When you’re young and healthy, it’s hard to envision how much you'll have to spend on health care costs in your later years. Besides, there will be time to think about that later, right? And yet, as with so many things, when you’re young is precisely the time to take action for the benefit of your future self.

That point was emphasized in Fidelity’s most recent study of retiree health care costs. The company estimates that a 65-year-old couple retiring this year can expect to spend $315,000 on such costs throughout their retirement — 5% more than last year. Fidelity’s calculation assumes the couple uses original Medicare (i.e., not Medicare Advantage) and the tally takes into account premiums, including Part D prescription drug coverage, as well as deductibles and co-insurance costs. It does not account for dental or long-term care costs.

On the one hand, if this couple lives another 20 years, that works out to $15,750 per year or $1,312.50 per month. That could be less than a younger person is paying per month right now for health care (certainly the case in our household, by a long shot!). On the other hand, Fidelity’s estimate is an average. Individual people’s actual health care needs vary considerably. Of course, the big unknown is whether you will need long-term care, and if so, how much care, for how long, and at what cost?

A call for more education

One of the most important aspects of the study is that it highlights the need for today's workers to gain a more realistic view of their future health care costs. According to Fidelity’s research, on average, Americans believe that a couple retiring this year will spend just $41,000 on health care throughout their retirement. Of course, that's an unrealistically low estimate. 

The study also highlighted the opportunity many younger workers have to prepare for such costs, especially those who qualify for a health savings account (to qualify, you need to have a high-deductible health insurance plan). A much higher percentage of those with an HSA feel prepared for their health care expenses in retirement than those who do not have an HSA.

Fidelity uses the example of a 35-year-old couple that maxes out HSA contributions and invests the balance, assuming an average annual return of 7%. As the illustration below shows, such a couple could use half of their HSA money for current expenses and still end up with a later life health care nest egg of nearly $500,000. If the couple had enough money to pay current health care costs with other funds, thereby not tapping any of the HSA money during their working years, they could end up with nearly $1,000,000. 

A "Super IRA"

As we noted in an article last year, Elevating the Role of Health Savings Accounts, the consulting firm Willis Towers Watson recently encouraged people to think of an HSA as a retirement account. The company suggested that qualifying workers make funding such an account their second-highest retirement-investing priority, right after investing enough in a workplace retirement plan to receive all available matching money an employer offers. After all, an HSA has the potential to function as a "super IRA," with contributions tax-deductible and investment gains and withdrawals tax-free as long as the money is used for qualified health care costs.

A number of HSA providers allow balances to be invested, not just saved, and Morningstar’s most recent evaluation of the HSA landscape gave Fidelity its highest marks. In fact, Fidelity was the only provider to receive Morningstar’s “High” assessment on a five-tier scale. Calling it the “clear-cut winner,” Morningstar noted that Fidelity offers a wide range of investment options and low fees. SMI came to a similar conclusion in the article mentioned earlier, writing:

It’s noteworthy that Fidelity is Morningstar’s top choice since it is also SMI’s top recommended broker. Opening a Fidelity HSA would enable you to use any SMI strategy to manage that account. The SMI Funds and SMI Private Client also allow for the use of HSAs, with Private Client able to manage balances using a custom blend of SMI strategies.

Other steps you could take to better prepare for post-retirement health care costs include:

  • Once you turn 65 and are eligible for Medicare, give careful consideration to which will be more beneficial to you — a Medicare Advantage plan or traditional Medicare plus Medigap. Some Medicare Advantage plans may pay for expensive items such as hearing aids, which traditional Medicare does not cover. If you plan to split your time in retirement, living in two locations, be sure the plan your choose will cover you in both places. (See the article links in the sidebar for more on this topic.)
     
  • Have honest conversations with your family about future medical care issues. People often “don’t want to be a burden” to their adult children, but those children may be very open to the idea of a multi-generational living arrangement, which used to be much more common. Also discuss how much care you would want if you became terminally ill, and specify your wishes in a living will.
     
  • Consider what you would do in case you need long-term skilled care. What’s the likelihood? Do you have a family history of dementia? Should you consider a long-term-care insurance policy?
     
  • Take good care of yourself. While we can’t control all of the factors that impact our health, many of today’s most common health issues are self-inflicted through poor diet, lack of exercise, too little sleep, too much stress, and other controllable factors.

What are you doing to prepare for later life health care costs?