Repayment Assistance Plan vs IBR: 2026

If you started medical school in 2026 or later, you have a new federal loan repayment option that didn't exist before: the Repayment Assistance Plan, or RAP. Created by the One Big Beautiful Bill Act (OBBBA) and live as of July 1, 2026, RAP is being marketed as a simpler alternative to the existing income-driven repayment plans. For physicians, the question is whether it actually helps — or quietly costs you more. Short answer: for most residents and attendings, IBR still wins. Here's the math. What Is the Repayment Assistance Plan (RAP)? RAP is a new federal income-driven repayment plan introduced by OBBBA. The key terms: Payment: 10% of your adjusted gross income (AGI) Forgiveness timeline: 30 years Eligibility: Only available for federal loans first disbursed on or after July 1, 2026 PSLF compatibility: RAP payments count toward PSLF's 120-payment requirement The "simplicity" pitch is that RAP calculates payments off your gross AGI with no poverty line exclusion. No discretionary income math, no family size adjustments — just 10% of whatever you made last year. That sounds clean. But that simplicity is what makes it more expensive for most physicians. What Is IBR (Income-Based Repayment)? IBR has been the default recommendation for residents pursuing PSLF for years. The mechanics: Payment: 10% of discretionary income (if you took out loans after July 1, 2014) Discretionary income: Your AGI minus 150% of the federal poverty line for your family size Forgiveness timeline: 20 years (for new borrowers), 25 years for older loans PSLF compatibility: Yes — IBR payments count toward PSLF The poverty line exclusion is what matters. It's the difference between paying 10% of your whole income and paying 10% of what's left after the government acknowledges basic living costs. RAP vs IBR: Side-by-Side Math Let's run the numbers for a typical PGY-1 resident. Scenario: PGY-1, $75,000 salary, family of 1, 2026 The 150% federal poverty line for a single person in 2026 is approximately $22,590. IBR payment: 10% × ($75,000 − $22,590) = 10% × $52,410 = $437/month RAP payment: 10% × $75,000 = $625/month Difference: $188/month more on RAP — $2,256/year Over a 4-year residency, that's roughly $9,000 in extra payments under RAP with no additional benefit toward PSLF (both plans give you the same PSLF credit: one qualifying payment per month). Now at the attending level: Scenario: Attending, $250,000 salary, family of 2, pursuing PSLF 150% FPL for a family of 2 in 2026 is approximately $30,750. IBR payment: 10% × ($250,000 − $30,750) = 10% × $219,250 = $1,827/month (capped at standard 10-year payment if lower) RAP payment: 10% × $250,000 = $2,083/month Difference: $256/month more on RAP At higher attending salaries, both plans eventually hit the standard repayment cap, so the gap narrows — but RAP gets there faster, meaning you pay more before the cap kicks in. Who RAP Actually Makes Sense For RAP is not inherently bad. It's just poorly suited for physicians specifically. RAP was designed for borrowers with simpler financial situations — people who don't track family size changes, don't file MFS vs MFJ strategically, and find the IBR poverty-line math confusing. For a borrower earning $45,000 with no dependents and no plans for PSLF, RAP's simplicity is a legitimate benefit. For physicians, that simplicity costs money. You have: High attending salaries that amplify the IBR vs RAP gap Long training periods where lower IBR payments compound over 5-7 years Likely PSLF eligibility if you're at a nonprofit or academic medical center Spouses whose income affects MFJ/MFS filing strategy — which IBR handles better There's one narrow case where RAP could be competitive: if you have a very small federal loan balance (say, $20,500 — the new annual Grad PLUS-eliminated limit) and a spouse with significant income already bumping you past the IBR cap. In that scenario the payment math converges. But most physicians carrying $200-400K in debt aren't in that band. The OBBBA Context: Why RAP Even Exists for Physicians The OBBBA that created RAP also eliminated the Grad PLUS loan program. Starting July 1, 2026, federal loans for graduate students are capped at $20,500 per year — the same unsubsidized limit that existed before Grad PLUS. Medical students now need private loans to cover the gap. This means RAP only applies to your federal loans going forward, not private loans. If you're an M1 who started in 2026, you might have $20,500/year in federal loans eligible for RAP and $30,000+ in private loans that don't qualify for any IDR plan. For those federal loans, IBR is still the better choice. For your private loans, refinancing terms and lender competition are what matter. PSLF and RAP: What You