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How to tame retiree health care costs

Plan ahead and make health care costs part of overall retirement planning discussions.

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Your retirement plans probably focus on doing some things you've had to put off during your working years. But you should also take into account the financial aspects of retirement, and that means planning for health care costs.

A 65-year-old couple retiring in 2015 is expected to need $245,000 on average (in today’s dollars) to cover health care costs in retirement, a hefty amount for most retirees.1

“Rising health care expenses are forcing people to make educated decisions ranging from the services they use to the age they choose to retire,” explains Bradford Kimler, executive vice president of Fidelity Benefits Consulting. “So it’s critical that people plan well in advance for the considerable cost of health care by making it part of their overall retirement planning discussions.”

As life expectancies increase and people spend more years in retirement, the money set aside to pay for health care will have to last longer as well. Clearly, factoring in health care expenses has become a critical part of retirement planning. Fortunately, there are steps you can take to ease your mind—and your budget—so you can arrive at retirement with potentially fewer worries about managing your health care costs.

1. Understand your health insurance options.

To take control of your health care expenditures, “You need to educate yourself about what your options for health expense coverage are: what you need, where you can get coverage, and the cost for that coverage,” says Sunit Patel, senior vice president of Fidelity Benefits Consulting. That education starts with understanding what your options for health insurance will be once you retire.

For most retirees, leaving full‐time employment will mean leaving employer‐provided health care coverage behind. Today, only 23% of firms with 200 or more employees still offer retirement health care coverage.2 Even then, the plan may differ dramatically from its preretirement version. There may be different deductibles, co‐pays, or other limitations, and you may be sharing a larger amount, if not all, of the cost of the premium.

Medicare covers most retirees.

While some people may have access to employer‐provided retiree health care coverage, the government’s Medicare health insurance program is still the primary source of health coverage for American retirees. Most automatically qualify for basic Medicare hospital insurance (known as Part A) as soon as they reach age 65. This coverage costs nothing if you or your spouse paid Medicare taxes during your working years.

On the other hand, Medicare medical insurance (known as Part B), which covers doctors’ services, outpatient hospital care, and some other medical services such as physical and occupational therapy and some home health care, is not free. You pay a monthly premium for Part B, and there’s no annual limit on your out‐of‐pocket expenses as there is with many private insurance policies.

Medicare Advantage plans combine Medicare Part A and Part B and supplemental coverage (private health insurance to cover what Medicare doesn’t cover) in a single policy. They are privately managed and can offer lower premiums or better benefits than the traditional Medicare setup where each part is treated separately. But these plans also can limit you to using only network providers.

Prescription drug costs have also gone up; U.S. spending on prescription medicines jumped 13%, to $374 billion in 2014, the biggest percentage increase since 2001.3 To cover prescription drugs in retirement, you also can purchase Medicare Part D prescription coverage to add to Part A, Part B, and your Medigap coverage (supplemental), or as part of a Medicare Advantage plan.

Although it can be time consuming to select coverage aimed at supplementing basic Medicare from the many private insurance options available in your state, it’s an exercise that can make a big difference in your costs.

The government’s Medicare site offers access to tools that help you compare coverage in your state and find insurers that offer the best value for your needs. Select "Find health & drug plans" on Medicare.gov. And don’t forget to ask prospective insurers if they have options to help you keep costs down, like higher deductibles, discounts for a healthy lifestyle, or using only in‐network providers.

What if you retire early?

If you retire before age 65, you can’t take advantage of Medicare right away. So if you don’t have other coverage in the interim, you will need to find a source to pay for your medical insurance while you await eligibility for Medicare. In this case, you have a number of choices. Among them:

  • Paying to continue your current employer coverage for a specified time under COBRA
  • Joining your spouse’s company health care plan
  • Purchasing your own medical insurance policy via Healthcare.gov or a local insurance broker
  • Using Veteran’s Administration benefits, if you are a veteran
  • Using Medicaid, if you qualify

As with any important financial purchase, think about the costs and coverage of your policy before you buy it, and look at the premiums you can afford, the deductibles, the available hospitals and doctors, the plan’s quality ranking information, the covered benefits, and the out‐of‐pocket expenses you will pay. Higher deductibles generally lower your costs but require you to pay more up front before your coverage kicks in.

