Americans can expect to pay a lot more for medical care in retirement

A 65-year-old couple retiring this year can expect to spend an average of $315,000 in health-care and medical expenses in their retirement, according to a new estimate by Fidelity Investments. That’s 5% higher than last year’s estimate.

While much of the increase this year came from higher Medicare Part B premiums for Americans 65 and older, health-care costs are expected to remain elevated. 

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“There’s a lot of upward cost pressure in the health-care system right now, due to investments that providers need to make to get ready for the next pandemic, due to issues around labor, particularly hospital nurses,” said Hope Manion, senior vice president and chief health and welfare actuary at Fidelity Investments.

Fidelity also found that most Americans have underestimated what health-care expenses will be in retirement, with the average person expecting costs to be $41,000 — a $274,000 shortfall from its estimate. 

“People do not realize that once they get on Medicare, they’re still going to be on the hook for some number of bills,” said Manion, adding that retirees must pay for premiums, over-the-counter and prescription drugs and some medical devices.  

If health-care costs grow at just 2% above consumer inflation for the next two years, a healthy 55-year-old couple could face $267,000 in additional medical costs when they retire at age 65, according to an analysis by HealthView Services. 

That same couple could expect to spend more than $1 million on health-care expenses in their lifetime — nearly the same amount as they could expect to collect in Social Security benefits. 

“Whether you’re affluent or you’re the average person … when you look at your Social Security check, you’re paying for health care,” said HealthView Services CEO Ron Mastrogiovanni. 

After paying the premiums, Medicare covers about two-thirds of the cost of health-care services, with out-of-pocket spending making up about 12%, according to the Employee Benefit Research Institute (EBRI).  

“Other than housing, food and transportation, [health care is] probably the most expensive item we’re going to face in retirement,” Mastrogiovanni said. “Know what it is. Be prepared.”

While physical fitness may help control some health-care costs, experts say planning ahead for medical expenses over a longer life should also be factored into the equation. 

Health savings accounts are one way to save for future health-care costs, but those require a high-deductible plan and have annual contribution limits.

For 2022, the limit is $3,650 for the single insured and $7,300 for families. For people over 55 years old, each of those limits increase by $1,000 with “catch-up” contributions.

Increasing savings now can add to security later. Experts say consider adding more money to your 401(k) plan or a Roth individual retirement account, if you qualify.

“The most important thing is that you start saving and you start saving early,” said Paul Fronstin, director of health benefits research at EBRI. “The earlier you do, the better prepared you’re going to be.”

There was a time when employers offered health benefits to retirees, but EBRI found only about 4% of companies have those benefits. That’s down from about 45% before an accounting rule change in the late 1980s required firms to put the liability on their balance sheets.

“When they had to do that, it just didn’t look good on the balance sheet, so they started cutting back on the benefit to the point where very few workers are going to be eligible for this kind of benefit in the future,” Fronstin said.