The real cost of health care in retirement

Health care

Health care is a difficult conversation, but planning now can help take the sting out of medical bills.


It’s never easy to talk about your health, and what it might look like in the future, but with health care costs climbing, it’s a critical conversation to have with family and the professionals you work with.

According to a report from RBC Wealth Management, the projected lifetime cost of care for a healthy 65-year-old is $404,253—and that doesn’t factor in long-term care costs, which could be as high as $100,000 a year.

Most Americans know medical care is expensive, with 80 percent of respondents to a recent survey telling RBC they are worried about how they’ll pay for those costs in retirement. However, many aren’t doing anything to calm their own fears. Just 56 percent of survey respondents said they’ve factored the cost of care into their financial plans, while half of those who have taken it into account feel as though they’re underestimating the price tag.

Indeed, they are. When RBC asked people how much they think they’ll spend on health care at age 65, they said about $2,700 a year, on average. In reality, experts estimate at age 65, the annual spend on health care for a healthy couple is close to $5,700 per person ($11,400 for a married couple). “These are out of pocket costs,” says Griffin Geisler, a wealth planning consultant with RBC Wealth Management–U.S.

“Medicare only covers a certain number of expenses, which means people have to fill that gap. The costs start to add up quickly,” he adds.

The rising costs of medical care

One reason for the higher costs is inflation—health care expenses rise faster than other costs—which is why RBC Wealth Management uses a five percent inflation number for clients who are near or in retirement—but it also has to do with people living longer and the need for more advanced treatments.

“This increase in costs is largely due to greater demand driven by longevity and advances in treatment and technology,” the report says. “For example, so-called maintenance procedures like joint replacement and cataract surgery are increasingly common, but carry significant price tags as they impact greater numbers of baby boomers.”

The report points out premiums, deductibles, co-pays and out-of-pocket costs are also climbing. Even when Medicare coverage is factored in, by age 75 health care expenditures will account for 15 percent of your overall spending, which is double what you would have spent during your working life.

Clearly, health care is expensive, so why aren’t more people planning for those costs?

“Part of it is denial,” says Geisler. “Healthy people don’t want to think about what life will be like when they’re older and not as healthy.”

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Start saving early

With costs only rising from here, people must start accounting for health care expenses in their financial plans, just like they would a house or an annual vacation, says Angie O’Leary, head of Wealth Planning at RBC Wealth Management–U.S. Medical goals should be realistic, she says, and work in that five percent inflation rate in any calculations.

Once you have a realistic view of how much you might spend on health care per year, the next hurdle is figuring out how to pay for it. That’s where your wealth advisor can help.

As with any kind of saving, the more money you can sock away in your younger years, the better off you’ll be. This is especially true with health care, as costs rise exponentially with age. According to the report, those between 65 and 74 spend about $13,000 a year on health care. That jumps to $24,000 between 75 and 84 and then rises to $39,000 for those over the age of 85. “For younger savers, time is truly on your side,” say the authors of the report.

Health care savings tools

As the data shows, though, it’s one thing to know health care is expensive and another to plan for those costs. Fortunately, there are a number of ways to save, with a big one being Health Savings Accounts (HSAs). These are investment accounts, typically offered by employers, which allow people to set aside pre-tax dollars for health care spending. Employers will sometimes match contributions, too.

HSAs are great savings vehicles because they come with a triple tax benefit: Contributions are made on a pre-tax basis, investments can grow tax free and withdrawals for qualified health care expenses are also tax exempt.

You can invest those dollars in a variety of vehicles, too, just like you would in a 401(k) or another retirement savings account.

“These are great,” says Geisler. “Money can carry over from year-to-year and you can build up a significant amount.”

Annual contribution limits are $3,650 a year for individuals and $7,300 for families, but since it’s not taxed, any money put into the fund should compound quickly. For instance, if you invest $100 in the account every month for 20 years, and assume a six percent rate of return, those dollars will grow to $46,000. You can withdraw money from an HSA at any time.

Another option is to invest in a Roth 401(k). Contributions are taxed when money is initially deposited, but you can withdraw your money tax-free in retirement. Start saving early and the tax hit will be low, while your dollars will be able to compound, tax-free, for decades.

“People should maximize any kind of tax-efficient savings vehicle as much as possible,” says Geisler.

There are other options, such as buying disability insurance and taking advantage of company-provided benefit packages, but living a healthy lifestyle is also important, says Geisler. Take care of yourself now and healthcare costs may be lower later.

It’s never too late to start saving

Of course, saving for health care-related issues, especially if you haven’t been putting money away yet, will require you to reduce spending elsewhere. Geisler recommends people put their expenses in different categories, such as needs, wants and wishes.

Health care should be in the first bucket and should be as much of a priority as basic living expenses and retirement savings, he says. You may need to drop some of those wants and wishes, like that extra trip you take every year, but consider the alternative of not being able to pay your hospital bill.

The health care conversation may be tough, but start talking now before it’s too late.

“You might think that having $1 million in retirement will last a long time, but understand that you’re going to have to spend a chunk of that on health care,” says O’Leary. “If you can get in front of this before you’re retired, then you’ll be able to do some catch up and adjust where you need to.”

Read more from our RBC Wealth Insights report Taking control of health care in retirement.

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RBC Wealth Management, a division of RBC Capital Markets, LLC, registered investment adviser and Member NYSE/FINRA/SIPC.

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