Retirement health care costs
- Proper planning can help ensure health-related expenses won't deplete your retirement savings.
- Government programs like Medicare only cover some medical expenses.
- Consider insurance to help pay the cost of long-term care (LTC).
Planning ahead for health care expenses is essential. How much will you need? Your costs will vary based on your income, age, health, location, your Medicare or supplemental plans and life expectancy.
Evaluating retirement health care costs
The financial impact of dealing with a serious illness can be devastating, and even everyday medical expenses such as prescription drug costs and routine medical services can add up over time. Planning now can help ensure you have enough money to pay for health care throughout retirement.
Health care costs for retirees are likely to continue to rise. For example, by 2020 a 65-year-old married couple without an employer-based health plan and with median drug expenses could need a total of $365,000 to $454,000 to pay for Medigap, Medicare Part B and Part D premiums and out-of-pocket drug expenses.1
Introduction to Medicare
Medicare is a federal health insurance program that provides coverage for people age 65 and older, and for some disabled people under age 65. The program consists of four parts, each of which covers different health-related expenses.
|Medicare Part A||Medicare Part B||Medicare Part C||Medicare Part D|
|Hospital Insurance||Medical Insurance||Medicare Advantage||Prescription Drug Plan|
|Helps pay for in-patient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care||Helps pay for doctors' services and many other medical services and supplies that are not covered by hospital insurance||Allows you to participate in PPO-, PFFS, and HMO-type managed care plans||Helps pay for medications prescribed by doctors|
|No premium if you and your spouse paid Medicare taxes during 40 or more quarters||Optional coverage||If you are enrolled in Medicare Part A and Part B, you are eligible to switch to Part C||Pays outpatient drug care costs|
|Requires a monthly premium payment for all participants2||Requires a monthly premium payment for all participants3|
|Deductible and cost-sharing limits may apply. In the coverage gap stage, there are different cost sharing percentages for brand name vs. generic drugs|
Several types of Part C plans are available, including:
- Preferred Provider Organization (PPO). This plan allows you to see any doctor or specialist; however, visiting doctors outside your PPO network will involve extra costs.
- Health Maintenance Organization (HMO). You have access to doctors in the HMO network only.
- Private Fee-for-Service (PFFS). You can see any doctor who is willing to accept the fees and terms of the PFFS.
- Special Needs. These plans are intended for people with certain chronic diseases or special health care needs.
- Medical Savings Account (MSA). This plan includes a high-deductible health insurance plan and a savings account in which Medicare deposits money for you to use for health care costs.
Enrolling in Medicare
If you are already receiving Social Security, you are automatically enrolled in Medicare at age 65. If you want to enroll in Medicare but are not taking (or not eligible for) Social Security, you can enroll three months before the month of your 65th birthday and the three months after. For example, if your birthday is March 15, you can apply anytime from November through the end of June.
Medigap and Medicaid
Medicare is only one of the sources of health care coverage available to retirees. You may also be eligible for Medigap or Medicaid.
|Individuals enrolled in Medicare Parts A and B are also eligible to purchase Medigap coverage from insurance companies.||Individuals with limited income who meet certain requirements may also be eligible to receive Medicaid.|
|Coverage and costs vary by state.||Medicaid is an insurance program sponsored jointly by states and the federal government.|
|Generally covers all or part of the costs not covered by Medicare, deductibles, co-payments and co-insurance||Covers some hospital care, prescriptions and nursing home costs|
|Enroll through private insurance agencies.||Enroll through your state's Department of Human Services.|
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
COBRA makes health coverage available at group rates for employees and their dependents who would otherwise lose health benefits when they retire, leave their job or have certain other qualifying events.
Generally, employers with 20 or more employees are subject to COBRA. Coverage applies to employees, former employees and certain dependents who are or were covered under a group health plan. Benefits include medical, dental, vision, health care reimbursement and employee assistance programs.
The average duration of long-term care for a retiree is estimated to be about three years. While long-term care (LTC) costs vary widely by region and type of facility, the national average cost for a private room in a nursing home in 2013 was $94,1704 per year. That adds up to $282,510 for three years of care — a significant expense which is expected to rise in the future. Medicare and Medigap policies offer limited, if any, coverage for LTC.
One way to plan for these costs is to purchase LTC insurance. Premiums for this coverage vary by company but are generally based on your age, health status and the level of benefit you are purchasing. Make sure that the benefit on your LTC insurance policy will be enough to cover the average cost of care in your region.
High-Deductible Health Plans (HDHP) and Health Savings Accounts (HSA)
A High-Deductible Health Plan (HDHP) may offer a practical way for retirees under age 65 (and therefore not yet eligible for Medicare) to deal with their medical costs. HDHP differs from other health insurance plans because its high deductible allows the policy to be offered at relatively low cost.
If an HDHP meets certain requirements, the policyholder may also open a Health Savings Account (HSA) to pay for HDHP deductibles and other qualified out-of-pocket costs. Money withdrawn from the HSA to pay for qualified expenses is tax-free as long as the expenses were incurred after the HSA was established and funded.
For 2015, the maximum annual contribution rates to an HSA are $3,350 for an individual and $6,650 for family coverage. Those who have reached age 55 but are not yet age 65 may contribute an additional $1,000 for 2015.
You can use an HSA account to pay for medical expenses as they occur, or you can accumulate funds in the account to pay for future health care expenses. Note that any distributions taken prior to age 65 that are not used for eligible medical expenses are subject to income tax and a 20 percent penalty.
Beginning in 2014, public and private insurance marketplaces became available to purchase coverage for individuals and small businesses.
The marketplaces in each state are designed to allow you to compare coverage and cost among the policies offered by area health insurance companies. Some states run their own marketplaces, others have opted to have the federal government run them. Either way, you purchase insurance through your state marketplace.