Step 4: Putting Together a Health Plan

Planning for healthcare in retirement is a tricky business. Some hardcore smokers live past 100, while some hardcore exercise and fitness gurus drop dead in their sixties. You just don’t know – which is why you need a plan.

Medicare

Once you turn 65, Medicare is available to most Americans. The problem is deciding what type of Medicare plan to purchase. Here is an overview:

Medicare Part A – This plan covers hospital stays, skilled nursing, hospice and some home health services. It is free for eligible beneficiaries but caps some benefit coverage and requires a deductible for each inpatient hospital stay. When a hospital stay is longer than 60 days, you’re required to pay a per-day rate – and that can add up.

Medicare Part B – This plan does charge a premium, and you have to buy it in concert with Part A. Part B covers doctor visits, preventive care, screenings, treatments, and medical equipment. It does not cover dental, vision, or hearing care and only pays for procedures deemed medically necessary. This plan also features a much lower deductible than Part A, but beneficiaries are responsible for 20 percent of covered services after the deductible.

Collectively, Parts A and B are what’s known as Original Medicare.

Medicare Part C – This plan is more commonly known as Medicare Advantage (MA). It is a paid alternative that combines coverage from Part A and B, plus offers add-on options for drug coverage, dental, vision, long-term care, etc. Plans vary significantly by insurer and may include any combination of deductibles, copayments, and coinsurance.

Medicare Part D – This plan offers coverage for prescription drugs. It charges a premium determined by your income, and deductibles, copayments, and coinsurance vary by plan. You have the option to purchase a standalone Part D plan when you enroll in Original Medicare.

Medigap – Also known as a Medicare Supplement Plan, this policy is a good idea whether you go for Original Medicare or an MA plan. That’s because it offers coverage for a lot of the gaps in those plans that generate high out-of-pocket expenses, including deductibles and coinsurance.

Long-Term Care

Among Americans who live past age 64, more than two out of three (70 percent) will at some point need long-term care. Whether you hire paid caregivers or move into a long-term care (LTC) residence, the cost of services currently averages between $60,000 and $100,000 a year in the United States. One of the biggest determinants of cost depends on whether you can get by with limited hours of help a day or need full 24-hour care. Note that for those with mobility issues (i.e., they cannot get to and from the toilet by themselves), 24-hour care is more likely.

Long-term care insurance (LTCi) can help you pay for this type of care so that you don’t deplete your savings quickly. This is especially important for couples, in which one spouse may need to enter an LTC residence while the other lives at home, with all the expenses that it entails.

The best time to buy LTC insurance is while you’re still healthy, as it is medically underwritten. The “sweet spot” is around age 55, but anytime in your mid-50s to early 60s is ideal. In most cases, policies are more expensive for women than men because women tend to live longer.

Caveats to Consider

• Policies typically pay out a limited daily amount, which may not cover the full cost.
• Policies typically pay out only for a limited period (e.g., 3 to 7 years)
• A policy may have a lifetime amount cap

All this is to say that you may purchase a generous LTCi policy, but if you outlive its limits, you will need to use your own money to pay for caregiving and/or rely on Medicaid when you run out of funds.

Hybrid Insurance

The biggest risk to purchasing an LTC policy is that you may never need it. Some policies offer a form of premium return, but like most insurance policies, LTCi generally uses it or loses it. To avoid this scenario, another option is to purchase a life + LTC insurance plan – also known as a hybrid policy. It provides a certain amount of life insurance upon death. However, if you need long-term care before you pass away, the policy will allow you to tap that death benefit amount to pay for it. This allows you to use the coverage either for LTC or as a life insurance payout for your beneficiaries.

Plan For These Expenses Now

While everyone is usually thinking about how to pay for household expenses, travel excursions, or a second home in retirement – they often don’t think about a health plan. As you can see, Medicare doesn’t cover everything and those expenses can add up, especially for people who live a long time.

But if you start planning long before retirement, you can contribute to an earmarked account that builds over time and uses that money to pay for medical expenses. The Health Savings Account (HSA) requires enrollment in a high-deductible health plan, whether offered by an employer or purchased on your own. Contributions made to an HSA are tax-free (which reduces taxable income), and the funds can be invested for tax-free growth in a variety of investment options. Withdrawals are also tax-free as long as they are used to pay for eligible healthcare products and services.

Note that HSA proceeds are your money, no matter what. It differs from employer-sponsored accounts such as an HRA (health reimbursement account) or an FSA (flexible savings account) because you have only a limited time to use those funds – then they revert back to the employer. In other words, you can’t access that money once you retire.