2. Factor health care costs into your income planning.

Once you have a better handle on the cost of the insurance coverage you’ll need, you can begin looking at your health care costs along with your other essential retirement expenses. “On the financial side, you want to look closely at your anticipated medical costs as part of your larger income planning goal, because they are such an important and essential expense in retirement,” advises Patel.

Some online retirement planning tools, like Fidelity’s Planning & Guidance Center,4 can help you estimate how much of your budget for essential expenses should be allocated to medical and health care costs.

You also can use Fidelity’s annual Retiree Health Care Costs Estimate as a basis for planning. This estimate suggests that a couple retiring in retiring in 2015 at age 65 would need $245,000 (in today's dollars) in total to pay for medical expenses throughout their retirement (20 years for men, 22 years for women, on average), not including nursing home or long‐term care.

That figure is an average cost, to be used as a general guideline, because it applies only to a 65‐year‐old couple retiring in 2015 and assumes other behaviors as well, including future lifestyle and needs. “If you’re younger, this is not the right number for you,” says Patel. To arrive at a figure that better reflects your personal situation, he suggests adjusting the number to take into account your family history and your health status, which might mean planning for a longer or shorter retirement and a larger or smaller total cost. You might want to earmark a portion of your budget for purchasing long term care insurance as well.5 The cost is based on age, so the earlier you purchase a policy, the lower the annual premiums.

Factoring future health care expenses into one’s retirement plan allows for a more realistic assessment of one’s retirement cash flow needs and, as a consequence, a more realistic assessment of one’s retirement savings needs and of the potential success of a retirement plan.

3. Take advantage of all possible funding sources.

In addition to any employer‐sponsored benefits, your retirement accounts, and personal savings, you may have other sources to help meet health care costs in retirement.

For example, if you have a health savings account (HSA) that is used in conjunction with a high‐deductible health plan (HDHP), you can make pretax contributions to be used to pay for qualified medical expenses. Earnings and withdrawals are also federal tax free if used to pay for qualified medical expenses.6 You can also use the funds in an HSA to pay for both current and future qualified medical expenses. Because you don’t have to use the money right away, it can be set aside to cover future qualified medical expenses, including those in retirement—and you’ll be able to withdraw it free of federal income taxes in the future. (For more on HSAs, read ViewpointsThree healthy habits for health savings accounts.”)

“Health savings accounts are a smart way to set aside funds specifically for medical needs,” says Steven Feinschreiber, senior vice president, Financial Solutions, at Strategic Advisers, Inc., a registered investment adviser and a Fidelity Investments company. “HSAs are not subject to the ‘use it or lose it’ rule and are completely portable for individuals who change employers.”

Another source of funds that might be available to cover your health care expenses is part‐time work. Keeping health insurance benefits, if your employer offers it to part‐time employees, can be an important benefit and is one of the leading reasons retirees continue to work. Fifty percent of retirees said keeping health insurance or other benefits was a “major” reason they continued to work, according to the 2014 EBRI Retirement Confidence Survey.7

4. Be a smart health care consumer.

“Being informed and proactive about choosing your health care providers and managing your care may be one of the most effective ways to control health care costs in retirement,” says Feinschreiber.

“If you identify the best providers for safe and cost‐effective solutions before care is needed, you can save a significant amount of time and money later on,” he explains. Feinschreiber suggests identifying in advance four types of providers to turn to in different situations:

  1. A primary care physician
  2. A specialist for any existing conditions or special needs
  3. An urgent care provider
  4. A full‐service hospital.

That way, you’ll know where to go for the care that offers you the most value.

Other ways to make sure you get the most from your health care dollars include the following:

Be prepared. Be ready to give your provider the information that he or she needs—even to the point of writing down your questions or symptoms in advance of each visit. In addition to ensuring that your concerns are addressed efficiently (and that you don’t forget something important), this also makes the best use of everyone’s time. Because physicians and facilities typically charge based on the time and complexity of a visit, this is even more important if you have an HDHP, where you shoulder more of the up‐front costs.

