/General/General%203.png?width=1280&height=853&name=General%203.png)
'Merck employees planning their retirement should consider how income levels influence ACA subsidies, as even small adjustments in taxable withdrawals can affect future health care affordability.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.
Healthcare Provider Update: Healthcare Provider for Merck Merck & Co., Inc., commonly known as Merck, is a global leader in the healthcare sector, renowned for its innovative pharmaceuticals, vaccines, and biologic therapies. As a prominent healthcare provider, Merck delivers a wide array of health solutions targeting various health conditions, particularly in areas such as immunology, oncology, and infectious diseases. Potential Healthcare Cost Increases in 2026 In 2026, healthcare costs are projected to rise significantly, primarily driven by the anticipated expiration of enhanced federal premium subsidies associated with the Affordable Care Act (ACA) and growing medical expenses. Faced with an average premium increase of 18%, healthcare consumers may experience out-of-pocket costs climbing by over 75%. This situation is exacerbated by surging medical care prices, as hospitals and providers seek to balance inflationary pressures while maintaining profitability. As a result, many individuals may find themselves priced out of adequate health coverage, prompting essential discussions on the need for policy interventions. Click here to learn more
'Merck employees approaching retirement should recognize that proactive income and health care planning can make the difference between preserving subsidy eligibility and facing sharply higher ACA premiums.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.
In this article, we will discuss:
-
How the expiration of enhanced ACA subsidies after 2025 could impact health care costs for retirees and early retirees.
-
Real-life case studies illustrating how different individuals are adjusting to rising ACA premiums.
-
Practical steps Merck professionals can take before enrolling in 2026 Marketplace plans.
by Brent Wolf, CFP®, Wealth Enhancement
As open enrollment for 2026 Marketplace plans begins, many households are seeing dramatic shifts in their renewal letters. Rising base premiums and the possible end of enhanced subsidies after 2025 could mean significantly higher out-of-pocket costs for anyone purchasing coverage through the Affordable Care Act (ACA) exchange.
The Kaiser Family Foundation (KFF) estimates that if Congress does not extend enhanced premium tax credits, average net premium payments could more than double in 2026. 1
“It feels like a second mortgage to pay this premium.”
Profile: A couple in their early 60s who retired a few years before becoming Medicare-eligible.
What changed: Their ACA premium had been manageable due to increased subsidies. Their renewal now indicates a rise of about $1,000 to $1,200 monthly if enhanced credits expire.
Decision pressure: They faced hard choices—drawing more taxable income from IRAs, going without coverage, or returning to the workforce for employer-based insurance.
Our response: We reworked their income plan to align with the ACA’s income-based subsidy structure. By controlling their Modified Adjusted Gross Income (MAGI) through smaller IRA withdrawals, use of cash reserves, and partial Roth conversions, we kept them eligible for key subsidies. Comparing a Bronze high-deductible plan with a health savings account (HSA) to a Silver plan revealed the Silver plan—thanks to cost-sharing reductions—was more economical given their expected medical treatments.
“I can’t risk losing coverage while battling an illness.”
Profile: A single client in her early 60s undergoing ongoing medical treatment.
What changed: Without enhanced subsidies, her premiums nearly tripled.
Decision pressure: Balancing affordability with the need to keep her care team and prescriptions consistent.
Our response: We prioritized staying with her provider network and controlling her out-of-pocket costs. A dedicated “medical reserve” fund—equal to one year’s maximum out-of-pocket limit—gave her a cushion without liquidating investments during market declines. We also worked with her physicians to identify lower-cost prescriptions through her plan’s formulary.
“The new premiums are hurting our business margins.”
Profile: A self-employed couple—one partner managing asthma and the other a cardiac rhythm condition.
What changed: Without subsidies, their net premiums are expected to rise sharply.
Decision pressure: Continue paying high premiums, choose a plan with a very high deductible, or seek W-2 employment for benefits.
