North Macedonia’s pension system faces fiscal sustainability challenges, particularly with its second pillar amid demographic and economic changes. This paper analyzes factors influencing pension fund sustainability, including demographic shifts, economic performance, investment outcomes, policy frameworks, and pension indexing practices. Currently, 68% of contributions go to the first pillar and 32% to the second, but all pensions are funded by the first pillar, causing a deficit that requires 30% state budget support. The paper explores the potential nationalization of the second pillar and reallocation of its funds to the first pillar, noting legal and individual approval constraints. It also examines immediate fiscal relief versus long-term risks, such as public trust erosion, financial market destabilization, and higher future pension obligations, while considering high migration impacts.