Need to Know RAP payments do count toward PSLF's 120-payment requirement. So if you're pursuing PSLF, you can technically use RAP and still hit forgiveness at 10 years. But there's no reason to — IBR gives you lower monthly payments and the same PSLF credit. The PSLF math is simple: every month of qualifying employment with a qualifying payment = one payment toward 120. IBR and RAP both give you one payment per month. Paying more per month under RAP gets you nothing extra. One exception worth knowing: if you're near the end of your PSLF window (say, 8-9 years in) and your income has grown substantially, the IBR payment may be higher than it was during residency due to your attending salary. In that case, both plans converge toward standard repayment anyway, and the difference is negligible. How to Compare RAP vs IBR for Your Specific Situation The numbers above are illustrative. Your actual payment depends on your AGI, family size, filing status, loan balance, and interest rate. A few inputs that change the math significantly: Married filing separately (MFS): IBR excludes your spouse's income if you file MFS. RAP uses your individual AGI either way. For high-income dual-physician households pursuing PSLF, MFS + IBR is often the lower-payment combination. Family size: IBR's poverty-line exclusion scales with dependents. A family of 4 has a significantly higher exclusion than a family of 1, meaning IBR payments drop further relative to RAP. Residency length: Longer training (surgery, neurosurgery) means more years where the IBR gap accumulates. A 7-year surgical resident saves substantially more under IBR over training than a 3-year IM resident. The MedDebt Calculator lets you model both scenarios with your actual numbers — salary by year, family size, filing status — and see a year-by-year comparison of total paid under each plan. Should You Switch to RAP? If you're already on IBR: no. RAP is not available for loans disbursed before July 1, 2026, so existing borrowers can't switch anyway. If you're an M1 who just took out your first federal loans in 2026: start with IBR. The eligibility and application process is the same as it's always been — you apply through your loan servicer after leaving school. RAP will be available too, but the math above shows IBR will cost less at nearly every income level physicians see during training and practice. If you want to verify this for your specific situation, run both scenarios in the MedDebt Calculator using the IDR plan selector. IBR will almost certainly come out ahead. FAQ Does RAP qualify for PSLF? Yes. RAP is a qualifying repayment plan for Public Service Loan Forgiveness. Payments made under RAP at a qualifying employer count toward the 120-payment requirement. That said, IBR also qualifies and typically produces lower payments, so there's no strategic reason to choose RAP for PSLF purposes. Can I switch from RAP to IBR? Yes. You can change IDR plans during an annual recertification window. If you start on RAP and later want to switch to IBR, you can do so — though switching mid-stream can reset some forgiveness calculations depending on your servicer. Confirm with your servicer before switching. What happened to SAVE? SAVE was struck down by the 8th Circuit Court of Appeals in March 2026 and is no longer a valid repayment option. Borrowers who were on SAVE were automatically moved to Standard repayment. IBR is the current recommended IDR plan for most physicians. Is RAP better than IBR for low-income borrowers? For very low incomes, RAP can produce similar or slightly higher payments than IBR because the poverty-line exclusion in IBR phases in. At $40,000 AGI for a single filer, IBR produces a payment of about $144/month vs RAP's $333/month — so IBR is still significantly lower. Who should even consider RAP? Borrowers with simple financial profiles, no PSLF intention, and who expect their income to stay relatively flat may find RAP's straightforward calculation easier to plan around. For physicians — with variable income across residency and attending stages, strong PSLF candidacy, and complex household situations — IBR handles the edge cases better. Run Your Own Numbers Every physician's debt situation is different. Use the MedDebt Calculator to model your exact repayment strategy — PSLF vs. aggressive payoff vs. refinancing — with your actual loan balance, specialty, and income. It's free, takes 2 minutes, and shows you net worth projections by year.

This article is for informational purposes only and does not constitute financial, legal, or tax advice. Every borrower's situation is unique — consult a certified student loan advisor or fee-only financial planner before making repayment decisions.

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