Our response: We compared total annual costs for a Silver plan versus a Bronze option, factoring in frequent specialist visits and prescriptions. Once total medical costs were considered, the Silver plan proved more cost-effective. We also aligned their life and disability coverage and tailored their tax approach to reflect potential changes in premium tax credits.
“I’m young and healthy—do I even need full coverage?”
Profile: An independent contractor in their 20s with minimal expected medical use.
What changed: Premiums for mid- and high-tier plans nearly quadrupled.
Decision pressure: Choosing between a high-deductible Bronze HSA plan and catastrophic coverage.
Our response: We modeled three options—a Bronze HSA-eligible plan, a mid-tier plan, and catastrophic coverage. The Bronze HSA option offered the best mix of lower premiums and long-term tax benefits. Monthly automated HSA contributions build a future medical fund that can later be used for qualified health care expenses or Medicare premiums (excluding Medigap) after age 65.
Five Steps to Take Before You Enroll
1. Evaluate your total annual cost, not just the premium. Factor in deductibles, copays, and the possibility of reaching your out-of-pocket maximum.
2. Manage your MAGI carefully. ACA subsidies depend on income. Coordinate Roth conversions, capital gains, and IRA withdrawals strategically.
3. Verify your doctor and prescription coverage. Always confirm your plan’s provider network and formulary before enrolling.
4. Maintain a medical reserve fund. Hold six to 12 months of premiums plus a portion of your maximum out-of-pocket in cash or short-term Treasuries.
5. Finalize your plan by December 15. Open Enrollment for 2026 coverage ends on December 15, with plans effective January 1.
If Affordability Is a Concern
Choosing to go without insurance can expose you to serious financial strain in case of illness or accident. Consider the most affordable Bronze plan that still meets ACA minimum coverage requirements. If your income decreases during the year, you may become eligible for Medicaid or CHIP and qualify for a Special Enrollment Period. 2
How The Retirement Group Supports Merck Professionals
For Merck employees approaching or already in retirement, the intersection of rising health care costs and income planning can be complex. The Retirement Group focuses on helping clients navigate ACA subsidy rules, tax-efficient withdrawal strategies, and health care cost planning during retirement transitions.
To speak with an advisor about aligning your retirement income and health care planning, call (800) 900-5867 today.
Featured Video
Articles you may find interesting:
Loading...
- Corporate Employees: 8 Factors When Choosing a Mutual Fund
- Use of Escrow Accounts: Divorce
- Medicare Open Enrollment for Corporate Employees: Cost Changes in 2024!
- Stages of Retirement for Corporate Employees
- 7 Things to Consider Before Leaving Your Company
- How Are Workers Impacted by Inflation & Rising Interest Rates?
- Lump-Sum vs Annuity and Rising Interest Rates
- Internal Revenue Code Section 409A (Governing Nonqualified Deferred Compensation Plans)
- Corporate Employees: Do NOT Believe These 6 Retirement Myths!
- 401K, Social Security, Pension – How to Maximize Your Options
- Have You Looked at Your 401(k) Plan Recently?
- 11 Questions You Should Ask Yourself When Planning for Retirement
- Worst Month of Layoffs In Over a Year!
- Corporate Employees: 8 Factors When Choosing a Mutual Fund
- Use of Escrow Accounts: Divorce
- Medicare Open Enrollment for Corporate Employees: Cost Changes in 2024!
- Stages of Retirement for Corporate Employees
- 7 Things to Consider Before Leaving Your Company
- How Are Workers Impacted by Inflation & Rising Interest Rates?
- Lump-Sum vs Annuity and Rising Interest Rates
- Internal Revenue Code Section 409A (Governing Nonqualified Deferred Compensation Plans)
- Corporate Employees: Do NOT Believe These 6 Retirement Myths!
- 401K, Social Security, Pension – How to Maximize Your Options
- Have You Looked at Your 401(k) Plan Recently?
