Retiree medical costs are expected to moderate but remain high

Retirees just got some encouraging news: Coming changes to Medicare rules for prescription drugs may help rein in their health costs.

In part because of recently enacted limits on retiree prescription drug costs, the estimated cost of health and medical care in retirement overall didn't rise this year, according to an annual analysis from Fidelity Investments.

A 65-year-old retiring this year can expect to spend an average of $157,500 on health and medical costs over a roughly 20-year retirement, said Hope Manion, senior vice president and chief actuary at Fidelity Workplace Consulting. The estimate is the same as it was in 2022 — the first time in almost a decade that the company's year-to-year projection has stayed flat.

While the latest estimate is a "welcome reprieve" from years of increasing health costs, Manion said, "it's still a big honking number." This year's estimate is almost double the company's estimate of $80,000 in 2002.

The estimated cost is $165,000 for women, who tend to live longer, and $150,000 for men.

Saving for health expenses in retirement is a bigger worry than it once was, not only because of rising medical costs but also because fewer employers offer health benefits to their retired workers. The Employee Benefit Research Institute, a nonprofit, reported that about a quarter of large employers offered retiree health benefits in 2021, down from half about 25 years ago. Fewer government employers are offering retiree health insurance as well.

"That's a huge chunk of the worker population that now has to worry about something their parents didn't," Jake Spiegel, research associate for health and wealth benefits at the institute, said in an email.

Fidelity bases its estimate on someone who is enrolled in traditional Medicare, the federal health program for people 65 and older and the disabled. Medicare covers hospital stays, doctor visits and lab tests, as well as prescription drugs. The estimate includes Medicare premiums, deductibles and copayments but not the cost of care that Medicare doesn't cover, such as dental, vision and long-term care like assisted living or extended stays in a nursing home.

Some people assume that once they have Medicare coverage, they won't have to pay anything out of pocket, but that's not the case. So people should factor those costs into their retirement savings plan, Manion said.

For instance, while most people pay no monthly premium for Medicare Part A, which covers treatment in a hospital, the premium for Medicare Part B, which covers doctor visits and lab tests, is now $165 a month (or more, depending on your income), and there's usually a 20% cost share when you receive treatment. Premiums vary for Part D, which covers prescription drugs. Starting in 2025, as part of changes made to Part D in the Inflation Reduction Act of 2022, out-of-pocket costs for prescription drugs will be capped at $2,000 a year.

The Employee Benefit Research Institute, using a probability approach, found that retirees with original Medicare may need to accumulate even more savings than Fidelity estimates to have a strong chance of covering their health costs because of the financial condition of the Medicare program and cuts to employer-based retiree health programs.

This year, the institute estimated that to have a 90% chance of having enough money to cover Medicare premiums and prescription drug costs in retirement, a 65-year-old man would need to have saved $166,000 and a woman $197,000. (The institute's estimate assumes the retirees have a Medicare supplement plan, also called a Medigap plan, with average premiums to help cover costs that Medicare doesn't.)

In some cases, the institute says, the savings needed may be much greater. A couple with particularly high drug costs, for instance, could need to save $383,000 to meet the 90% threshold.

"It's a pretty sobering number," Spiegel said.

Spending estimates may be lower for retirees in increasingly popular Medicare Advantage plans, federally funded but privately managed health plans that cover medical care as well as prescription drugs. Such plans have trade-offs, however, like limited doctor networks.

A man enrolled in Medicare Advantage who has median drug spending and average use of health care services would need $96,000 to have a 90% chance of meeting health spending needs in retirement, while a woman would need $113,000, according to the institute.

Cheryl Costa, a certified financial planner in Framingham, Massachusetts, said the projections might seem scary but it could help to think about the estimates in annual or monthly costs, rather than a lump sum. Over 20 years, Fidelity's average estimate works out to $656 a month — not out of line with what you may already be paying for health care, she said.

"Keep it in perspective," she said.

Carolyn McClanahan, a certified financial planner in Jacksonville, Florida, said health care costs have many variables and future changes to Medicare rules are unpredictable. So rather than focusing on generic estimates to save for retirement health costs, she said, people should consider their specific situation, including what they currently pay for health care, their general health status, their family history and how much health care they use.

"What is your health care mindset?" McClanahan said. If you don't go to the doctor that often and you're exercising and maintaining a healthy weight, your out-of-pocket costs in retirement may be lower and you can budget accordingly, she said.

Here are some questions and answers about health costs in retirement:

Are health savings accounts useful for retirement health costs?

Health savings accounts offer valuable tax advantages and can be a great way to save for retiree medical costs, financial advisers say — if you qualify to contribute to one. You must be enrolled in a high-deductible health care plan, with a specific annual deductible (at least $1,500 for individual coverage in 2023).

Money is deposited pretax, grows tax free and isn't taxed when you withdraw it, as long as you spend it on eligible expenses. An individual can contribute up to $3,850 in 2023, plus an extra $1,000 for those over 55. (Once you enroll in Medicare, you can no longer contribute to an HSA, but you can use the funds to pay for health and medical expenses.)

One catch is that people often must use the money in the account to pay for current health expenses, so they don't think of them as useful for long-term savings. But if you can afford to pay for current costs out of pocket, investing your HSA balance can help with medical costs later in life.

"I encourage savers to think of it as a retirement account, not a health care spending account," Manion said.

Where can I get an estimate of my Medicare costs in retirement?

A financial planner can help with this. If you don't work with one, the Centers for Medicare and Medicaid Services, which oversees Medicare, offers an online tool to help you estimate costs, as does the National Council on Aging. AARP, the advocacy group for older people, offers information on its website about affording retirement health costs.

How much can long-term care cost?

According to the Genworth Cost of Care Survey for 2021, the national median cost for assisted living is $4,500 a month, while the cost of a semiprivate nursing home room is $7,908 a month. Again, these are costs that Medicare doesn't cover.