For useful resources, direct help, or to geek out on all things student loans, check out StudentLoanAdvice.com. A special thank you to Andrew for joining us for this episode!

Who’s Getting Hit and How? Two Camps, Two Stories

This isn’t just another tweak to an already confusing system. These changes hit two very different groups right in the wallet:

• Current borrowers: You’re already in repayment, you survived med school, you’re probably juggling a pager and a mountain of paperwork. Guess what? Your payment programs are changing, and some are vanishing.
• Future students (matriculating Fall 2026 and later): If you haven’t even started school yet (hi future docs!), get ready for a shiny new $200,000 federal borrowing cap and a loan system that plays by different rules.

Each group’s about to face its own set of hoops, so knowing which camp you’re in is step one.

Current Borrowers: Programs Merge and Payments Rise

If you’re paying today, it’s time to get friendly with new numbers. The old buffet of income-driven repayment plans? It’s shrinking. Instead of hopping between five different repayment options, things are getting crammed together. The short version? What used to be about 10% of your income could now be closer to 15%. Here’s the breakdown:

Before:

• Most income-driven plans: Around 10% of income – Now
• New plan math: 15% of income is on the table for many

So yeah, your payment could go up if you’re not paying attention. Don’t just set it and forget it anymore.

The Wild New Cap: Federal Loans Now Stop at $200,000

Here’s the bombshell for future docs: Starting with the class of Fall 2026, federal student loans will cut off at $200,000. Before this, you could borrow up to your school’s full sticker price, including living costs and textbooks that seem priced by jokesters. Now, you’ll probably need to fill your funding gap with private loans—and I mean real, bank-loaned, for-profit, not-messing-around types.

Heads up:

• Federal loans: These come with built-in safety nets, like forbearance, hardship options, and loan forgiveness programs.
• Private loans: More like, “Here’s your bill, good luck.” The rules are tougher, interest is often way higher, and if things get rough, banks don’t send you sympathy cards.

Who Gets Hurt by the Cap? Let’s Talk Equity, Access, and Sticker Shock

This new cap isn’t just a line on a spreadsheet. It’s about access, opportunity, and which future docs even walk through those hospital doors. Here’s how the pros and cons shake out:

1. Pros
   • Could (maybe, hopefully?) push schools to stop jacking up tuition.
   • Forces deep thinking about ROI: Is the paycheck worth the upfront investment?
   • Some families with $$ or resources aren’t hit as hard.
2. Cons
   • Hits first-gen and less wealthy students hardest—they’re less likely to have parents ready to co-sign for a $300,000 private loan at 11%.
   • May scare off people who’d otherwise be awesome doctors, especially in primary care (where salaries aren’t moon-high).
   • Piles on stress just to chase your dream, and nobody needs more of that.

This change could push some would-be doctors out of the pipeline. Plus, it’s not clear if schools will lower tuition anytime soon, so the financial gauntlet may just get harder for many.

The Never-Ending Tuition Game

You know how tuition seems to always go up, like someone’s inflating a balloon that’s never meant to pop? That’s tuition inflation. Schools kept nudging prices higher, knowing students could borrow what they needed. Now the cap may make things awkward, but don’t hold your breath for instant price drops. The cost of attendance is still a beast, and schools don’t slash tuition just because the loan faucet gets a smaller spout.

Meet RAP: The New Repayment Assistance Plan in Town

Everyone, wave hello to RAP—the Repayment Assistance Plan—kicking in July 1, 2026. Think of it as the new main event for federal income-driven repayment. It wipes out several old plans by jamming them together into one new bowl of alphabet soup.

What stands out? RAP uses your adjusted gross income (AGI) to figure out what you owe every month. Forget the long sheets of calculations and family size discounts. If you earn under $100k, you pay as little as 1% of your income. Over $100k? You’ll pony up 10% (and most docs fall here).

Quick Chart:

Plan	Payment Base	% of Income	Forgiveness Timeline
RAP	AGI	1%-10%	30 years (non-PSLF)
SAVE	Discretionary (after poverty line deduction)	10%	20-25 years
IBR	Discretionary	10-15%	20-25 years
PAYE	Discretionary	10%	20 years

RAP: Easier Math, Tougher Payments

On RAP, payments skip all the clever deductions like federal poverty line adjustments. They’re just straight-up slices of your AGI. It’s clean, simple, and often, yeah, bigger than you might like—especially if you’ve got a big family.

Pros:

• Simpler math—no more guessing games with deductions
• No phase-out if your income explodes after med school

Cons:

• Can pinch those supporting bigger households
• Payments could rival a midsize car payment (every month, for years)

Married Filing Separately? RAP Has Good News for You

Here’s a silver lining. RAP keeps one of the best benefits from older plans: if you’re married and file taxes separately, you can exclude spousal income from the repayment math. That’s big if your spouse is making the big bucks and you’re trying to keep payments low while going for forgiveness.

Tax filing status suddenly matters again. You don’t have to stress over a joint tax return pumping up your monthly bill. Past proposals to end this dodge are off the table, at least for now.

RAP and PSLF: Still Dance Partners

You can still use RAP to qualify for Public Service Loan Forgiveness, which is great news if you plan to stick with a nonprofit employer. Just know that RAP comes with a 30-year forgiveness timer if you’re not doing PSLF (which, let’s be honest, feels like an eternity).

Quick Forgiveness Timeline Cheat Sheet:

• RAP: 30 years (non-PSLF)
• SAVE: 20-25 years
• IBR: 20-25 years
• PAYE: 20 years

And under RAP, there’s no limit to how high payments can fly, so the more you make, the more you pay.

