Key Facts
Medical school has always been expensive. What changed on July 1, 2026 is that federal loans no longer cover the full cost. The Reconciliation Act of 2025 eliminated Grad PLUS and capped federal borrowing for professional students at $50,000 per year. At virtually every private medical school in the country, that leaves a gap.
This article covers the exact gap at top MD, DO, and dental programs, what the numbers mean for four-year total costs, and the concrete options for covering the difference.
The New Federal Cap for Medical Students
Professional students -- MD, DO, JD, DDS, PharmD, DVM, and OD -- are now capped at $50,000 per year in federal unsubsidized loans, with a $200,000 lifetime aggregate.
For a four-year MD program:
- Maximum total federal borrowing: $200,000
- At a school with $100,000 per year in cost of attendance: $200,000 gap over four years
The cap is not applied to tuition alone. It applies to the total federal loan amount regardless of how you allocate it across tuition, fees, and living expenses.
The key advantage of federal loans that makes them worth maxing out: income-driven repayment, Public Service Loan Forgiveness, and deferment during residency. Borrow the full $50,000 federal cap first, then plan for the remainder.
What Medical School Actually Costs
Cost of attendance includes tuition and fees plus the school's estimated living expenses (housing, food, transportation, and personal costs). Here are current figures at leading programs:
| School | Program | COA/Year | Federal Cap | Gap/Year | 4-Year Total Gap |
|---|---|---|---|---|---|
| Columbia | MD | $115,000 | $50,000 | $65,000 | $260,000 |
| Harvard | MD | $113,000 | $50,000 | $63,000 | $252,000 |
| Stanford | MD | $109,000 | $50,000 | $59,000 | $236,000 |
| Yale | MD | $105,000 | $50,000 | $55,000 | $220,000 |
| Johns Hopkins | MD | $105,000 | $50,000 | $55,000 | $220,000 |
| Georgetown | MD | $105,000 | $50,000 | $55,000 | $220,000 |
| Duke | MD | $100,000 | $50,000 | $50,000 | $200,000 |
| University of Michigan (private) | MD | $95,000 | $50,000 | $45,000 | $180,000 |
These figures are based on IPEDS 2024 published cost of attendance data. Living expense estimates vary by location, and some schools publish separate on-campus and off-campus figures.
Public medical schools (in-state) often have total COA of $40,000 to $60,000 per year, which in some cases falls within or near the new $50,000 federal cap. If you are a strong in-state candidate, the funding math is substantially different from private programs.
DO Programs: Similar Costs, Same Gap
Doctor of Osteopathic Medicine programs at private osteopathic schools follow a similar cost structure to private MD programs. Tuition at leading DO programs runs $55,000 to $75,000 per year. Total COA including living expenses is generally $85,000 to $100,000 per year.
Under the $50,000 professional student cap, most DO students face gaps of $35,000 to $50,000 per year, or $140,000 to $200,000 over four years.
DO students qualify for the same federal loan cap and protections as MD students, and the same private lending options apply.
Dental School: Large Gaps with Shorter Programs
DDS and DMD programs are typically four years but carry some of the highest per-year costs in graduate education. Private dental school tuition runs $70,000 to $90,000 per year. Total COA including living expenses regularly reaches $100,000 to $120,000 per year.
Under the $50,000 cap, dental students face gaps of $50,000 to $70,000 per year, or $200,000 to $280,000 over a four-year program.
Dental students also have a different income timeline than physicians. Dentists typically go directly into practice after graduation without a residency, which affects repayment strategy but does not change the borrowing problem.
The Long Residency Problem
Physicians face a challenge that distinguishes them from most other professional borrowers: residency.
After graduating with $300,000 to $400,000 in total debt, physicians typically enter residency programs paying $60,000 to $75,000 per year for three to seven years. Monthly loan payments on a $300,000 balance at market rates would exceed $3,000 per month -- far more than manageable on a resident's income.
Federal loans solve this with income-driven repayment (IDR), which caps payments at a percentage of discretionary income. On a $65,000 resident salary, IDR payments are minimal. Private loans have no equivalent.
