Plan for Health Care Costs

Fidelity Investments estimates that the average Avoca 65-year-old couple retiring now will need about $260,000 to pay out-of-pocket health care costs, including deductibles and Medicare premiums, over the rest of their lives. That doesn’t include long-term care, which can be a major budget buster.

There are a variety of options to help pay these future medical bills. One tax-friendly way is a health savings account. As long as you have an eligible high-deductible health insurance policy, you can contribute to an HSA either through your employer or on your own (but you can no longer contribute after you’ve signed up for Medicare).

An HSA offers a triple tax advantage. You contribute money on a pretax basis to the account. Money in the account grows tax-deferred. And withdrawals are tax-free if used to pay medical expenses, either today or when you’re retired. (You’ll owe income taxes and a 20% penalty on withdrawals used for other purposes, although the penalty disappears once you turn 65.)

To make the most of the HSA, contribute as much as you can to the account and pay current medical bills out of pocket. That way, the money in the account has time to grow. Years from now, you can use HSA funds to reimburse yourself for medical bills you’re paying today.

The maximum contribution for 2020 is $3,550 for single coverage and $7,100 for families, plus an extra $1,000 if you’re 55 or older. Your health insurance policy must have a deductible of at least $1,400 for singles and $2,800 for families.

Employers are increasingly offering workers this option to contain costs because premiums for high-deductible plans tend to be lower than for traditional insurance. Among Fidelity-run plans, nine out of 10 employers kick in money to workers’ accounts to encourage participation. The average employer contribution is $541 for singles and $991 for families.

If you’re looking for an HSA on your own, review fees and investment options. Morningstar recently looked at plans offered by the 10 most prominent providers and found that only one—offered by The HSA Authority—did a good job for both current spending and future investing.

You can use HSA funds to pay for long-term-care premiums—but that’s a small compensation given the steep price tag for a long-term-care policy. If you can’t afford a long-term-care policy that would cover at least three years of long-term care with inflation protection, another option is to buy enough coverage to pay the difference between the cost of care for three years and what you can afford to pay from savings and income.

Another solution: a hybrid policy that combines life insurance and long-term-care benefits. It’s basically a permanent life insurance policy that allows you to spend down the death benefit to pay for long-term care should you need it. You can also get a rider that will cover long-term care above and beyond the death benefit. If you don’t need long-term care or don’t entirely use up the death benefit, your heirs will collect what remains of it.

Lincoln National, for example, offers a hybrid policy called MoneyGuard that you purchase with an up-front lump sum or in installments over 10 years. A 60-year-old  Avoca man paying $10,000 a year over a decade could get monthly long-term-care benefits at age 80 of $7,983 for up to six years, growing at 3% annually. The death benefit at that point would total $106,400, or he could cash in the policy and get 80% of his premiums returned. Under a similar scenario, a woman would get $7,076 per month for long-term care or a $113,600 death benefit.

The trade-off is that hybrid policies are doing double duty, so you’ll get a lower long-term-care benefit for your money than if you purchased a stand-alone long-term-care policy.

MONEY TIP: 

If paying for long-term care is your chief goal and you don’t need more life insurance, buy a stand-alone policy rather than a hybrid policy. Today’s long-term-care policies are more accurately priced than those issued years ago, so it’s less likely that you’ll see steep premium jumps in the future, says Pinnacle’s Kitces. Plus, you may be able to deduct part of your premiums on your tax return, something you generally can’t do with a hybrid policy.