The RAP Deadline: Why July 1, 2026, Is Circled in Red

If you’re thinking about consolidating loans or starting fresh borrowing, July 1, 2026 is the magic date. After that, RAP is the only game in town for new borrowers and new consolidations. If you want to stick with an older plan, get your ducks in a row before that deadline. Otherwise, the window slams shut.

Should You Choose RAP or Stick With the Old School? Let’s Compare

Already in repayment? You might get to pick between RAP and IBR. Here’s what matters:

• If you’ve got a large family, IBR’s calculation (which includes deductions for household size) could mean lower payments, even though their percentage is higher.
• If you earn more than your loan balance, older IBR rules used to block you from qualifying (thanks, partial financial hardship rule). That’s changing—you might still get in.

Side-by-Side Snapshot:

• RAP: 10% of AGI, no payment cap, easier access
• IBR: 15% of discretionary income, caps payment size, considers family size

Partial Financial Hardship: Gone and Not Missed

“Partial financial hardship” (the rule that could block you from an income-driven plan if your income was higher than your loans) is gone for IBR. In plain speak: High earners now have a way into plans that used to keep them out. That matters if you’re a future surgeon climbing the pay ladder but still dog-paddling through huge debt.

PAYE and SAVE: On the Way Out

PAYE is fading out (gone by July 1, 2028—and maybe before). The SAVE program is caught up in legal disputes and is likely to disappear much sooner. Over time, the alphabet soup we all love to hate will shrink to basically RAP and maybe IBR, with fewer exceptions and loopholes.

PAYE vs. IBR: Which Is Right Now If You’re Eligible?

• If your first loan is from before October 2007, PAYE may not be an option.
• If your loans are newer, you can usually choose PAYE or IBR.
• PAYE’s lower payment cap makes it the usual choice if you want the lowest payments, but watch the rules—they keep changing.

Once You Go RAP, It Might Be One-Way

Bold warning: Signing up for RAP could be a one-way street. Nobody’s handing out free passes back to PAYE or IBR once you go all-in on RAP. Make the choice carefully and do your homework—or you might be stuck with it for the long haul.

Student Loan Stress: Yes, It’s Real

If you’ve ever considered changing your tax status, delaying a wedding, or even plotting a “strategic divorce” just for loan math, you’re not alone. These rules make people do some wild things. The key: Don’t go it alone. Getting clear advice can make the difference between a decade of stress and a solid plan (or a very awkward family dinner).

You Don’t Have to Be Alone: Getting Professional Help

Student loans for doctors aren’t just “another bill.” They’re often six figures, and a tiny shift in strategy can mean the difference between being debt-free by 40 and still shelling out into your 60s. StudentLoanAdvice.com (Andrew Paulson’s shop, by the way) helps docs of all stripes sort through the tangle—repayment reviews, refinance questions, tax moves, and even how to mix student loans with retirement savings.

They do one-time deep-dive meetings so you don’t have to buy a giant plan. Average case? About $320,000 in loans. Yes, really.

Some Wild Loan Balances: You’re Not Alone

You think your $200,000 is a lot? Try $800,000 (the record for an individual doc), and for a household—a dual doc couple—$1.7 million. One heroic med school grad racked up $725,000, got it wiped through PSLF, and is now breathing fresh air again. The point: Student debt is huge in this field, but the right strategy can move mountains.

Is PSLF Still Safe and Worth It?

Short answer: Yes, if you already have federal loans and are in the system. PSLF is still reliably forgiving debts, and it’s actually quicker to process thanks to new automations (finally, something good from the robots). Your monthly payments might nudge higher, but the “rug pull” folks have feared hasn’t happened. If you’re entering practice now, PSLF should be on your radar.

FAQ: Is PSLF safe for me?

• Are you already in repayment on federal loans? Yes—PSLF is still processing applications, and people are literally getting forgiven as we speak.
• Should you worry if you’re about to start med school after 2026? Getting PSLF for all your debt is going to be a whole lot harder, since private loans don’t count. You’ll only be able to use PSLF on the federal part.

PSLF for Future Docs: The New Reality

With federal loan caps and more private lending, PSLF is losing some of its punch for folks starting med school in 2026 or later. There’s no payment cap on RAP, so big earners will dig deeper every single month. In short: The program will still exist, but wringing full value from it just got a lot trickier. You might look closer at VA jobs, military routes, or other options that offer big loan help beyond PSLF.

PSLF Buyback: Tread Carefully

Buyback sounds like free months of credit, but don’t trust it to deliver a miracle. Processing times are slow—think years, not months—and payment calculations are sometimes wildly off. If you’re six months from hitting PSLF, don’t bank on buyback to fill the gap. File early, stay current on real payments, and only look at buyback as a bonus, not a cornerstone of your plan.

SAVE Program: Time to Move On

If you’re riding the SAVE plan and think you’re winning the game, know this: It’s tied up in the courts and is probably on the way out. If you’re not aiming for forgiveness and seeing high interest rates, refinancing could save you real money right now. If you’re heading for PSLF, switch to a surviving plan so you keep moving forward.

Wrapping It Up: What Should You Do Now?

Student loan planning used to be about picking the least-awful plan. Now, with new caps, merged payment options, and giant legal changes, it’s more like picking your way through a Lego-filled obstacle course blindfolded. The stakes are sky-high. Start planning now—especially if you’re staring at graduation, prepping for med school, or carrying a six-figure balance.

Remember: You don’t have to do it alone. Getting on the right track could clear hundreds of thousands in debt and free you up for the life you imagined when you signed up to heal the world. Got questions? Talk to pros who live and breathe this stuff. It’s never too early (or too late!) to figure out your plan.

For useful resources, direct help, or to geek out on all things student loans, check out StudentLoanAdvice.com. A special thank you to Andrew for joining us for this episode!