This is the clearest reason to minimize private borrowing if you plan a long residency. A physician planning to work at an academic medical center or teaching hospital may also qualify for Public Service Loan Forgiveness after 10 years of IDR payments -- which would include residency and early attending years at a nonprofit institution.
Covering the Gap: Options for Medical Students
1. Federal loans first ($50,000/year)
Borrow the full federal cap. The income-driven repayment and PSLF eligibility alone justify this before touching any other source.
2. Private student loans
For most students, private loans are the primary mechanism for covering the gap after federal borrowing. Private graduate lenders typically offer:
- Loan amounts up to cost of attendance
- Fixed or variable rates
- Deferment during school and residency (in some cases)
- No income-driven repayment or forgiveness
Credible
Compare multiple lenders in 2 minutes with no hard credit pull
SoFi
No origination fees, unemployment protection, career coaching
Earnest
Flexible payments and a skip-a-payment option once per year
ELFI
Among the lowest fixed rates for medical and professional school
If you plan to pursue PSLF through residency and attending work at a nonprofit hospital, minimize private borrowing aggressively. Every dollar of private debt is excluded from PSLF and must be repaid in full.
3. Military Health Professions Scholarship Program (HPSP)
HPSP covers full tuition, fees, and a monthly stipend in exchange for active duty service after graduation. The commitment is typically one year of service for each year of scholarship funding. For students open to military medicine, this eliminates the borrowing problem entirely.
Branches offering HPSP: Army, Navy, Air Force. Applications are competitive and require MCAT scores, GPA, and a commitment to military service.
4. Indian Health Service Loan Repayment Program
IHS offers up to $40,000 per year in loan repayment for physicians who commit to working at least two years in underserved tribal areas. Renewable annually. This is a repayment program, not a scholarship, so you still borrow upfront -- but it can substantially reduce your net debt.
5. NHSC Loan Repayment
The National Health Service Corps offers up to $50,000 in loan repayment for two years of service in a federally designated Health Professional Shortage Area. Applies to primary care, mental health, dental, and other disciplines. Physicians can earn additional repayment through continued service.
6. Institutional scholarships
Some medical schools award merit or need-based scholarships that reduce tuition. NYU Grossman School of Medicine offers full-tuition scholarships to all students. A growing number of schools have launched similar programs. These are worth researching during the application process, not after admission.
What to Do Right Now
- Calculate your exact gap. Enter your program and school to get the specific number -- gap size determines how aggressive your private borrowing strategy needs to be.
- Borrow the full $50,000 federal cap regardless of other options.
- Research PSLF eligibility based on your target specialty and employer type. If you plan to work at a nonprofit health system, this changes your entire repayment calculus.
- If eligible, apply for HPSP, IHS, or NHSC before or during the application process.
- For private loans, compare at least three lenders on fixed rate, origination fees, and deferment terms. On a $60,000 loan over 10 years, a 1% rate difference is about $3,300 in total interest.
Frequently Asked Questions
What is the federal loan cap for medical students in 2026?
Professional students including MD, DO, DDS, PharmD, and DVM students are capped at $50,000 per year and $200,000 aggregate in federal unsubsidized loans. Grad PLUS no longer exists for students entering programs on or after July 1, 2026.
Can I use Public Service Loan Forgiveness for medical school debt?
Federal loans are eligible for PSLF after 10 years of qualifying payments while working full-time at a nonprofit or government employer. Many residency and fellowship programs qualify. Private loans do not qualify for PSLF.
What do DO programs cost compared to MD programs?
DO programs at private osteopathic medical schools typically cost $85,000 to $100,000 per year in total COA. Under the $50,000 cap, DO students face gaps of $35,000 to $50,000 per year.
Are dental school funding gaps similar to medical school?
Yes. DDS and DMD students at private programs typically face gaps of $50,000 to $70,000 per year under the new $50,000 cap, similar to private MD students.
Do MD students qualify for income-driven repayment?
Federal loans qualify for IDR plans including SAVE, IBR, PAYE, and ICR. Private loans do not. This is especially important during residency when income is low relative to total debt.
How do I calculate my exact gap?
Use the Loan Cliff calculator with your school name and program type. The tool uses IPEDS 2024 cost of attendance data and the statutory caps from the Reconciliation Act of 2025.