costs in the United States rise faster than inflation most years. Hospitals, doctors, and drug manufacturers increase their prices. More seniors enroll in Medicare as the population ages. Medical technology becomes more expensive. These factors push up what Medicare expects to spend, which pushes up premiums.
Additionally, if a particular year sees higher-than-expected claims — for example, if a flu season is severe — the next year's premium may jump to cover the shortfall. Premiums can also rise if fewer healthy people enroll relative to sicker people, because the average cost per beneficiary goes up.
No administration has found a way to reverse these trends. Premiums have risen under Democratic and Republican presidents alike. The question is not usually whether premiums will rise, but by how much.
The difference between premiums and out-of-pocket costs
Sometimes people confuse the monthly premium with the total amount they pay for healthcare. The premium is only one piece. Seniors also pay deductibles (the amount they must spend before insurance kicks in), copayments (a fixed amount per visit), and coinsurance (a percentage of the cost). For many seniors, these out-of-pocket costs add up to more than the premium itself.
Policies that affect deductibles or copayments can change how much a senior pays overall, even if the premium stays the same. The Trump administration did not introduce major changes to these costs for traditional Medicare beneficiaries, though some policies affected Medicare Advantage plans, which are run by private insurers and have different cost structures.
What to ask your doctor or Medicare counselor
If you are concerned about your Medicare costs, it helps to understand exactly what you are paying for. Ask your doctor's office or your Medicare plan to explain your premium, deductible, and copayments. Some seniors may have access to for programs that help pay premiums and out-of-pocket costs — these are based on income and vary by state.
You can also contact your State Health Insurance information Program (SHIP) for free counseling about your coverage and costs. SHIP counselors can review your specific situation and suggest ways to lower what you pay. Your local Area Agency on Aging can connect you to SHIP.
Frequently Asked Questions
Did any president actually lower Medicare premiums?
No president has lowered Medicare premiums in the way that question implies. Premiums have risen under every administration since Medicare began. What has happened occasionally is that premiums held steady for a year or two, or rose by a smaller amount than the year before — but these are slowdowns, not reductions.
Why do I hear different numbers about what premiums were?
Medicare premiums vary by plan, by state, and by whether you are in traditional Medicare or Medicare Advantage. The numbers cited in news stories are usually the national average for Part B, but your actual premium may be different. Check your Medicare card or your monthly bill to see what you personally pay.
Can I do anything to lower my Medicare premiums?
You cannot negotiate your Part B premium, but you can shop for Part D plans every year during open enrollment and choose the one with the lowest premium and best coverage for your drugs. You may also may have access to for the Low-Income Subsidy program if your income is below certain limits. Contact your local SHIP office to learn what programs you may may have access to for.
What is the difference between a COLA and a premium decrease?
A COLA is an increase to your Social Security check based on inflation. It gives you more money to spend, but it does not lower your Medicare premium. If your COLA is larger than your premium increase, you have more money left over — but the premium itself has not gone down.
Where can I find out what my Medicare premiums will be next year?
Medicare announces the next year's premiums in late September or early October. You can find the official amounts on Medicare.gov, or call 1-800-MEDICARE to speak with someone. Your current Medicare plan will also send you a notice in the mail explaining any changes to your coverage and costs.