The Hidden Costs of Healthcare in Retirement: How to Prepare Now

For decades, retirement planning advice has centered around a simple directive: contribute to your 401(k), watch it grow, and withdraw from it in retirement. While 401(k)s and similar defined contribution plans are valuable tools, relying solely on market-based accounts creates significant risks for retirees. True retirement security comes from building multiple income streams that work together to provide reliability, growth potential, and protection from various risks. At American Assurance, we believe that a comprehensive retirement income strategy is essential for long-term financial security. This guide explores how to create reliable income streams beyond your 401(k) to ensure your retirement remains financially secure regardless of market conditions, inflation, or longevity. The Limitations of the Traditional Retirement Approach Before diving into alternative income sources, it’s important to understand why relying exclusively on traditional retirement accounts may not be sufficient: Market Volatility Risk When your retirement income depends entirely on investment performance, market downturns can be devastating, particularly if they occur early in retirement. This “sequence of returns risk” can permanently damage your portfolio’s ability to provide sustainable income. Inflation Risk Even modest inflation of 3% annually will cut your purchasing power in half over approximately 24 years. Traditional retirement accounts may not keep pace with inflation, especially if you’re taking conservative positions to reduce volatility. Longevity Risk With lifespans increasing, many retirees face the very real possibility of outliving their savings. The longer your retirement, the more challenging it becomes to make your money last using traditional withdrawal approaches. Withdrawal Rate Uncertainty The traditional “4% rule” for retirement withdrawals has been questioned in today’s low-yield environment. Many financial professionals now suggest lower sustainable withdrawal rates of 3-3.5%, which means you need a larger nest egg to generate the same income. Building a Reliable Retirement Income Framework A more secure approach to retirement income planning involves creating multiple streams of income with different characteristics. Think of these as building blocks that together form a comprehensive strategy: The Five Essential Income Pillars 1. Guaranteed Lifetime Income This foundational layer consists of income sources that continue regardless of market performance or how long you live: ● Social Security: The most common source of guaranteed lifetime income, with built-in inflation protection● Pensions: Becoming less common but extremely valuable for those who have them● Income Annuities: Purchased from insurance companies to create personal pension-like income● Qualified Longevity Annuity Contracts (QLACs): Special annuities that can provide income later in retirement Ideal allocation: 70-80% of essential expenses (housing, food, healthcare, utilities) should be covered by guaranteed income sources to create security and peace of mind. 2. Growth-Oriented Investments These investments offer the potential for increasing income and keeping pace with inflation: ● Dividend-Focused Stock Portfolios: Companies with histories of stable and growing dividends● Growth-Oriented Mutual Funds and ETFs: Provide potential for capital appreciation● Real Estate Investment Trusts (REITs): Offer potential for income and growth through real estate● Growth-Oriented Portions of Your 401(k)/IRA: Allocated for long-term growth Ideal allocation: 15-30% of your retirement portfolio, depending on your risk tolerance and time horizon. 3. Interest-Generating Investments These more conservative investments provide stability and reliable income: ● Bonds and Bond Funds: Government and high-quality corporate bonds● Certificates of Deposit (CDs): For safety with modest returns● Fixed-Income Portions of Your 401(k)/IRA: The more conservative allocations● High-Yield Savings Accounts: For emergency funds and short-term income needs Ideal allocation: 20-40% of your retirement portfolio, with the percentage increasing as you age. 4. Alternative Income Sources These diversifying income streams aren’t correlated with traditional markets: ● Rental Real Estate: Direct ownership of income-producing properties● Business Interests: Ongoing income from businesses you own or partially own● Royalties: Ongoing payments from intellectual property● Private Lending: Acting as a lender through peer-to-peer platforms or direct loans Ideal allocation: 0-15% of your retirement income strategy, depending on expertise and risk tolerance. 