The Math on Retirement Health Care Costs Is Scarier Than It Looks

Analysis September 27, 2023 at 03:21 PM
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Millions of older American workers and retirees are grappling with the challenge of creating a secure income stream that may need to last 30 years or longer, and one area that must be at the forefront of financial planning discussions is the potentially devastating impact of excessive health care costs.

As Ron Mastrogiovanni, founder and CEO of HealthView Services, recently told ThinkAdvisor, the health care game has changed entirely for current and future retirees relative to prior generations.

Alongside the decline in defined benefit pension plans, corporate America has also shifted rapidly away from providing supplemental retiree health care support, even for long-tenured workers. This means Americans are increasingly left to rely on their own Social Security, private savings and Medicare to address the often mountainous cost of care, Mastrogiovanni observes.

The potential costs of long-term care, prescription drugs and hospital stays can derail the financial plans even of retirees with millions in the bank, especially in cases of chronic physical or cognitive illness.

What this all means for financial advisors is clear, Mastrogiovanni argues: They must bring better health care cost analysis into the financial planning equation.

What's Happening With Retiree Care Costs?

To demonstrate the challenging nature of health care cost projections, Mastrogiovanni points to a recent article published by The New York Times showing the average annual cost to the government per Medicare beneficiary has not significantly increased since 2010.

While this is a notable trend, Mastrogiovanni says, advisors and their clients should not assume this means that health care costs incurred by individual retirees have not been rising. Instead, a deeper look at key data points conducted by HealthView Services reveals demographic changes are at the heart of this seeming contradiction.

As the analysis explains, the first baby boomers started to retire in the late 2000s, and they have been entering retirement at a rate of around 10,000 a day ever since. Driven by this demographic wave, the number of Medicare recipients has increased by 39.8% since 2010, jumping from 47.2 million to 65.8 million.

As a result, the proportion of the 65-and-older population has skewed younger and healthier relative to historical averages and especially compared to a decade ago.

"Since health care costs are highest toward the end of retirement as health declines, the average annual cost per retiree under Medicare will naturally be lower for a younger population," Mastrogiovanni explains. "Looking forward, aging baby boomers will eventually make for an older and less healthy retiree population."

This will naturally result in significantly higher average per-beneficiary expenses, assuming all else remains equal, and it underscores the point that individual costs and population costs are different animals.

Today's near retirees and early retirees should not take the recent Medicare spending data as a sign that they will somehow benefit from health care cost deflation or even stability, Mastrogiovanni says. Sadly, he says, the opposite is true, and action must be taken early to ensure clients have the best chance of meeting their spending needs.

What It Really Takes to Be Ready

According to HealthView Services, although the U.S. has seen a dramatic increase in Medicare Advantage enrollment over the last decade — which was expected to reduce costs to the government — industry data indicates that this trend, too, has not had a particularly beneficial impact on government costs.

"In fact, there is evidence that the opposite may be true," Mastrogiovanni warns. "Advisors and retirees need to focus on the big picture."

The bottom line, according to HealthView Services, is that the average individual's Medicare costs have increased meaningfully in the recent past, and all signs indicate the same will be true moving forward.

"Our actuarial data, which is based on 530 million actual health care claims, shows that annual total health care costs for 65-year-old retirees have increased by 60% since 2011," Mastrogiovanni warns.

This implies that a healthy 65-year-old couple would have spent $8,900 in 2011 on Medicare Part B and D premiums, supplemental insurance, dental insurance and out-of-pocket costs for hospitalization, doctor visits, tests, prescription drugs, dental, vision and hearing care. Today, a 65-year-old couple will spend $14,100, an increase of $5,200.

"The fact is that financial burden for a couple starting Medicare in 2023 will be substantial," Mastrogiovanni says. "We expect to see the decades-long trend continue, with health care costs rising up to twice as fast as the consumer price index."

For all premiums and out-of-pocket expenses, the planning data shows a couple should expect just over $780,000 (future value) in total retirement health-related expenditures. This assumes they live to actuarial life expectancy of 88 (male) and 90 (female).

The good news here, Mastrogiovanni says, is that today's workers and retirees can save and invest to get ahead of this problem. When one accounts for market growth, for example, the typical client couple may need only $260,995 saved at retirement to cover this expense, assuming a 6% return on their portfolio.

The Bottom Line for Clients and Advisors

The simple fact is that the big health care cost projection numbers tell an important story, but they only speak to the aggregate experience of retirees. Any given individual or couple could experience unexpectedly low or unexpectedly high health care costs in retirement, and it is up to the advisor to help them understand the right level of risk to take given their personal preferences and risk tolerance.

The other fact of the matter is that health care access, quality and expenses vary tremendously by geographic location. For that reason, too, advisors and their clients must look beyond rote averages and simple national projections to actually create some clarity about their unique situation.

And, Mastrogiovanni explains, clients may want be careful what they wish for. From a medical cost perspective, the cheapest retirement is likely to be a short retirement — one in which a person dies shortly after they leave the work force.

In this sense, the need to project and plan for higher health care costs has a silver lining. It means retirees are anticipating living longer and gaining access to life-altering care that can extend both the length and quality of life.

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