- 11 Questions You Should Ask Yourself When Planning for Retirement
- Worst Month of Layoffs In Over a Year!
Sources:
-
1. Cox, Cynthia, et al. “ACA Marketplace Premium Payments Would More Than Double on Average Next Year if Enhanced Premium Tax Credits Expire.” Kaiser Family Foundation (KFF) , 2025, pp. n.p., https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/ .
-
2. Centers for Medicare & Medicaid Services. ' Understanding Special Enrollment Periods. ' June 2025.
-
Other resources:
-
1. “When Can You Get Health Insurance? | Dates & Deadlines.” HealthCare.gov , U.S. Centers for Medicare & Medicaid Services, n.d., https://www.healthcare.gov/quick-guide/dates-and-deadlines/ .
-
2. Publication 969: Health Savings Accounts and Other Tax-Favoured Health Plans. Internal Revenue Service, 2024, pp. 8–9, https://www.irs.gov/pub/irs-pdf/p969.pdf .
-
3. “Silver vs. Bronze Plan Selection: Cost-Comparison Scenarios.” Centers for Medicare & Medicaid Services (CMS) , 23 Dec. 2024, pp. 1–3, https://www.cms.gov/files/document/silver-vs-bronze-cost-comparison-scenario-resource.pdf .
-
4. Murphy, Tom. “Expect Health Insurance Prices to Rise Next Year, Brokers Say.” AP News , Associated Press, 24 Aug. 2025, https://apnews.com/article/health-insurance-drug-costs-2026-rates-c4d865ec09c7088ecc6b55dc520f3566 .
How does Merck's new retirement benefits program support long-term financial security for employees, particularly regarding the changes to the pension and savings plans introduced in 2013? Can you elaborate on how Merck's commitment to these plans is designed to help employees plan for retirement effectively?
Merck's New Retirement Benefits Program: Starting in 2013, Merck introduced a comprehensive retirement benefits program aimed at providing all eligible employees, irrespective of their legacy company, uniform benefits. This initiative supports Merck's commitment to financial security by integrating pension plans, savings plans, and retiree medical coverage. This approach not only aims to help employees plan effectively for retirement but also aligns with Merck’s post-merger goal of standardizing benefits across the board.
What are the key differences between the legacy pension benefits offered by Merck before 2013 and the new cash balance formula implemented in the current retirement program? In what ways do these changes reflect Merck's broader goal of harmonizing benefits across various employee groups?
Differences in Pension Formulas: Before 2013, Merck calculated pensions using a final average pay formula which typically favored longer-term, older employees. The new scheme introduced a cash balance formula, reflecting a shift towards a more uniform accumulation of retirement benefits throughout an employee's career. This change was part of Merck's broader strategy to harmonize benefits across various employee groups, making it easier for employees to understand and track their pension growth.
In terms of eligibility, how have Merck's pension and savings plans adjusted for years of service and age of retirement since the introduction of the new program? Can you explain how these adjustments might affect employees nearing retirement age compared to newer employees at Merck?
Adjustments in Eligibility: The new retirement program revised eligibility criteria for pension and savings plans to accommodate a wider range of employees. Notably, the pension benefits under the new program are designed to be at least equal to the prior benefits for services rendered until the end of 2019, provided employees contribute a minimum of 6% to the savings plan. This adjustment aids both long-term employees and those newer to the company by offering equitable benefits.
Can you describe the transition provisions that apply to legacy Merck employees hired before January 1, 2013? How does Merck plan to ensure that these provisions protect employees from potential reductions in retirement benefits during the transition period?
Transition Provisions for Legacy Employees: For employees who were part of legacy Merck plans before January 1, 2013, Merck established transition provisions that allow them to earn retirement income benefits at least equal to their current pension and savings plan benefits through December 31, 2019. This ensures that these employees do not suffer a reduction in benefits during the transition period, offering a sense of security as they adapt to the new program.
