Trump's $5,000 dividend would cost more than 600 times the funded $90 Medicare rebate

Larry Levitt of KFF said previous administrations have not used the Medicare Improvement Fund in this way, although Congress has periodically taken money from the fund, including $20.74 billion for the creation of the Affordable Care Act in 2010.

"The Medicare Improvement Fund language is quite broad and gives substantial discretion to the administration," Levitt said.

Roughly 245 million adult U.S. citizens multiplied by $5,000 comes to about $1.23 trillion; using 250 million adults puts the tab near $1.25 trillion.

Seniors receiving Medicaid premium assistance, paying income-adjusted premiums, or enrolled in Medicare Advantage are not eligible; more than half of eligible Medicare beneficiaries have Medicare Advantage, according to KFF.

The president cannot simply order more than $1 trillion in new checks from existing accounts; Congress would have to act.

Sen. Bernie Moreno of Ohio said he plans to have legislation ready after the Nov. 3 election.

Rep. Chip Roy of Texas has questioned how Washington intends to pay for "well over $1 trillion."

Vice President JD Vance has argued that tariff revenue could cover the program and suggested wealthy Americans might be excluded.

Medicare Part B enrollees can expect a one-time payment in October by direct deposit or check; total monthly costs for the program start around $200 and vary with income.

Trump said last month that about 1 million people would get rebate checks of $500 for Affordable Care Act premiums.

Fortune described the $90, $500 and $5,000 payments as 'more inflationary money for voters' and said the $5,000 pledge would likely cost more than $1 trillion, adding to the deficit and worsening inflation.

More than 20 million beneficiaries at $90 each is at least $1.8 billion, consistent with the nearly $2 billion program cost.

Trump says tariffs and economic growth make the dividend possible; he put its cost at "approximately $1 trillion" and pointed to what he described as $21 trillion in new investment over 15 months, but investment and government revenue are not the same pot of money.

Net tariff collections have been running below $200 billion annually, while 2026 gross tariff and excise receipts are around $210 billion.

Erica York of the Tax Foundation said the dividend would consume roughly a decade of projected tariff revenue in one payment, with none of that money going toward federal debt, which crossed $40 trillion in August.

With Part B monthly costs starting around $200, the $90 rebate covers at most about 45% of one month's premium.

Federal law makes it a crime to offer money to induce someone to vote in a particular way; former prosecutors have said Trump's wording could raise questions under the statute, while legal experts have expressed skepticism that such a case would go anywhere.

The roughly $1.2 trillion dividend costs more than 600 times the Medicare rebate program, which costs less than $2 billion.

The $500 ACA rebates for about 1 million people come to about $500 million; with the $1.8 billion Medicare rebates, the two total about $2.3 billion, roughly one five-hundredth of the $1.2 trillion pledge.

At 2026 gross tariff and excise receipts of about $210 billion, a $1.2 trillion payment equals about 5.7 years of receipts.

York's estimate that the dividend equals roughly a decade of projected tariff revenue implies projected revenue of about $120 billion a year.