About 20.8 million people on traditional Medicare, the US government health insurance programme for older people and some younger people with disabilities, are due to get a one-time $90 payment, according to a fact sheet the Centers for Medicare & Medicaid Services (CMS) published on October 3.
CMS is the agency that runs Medicare.
President Donald Trump announced the payment a day earlier, weeks before the November 3 midterm elections, the vote halfway through a president's term that decides who controls the US Congress.
The White House said the money is meant to help with Part B premiums, the monthly amount people pay for Medicare's medical insurance, which covers doctor visits and outpatient care.
A CMS notice from November 2025 shows the standard premium at $202.90 a month this year.
That is $2,434.80 over twelve months, so the $90 is about 3.7% of the year's bill, and less than half of a single month's premium.
CMS said the payment goes to people in Original Medicare, the traditional government-run version of the programme.
They must live in the United States and get no premium help from Medicaid, the US programme for low-income people.
Anyone who pays the income-related surcharge, a higher premium for higher earners, is also excluded.
CMS's premium schedule puts that surcharge at incomes above $109,000 for single filers and $218,000 for couples filing together. It says the surcharge affects roughly 8% of people with Part B.
People in Medicare Advantage, the private-insurer alternative to traditional Medicare, are not eligible either, CMS said.
KFF, a health policy research nonprofit, counted 64.2 million people with both hospital and medical cover (Parts A and B) in March 2026.
It found 35.2 million of them, or 55%, in Medicare Advantage.
That makes the 20.8 million about one in every three of the 64.2 million.
Of the roughly 29 million left in traditional Medicare, about seven in ten qualify.
CMS said most people will get a direct deposit from the Social Security Administration, the agency that pays US retirement benefits, on or around October 8.
An email or letter from Trump follows in mid-October.
Some people will get a paper cheque from the US Treasury later in October, CMS said, and the cheque will carry a note calling it a payment to offset the October premium.
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The White House fact sheet had put the cheques in early October. All of those dates fall before the election.
The money comes from the Medicare Improvement Fund. At $90 each, 20.8 million payments come to about $1.87 billion, nearly all of the $2 billion the White House says Congress gave the fund.
CMS noted that a 2008 law created the fund for improvements to traditional Medicare.
The White House fact sheet said Trump believes the fund should help people on Medicare directly, not special interest groups.
The White House said no administration had ever made payments from the fund.
Both it and CMS acknowledged that Congress had taken money out before to cover other spending.
CMS counted about 20 withdrawals, and the White House pointed to $20.7 billion taken in 2010 to help pay for the Affordable Care Act, the US health law often called Obamacare.
CMS described Trump as the first president to use the fund to make Medicare cheaper for enrollees.
Trump announced the payment in a social media post on October 2, The Hill reported.
He wrote that the fund, together with his drug-pricing deals with pharmaceutical companies, is lowering costs for seniors.
The same post repeated a pledge of a $5,000 "dividend" for every US citizen if Republicans win the midterms, Moneywise reported.
In a video the next day he said it would go to adult citizens, according to the same report. Asked which version stands, the White House did not answer directly, Moneywise said.
The pledge is not law.
Congress would have to pass a bill to pay for it, which House Speaker Mike Johnson, who leads the House of Representatives, has acknowledged, and no bill has been introduced, Moneywise reported.
Trump has put the cost at about $1 trillion.
The Committee for a Responsible Federal Budget, a nonpartisan group that tracks government spending, estimated over $1.2 trillion for adult citizens in 2027, Fox Business reported.
The White House said Trump announced on September 10 that nearly 1 million people on Affordable Care Act plans would get $500 refunds, for what it said was overcharging on their coverage.
CNN noted that the $90 payment comes as Republicans try to keep their majority in Congress while voters worry about the cost of living.
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