American Dream Ledger: Lifetime Health Care Cost (Two Adults)

## What this measures

Health spending paid by households per person (their share of employer insurance premiums, individually bought insurance, Medicare premiums, and out-of-pocket spending) from the CMS National Health Expenditure Accounts, × two adults × a 60-year adult lifetime. Dollars, monthly.

## Why it matters

Health care is a large and fast-rising lifetime cost, and most of it reaches households as premiums they don't see on a bill.

## How to read it

Higher means health care costs households more. Moves with the CPI medical care index between CMS releases (each December).

## What it does not say

It is an average per person across all ages; older people spend more. Payroll taxes for Medicare and what employers pay toward premiums are not counted. Children's health care sits in the children component.

## How it is priced

Each month is priced in that month's dollars. Annual public figures (a BLS Consumer Expenditure Survey year, an NCES academic year, a CMS health-spending year) are the average for their own period: a month inside the period is the figure × the matching CPI-U index for the month ÷ its average over the period, and months after the newest published period carry that figure forward by the same index until the next edition replaces it. Nothing is projected forward and nothing is discounted: it is the price tag at today's prices. A month is written once its CPI and a full month of mortgage rates exist. October 2025 has no reading because BLS published no CPI for it.

## Assumptions

Assumptions used across the American Dream Ledger: an adult lifetime of 60 years (18 to 78, about the remaining period life expectancy at 18 in SSA's life tables); a working lifetime of 40 years (25 to 64); two adults and two children; a 30-year fixed mortgage with 20% down; four years of public in-state college per child; retirement of 20 years from 65 (about SSA's period life expectancy at 65, men and women averaged) at 70% of median household income. Weddings are left out: no public-domain source measures what a wedding costs.

## Source

Palanor calculation (src/lib/standards/american-dream.ts), recomputed daily by /api/cron/american-dream. Inputs: CMS Office of the Actuary, National Health Expenditure Accounts, Table 5-2 Household Sponsor Expenditures and Table 1 population (public domain); CPI-U medical care (BLS via FRED).