RAP vs IBR: Which Repayment Plan Should Physicians Choose in 2026?
by Malik Amine
Key Takeaways
- RAP (Repayment Assistance Plan) replaces SAVE and will eventually replace IBR for new borrowers after July 1, 2026.
- RAP charges 15% of discretionary income vs roughly 10% under current IBR plans.
- If you already have federal loans, you can still consolidate into IBR before July 1, 2026 to keep the lower rate.
- PSLF still works under both plans, but the math changes significantly depending on which plan you're on.
- There's no one-size-fits-all answer. Your income trajectory, loan balance, and career plans all matter.
The Old Playbook Is Gone
If you went to medical school anytime in the last 15 years, you probably heard some version of this advice: get on an income-driven repayment plan, make your payments during residency, and either pay it off as an attending or get forgiveness through PSLF.
That playbook still works. But the plans underneath it are changing, and the differences aren't small.
The SAVE plan, which was the most generous option for a lot of borrowers, got eliminated through the OBBBA legislation. IBR is still available right now, but after July 1, 2026, new borrowers will only have access to RAP.
So the question becomes: which plan should you be on?
How RAP Actually Works
RAP is the government's replacement for the income-driven plans that existed before. Here's the quick version.
You pay 15% of your discretionary income. Discretionary income is your adjusted gross income minus 150% of the federal poverty line for your family size. For a single person in 2026, that poverty line threshold is roughly $22,000.
So if you're a resident making $65,000, your discretionary income is about $43,000. Fifteen percent of that is $6,450 per year, or about $537 per month.
Compare that to IBR, where you'd pay about 10% of discretionary income. Same resident, same $43,000 in discretionary income, that's $4,300 per year or about $358 per month.
The difference: $179 per month. Over a 3-year residency, that's $6,444.
When IBR Makes More Sense
If you can still get on IBR (meaning you consolidate before July 1, 2026), it's almost always the better deal during residency and fellowship. The lower payment percentage saves you real money during the years when your income is lowest.
This is especially true if you're planning to pursue PSLF. Lower payments during training years means less money out of pocket before forgiveness kicks in. And since PSLF forgives whatever balance remains after 120 qualifying payments, paying less each month is actually the optimal strategy.
The math is clear. A resident on IBR making $65,000 pays about $4,300/year toward loans. A resident on RAP making $65,000 pays about $6,450/year. Over 3 years of residency, that's $6,450 more on RAP. Money that, if you're going for PSLF anyway, would have been forgiven.
When RAP Might Be Fine
Here's the thing. Not everyone qualifies for IBR consolidation before the deadline. And not everyone is pursuing PSLF.
If you're planning to aggressively pay off your loans as an attending, the repayment plan during residency matters less. You're going to refinance to a private loan at a lower rate and pay it down in 3 to 5 years regardless. In that case, whether you pay $358 or $537 during residency is a smaller piece of the overall picture.
RAP also isn't terrible if you have a smaller loan balance. The 15% rate hurts most when you have $250K+ in loans and a long repayment horizon. If you borrowed $120K for medical school and you're becoming an attending in a high-paying specialty, the plan differences are less dramatic.
The PSLF Factor
PSLF is where the plan choice really matters.
Under both IBR and RAP, your payments count toward the 120 qualifying payments needed for PSLF forgiveness. The key difference is how much you pay before that forgiveness kicks in.
Here's a simplified example:
Physician with $280,000 in loans, starts residency at $65,000, becomes an attending at $250,000 after 3 years of training:
On IBR: total payments over 10 years are roughly $120,000 to $140,000 before forgiveness. On RAP: total payments over 10 years are roughly $160,000 to $180,000 before forgiveness.
That's $40,000 more paid out of pocket before the same forgiveness event. Same job. Same loans. Different plan. $40,000 difference.
This is why the July 1 consolidation deadline matters so much.
What About Married Physicians?
Filing status complicates this. Under RAP, your spouse's income is included in the payment calculation regardless of how you file. Under the old IBR rules, filing separately could exclude your spouse's income.
If you're married to another physician or a high earner, this changes the math significantly. Your combined income pushes your discretionary income higher, which means higher payments under RAP.
This is one of those areas where you really need to run the numbers for your specific situation. A physician married to a teacher has a very different calculation than two physicians married to each other.
What to Do Right Now
If you're currently in residency or fellowship with federal loans, check whether you're on IBR. If you're not, look into consolidating before July 1, 2026 to get access to it.
If you're already on IBR, you should be fine. The current plan rules are grandfathered as long as you don't consolidate loans that include post-July 2026 borrowing.
If you're starting residency this July, you're in the transition zone. Consolidate your existing med school loans before July 1 to lock in IBR. Any future borrowing will fall under RAP.
And if you're an attending already making good money, this might not affect you directly. But if you're mentoring residents or have colleagues still in training, pass this along. Seriously.
Summary
RAP and IBR are both income-driven repayment plans, but the 5 percentage point difference in payment rates adds up to tens of thousands of dollars over a physician's career. If you can lock in IBR before July 1, 2026, do it. If you're stuck with RAP, it's not the end of the world, but you need to understand how it changes your repayment strategy. Run the numbers. Don't just pick a plan because it's the default.