How does employee contribution to the retirement savings plan affect the overall retirement benefits that Merck provides? Can you discuss the implications of Merck's matching contributions for employees who maximize their savings under the new retirement benefits structure?
Impact of Employee Contribution to Retirement Savings: In the new program, Merck encourages personal contributions to the retirement savings plan by matching up to 6% of employee contributions. This mutual contribution strategy enhances the overall retirement benefits, incentivizing employees to maximize their savings for a more robust financial future post-retirement.
What role does Merck's Financial Planning Benefit, offered through Ernst & Young, play in assisting employees with their retirement planning? Can you highlight how engaging with this benefit changes the financial landscapes for employees approaching retirement?
Role of Merck’s Financial Planning Benefit: Offered through Ernst & Young, this benefit plays a critical role in assisting Merck employees with retirement planning. It provides personalized financial planning services, helping employees understand and optimize their benefits under the new retirement framework. Engaging with this service can significantly alter an employee’s financial landscape by providing expert guidance tailored to individual retirement goals.
How should employees evaluate their options for retiree medical coverage under the new program compared to previous offerings? What considerations should be taken into account regarding the potential costs and benefits of the retiree medical plan provided by Merck?
Options for Retiree Medical Coverage: With the new program, employees must evaluate both subsidized and unsubsidized retiree medical coverage options based on their age, service length, and retirement needs. The program offers different levels of company support depending on these factors, making it crucial for employees to understand the potential costs and benefits to choose the best option for their circumstances.
In what ways does the introduction of voluntary, unsubsidized dental coverage through MetLife modify the previous dental benefits structure for Merck retirees? Can you detail how these changes promote cost efficiency while still providing valuable options for employees?
Introduction of Voluntary Dental Coverage: Starting January 2013, Merck shifted from sponsored to voluntary, unsubsidized dental coverage through MetLife for retirees. This change aligns with Merck’s strategy to promote cost efficiency while still providing valuable dental care options, allowing retirees to choose plans that best meet their needs without company subsidy.
How can employees actively engage with Merck's resources to maximize their retirement benefits? What specific tools or platforms are recommended for employees to track their savings and retirement progress effectively within the new benefits framework?
Engaging with Merck’s Retirement Resources: Merck provides various tools and platforms for employees to effectively manage and track their retirement savings and benefits. Employees are encouraged to utilize resources like the Merck Financial Planning Benefit and online benefit portals to make informed decisions and maximize their retirement outcomes.
For employees seeking additional information about the retirement benefits program, what are the best ways to contact Merck? Can you provide details on whom to reach out to, including any relevant phone numbers or online resources offered by Merck for inquiries related to the retirement plans?
Contacting Merck for Retirement Plan Information: Employees seeking more information about their retirement benefits can contact Merck through dedicated phone lines provided in the benefits documentation or by accessing detailed plan information online through Merck's official benefits portal. This ensures employees have ready access to assistance and comprehensive details regarding their retirement planning options.
With the current political climate we are in it is important to keep up with current news and remain knowledgeable about your benefits.
Merck offers a defined benefit pension plan with a cash balance formula. Benefits are determined based on years of service and compensation. Employees can choose between a lump-sum payment or a monthly annuity upon retirement.
Operational Changes: Merck is restructuring its business to focus more on its core pharmaceuticals and vaccines segments, leading to layoffs affecting around 1,800 employees (Source: Bloomberg). Strategic Initiatives: The company aims to enhance operational efficiency and invest more in research and development. Financial Performance: Merck reported a 10% increase in net sales for Q3 2023, driven by strong demand for its COVID-19 treatments and vaccines (Source: Merck).
Merck grants RSUs that vest over time, providing shares to employees upon vesting. The company also offers stock options, allowing employees to purchase shares at a fixed price.
-2.png?width=300&height=200&name=office-builing-main-lobby%20(52)-2.png)
.webp?width=300&height=200&name=office-builing-main-lobby%20(27).webp)
-2.png)
.webp)