Ask the hard questions. Make sure you get a clear description of any diagnosis and the doctor’s proposed plan of care, free of confusing jargon. Ask about the benefits and risks of any procedures, and know the outcomes you can expect. See whether any alternative treatments are available, and compare the cost and outcomes of those choices too.

Know what you’re paying for. What are the charges, fees, and out‐of‐pocket costs you should expect for the recommended treatment plan? Are there any factors you should know about that could cause the anticipated expenses to increase? Remember, along with your patient privacy rights, you also have the right to know as much as you can about the medical services being recommended, and their costs. Being a good health care “shopper” may also help you lower your out‐of‐pocket costs for prescription drugs. Even with improved Part D insurance plans, prescriptions can cost thousands of dollars a year if you’re treating a chronic condition. So check with your doctor or pharmacist to see whether there are safe, efficient, and lower‐cost alternatives to any brand-name drugs you’re using.

Also, Feinschreiber says that health care costs vary widely by geographical region, and suggests that people who are thinking about living in a different state during retirement should take these differences into account. To learn more about the state and regional cost comparisons, check the reports online at the Centers for Medicare & Medicaid Services.8 Finally, “Don’t underestimate the link between your health and your financial wealth,” says Patel. “It’s important to know what you can do to influence your costs and to understand how your good health may play a role.”

Planning for health care expenses in retirement has never been more important. By carefully considering your needs, expenses, and financial resources ahead of time, you will likely be in a better position to handle the costs when retirement finally arrives.

Learn more

  • Get a holistic view of your retirement plan with our Planning & Guidance Center, and explore changes that may help you become better prepared.
  • Get information about Medicare health insurance coverage and supplemental coverage in your state at Medicare.gov.
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1. 2015 Fidelity analysis performed by its Benefits Consulting group. Estimate based on a hypothetical couple retiring in 2015, at 65 years old, with average life expectancies of 85 for a male and 87 for a female. Estimates are calculated for “average” retirees but may be more or less depending on actual health status, area of residence, and longevity. The Fidelity Retiree Health Care Costs Estimate assumes that individuals do not have employer-provided retiree health care coverage but do qualify for the federal government’s insurance program, Original Medicare. The calculation takes into account cost-sharing provisions (such as deductibles and coinsurance) associated with Medicare Part A and Part B (inpatient and outpatient medical insurance). It also considers Medicare Part D (prescription drug coverage) premiums and out-of-pocket costs, as well as certain services excluded by Original Medicare. The estimate does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Life expectancies are based on research and analysis by Fidelity’s Benefits Consulting group and data from the Society of Actuaries, 2014.
2. http://kff.org/report-section/ehbs-2015-section-eleven-retiree-health-benefits/
3. Bill Berkrot, “U.S. prescription drug spending rose 13 percent in 2014: IMS report,” Reuters, April 14, 2015.
4. Guidance provided by Fidelity through the Planning & Guidance Center is educational in nature, is not individualized, and is not intended to serve as the primary basis for your investment or tax-planning decisions.
IMPORTANT: The projections or other information generated by Fidelity’s Retirement Income Planner tool regarding the likelihood of various investment outcomes are hypothetical in nature, do not reflect actual investment results, and are not guarantees of future results. Results may vary with each use and over time.
5. “How Much Care Will You Need?” LongTermCare.gov.
6. With respect to federal taxation. State taxation may vary from state to state.
7. Ruth Helman, Greenwald & Associates, and Nevin Adams, JD; Craig Copeland, PhD; and Jack VanDerhei, PhD; EBRI. “The 2014 Retirement Confidence Survey: Confidence Rebounds—for Those With Retirement Plans,” EBRI Issue Brief #397, March 2014.
8. Centers for Medicare & Medicaid Services: U.S. per Enrollee State Estimates by State of Residence.
Views expressed are as of the date indicated and may change based on market and other conditions. Unless otherwise noted, the opinions provided are those of the speakers, and not necessarily those of Fidelity Investments.
Fidelity does not provide legal or tax advice, and the information provided above is general in nature and should not be considered legal or tax advice. Consult an attorney or tax professional regarding your specific legal or tax situation.
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