5. Flexible Income Options These sources provide adaptability and additional income when needed: ● Part-Time Work: Consulting, freelancing, or flexible employment● Home Equity: Tapping into home value through downsizing, home equity lines of credit, or reverse mortgages● Monetizing Hobbies: Turning passions into income sources● Deferred Benefits: Strategically timing when to activate certain benefits or income streams ● Ideal allocation: Variable based on personal preferences and needs, typically representing 5-15% of potential income. Strategies for Creating Reliable Retirement Income Now let’s explore specific strategies to implement each income pillar effectively: Maximizing Guaranteed Income Sources Social Security Optimization Social Security represents a foundation of guaranteed, inflation-adjusted income, making optimization crucial: ● Delayed Claiming Strategy: For each year you delay claiming beyond Full Retirement Age (up to age 70), benefits increase by 8%● Spousal Coordination: Married couples can coordinate claiming strategies to maximize household benefits● Survivor Benefit Planning: Ensuring the surviving spouse receives the highest possible benefit Example: James delays claiming Social Security from his Full Retirement Age of 66 to age 70, increasing his monthly benefit from $2,800 to $3,696. This not only maximizes his lifetime benefits but also ensures his wife will receive a higher survivor benefit if he predeceases her. Pension Maximization For those fortunate enough to have pension options: ● Lump Sum vs. Annuity Analysis: Determining whether to take a pension as a lump sum or lifetime income● Single Life vs. Joint and Survivor Options: Balancing higher initial income against protection for a surviving spouse● Pension Maximization with Life Insurance: Using life insurance to protect a spouse while selecting the higher single-life pension option Example: Elizabeth has a pension offering either $4,000 monthly as a single-life annuity or $3,400 monthly as a joint-and-survivor annuity with her husband. After analysis, she chooses the higher single-life option and purchases a permanent life insurance policy with a portion of the additional $600 monthly to protect her husband if she dies first. Strategic Use of Income Annuities Annuities can create guaranteed income streams to supplement Social Security and pensions: ● Single Premium Immediate Annuities (SPIAs): Convert a lump sum to immediate lifetime income● Deferred Income Annuities (DIAs): Purchase now for income starting at a future date● Qualified Longevity Annuity Contracts (QLACs): Special annuities that provide income later in life (typically 80+) while reducing required minimum distributions● Fixed Indexed Annuities with Income Riders: Provide withdrawal guarantees with some growth potential Example: Robert

When planning for retirement, most Americans focus primarily on building a nest egg to support their desired lifestyle, perhaps calculating housing costs, travel expenses, and daily living needs. Yet one crucial expense is frequently underestimated or overlooked entirely: healthcare. According to Fidelity’s latest retiree healthcare cost estimate, the average 65-year-old couple retiring in 2024 can expect to spend approximately $315,000 on healthcare expenses throughout retirement—a figure that doesn’t even include potential long-term care costs. For many, this represents their second-largest retirement expense after housing. At American Assurance, we believe that understanding and planning for healthcare costs is essential to creating true financial security in retirement. This guide will help you understand what to expect and how to prepare for these significant expenses. Medicare Fundamentals: What It Covers and What It Doesn’t Many Americans assume Medicare will cover all their healthcare needs in retirement, but this common misconception can lead to serious financial shortfalls. Let’s examine what Medicare actually covers—and more importantly, what it doesn’t. The Four Parts of Medicare Medicare Part A (Hospital Insurance) ● Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care● Most people receive premium-free Part A if they or their spouse paid Medicare taxes for at least 10 years● For those who don’t qualify for premium-free coverage, Part A can cost up to $505 monthly in 2024  Medicare Part B (Medical Insurance) ● Covers doctor visits, outpatient care, preventive services, and some home health care● Standard monthly premium is $174.70 in 2024 (higher for individuals with income above $103,000)● Annual deductible of $240 (2024)● After meeting the deductible, you typically pay 20% of the Medicare-approved amount for covered services  Medicare Part C (Medicare Advantage) ● Private insurance alternative to Original Medicare (Parts A and B)● May include prescription drug coverage and extra benefits like dental, vision, and hearing● Monthly premiums vary by plan and location● May have network restrictions or require referrals for specialists  Medicare Part D (Prescription Drug Coverage) ● Helps cover prescription medication costs● Provided through private insurance companies● Monthly premiums vary by plan, but average around $55 in 2024● Includes a coverage gap (“donut hole”) phase where costs may be higher  Significant Gaps in Medicare Coverage Despite its comprehensive nature, Medicare leaves notable gaps that can result in substantial out-of-pocket expenses: ● Dental Care: Routine dental services, including cleanings, fillings, extractions, and dentures, are generally not covered● Vision Care: Eye exams for glasses and contact lenses are typically not covered● Hearing Aids: Neither the devices nor fitting services are covered, despite average costs of $2,000-$5,000 per aid● Long-Term Care: Medicare provides very limited coverage for skilled nursing facilities and no coverage for custodial care (help with daily activities like bathing and dressing)● Overseas Coverage: Medicare generally doesn’t cover healthcare services outside the United States● Cosmetic Procedures: Elective surgical procedures are not covered● Deductibles, Copayments, and Coinsurance: These out-of-pocket costs can add up significantly over time Breaking Down Retirement Healthcare Costs To effectively plan for healthcare in retirement, it’s helpful to understand where the estimated $315,000 for a retired couple actually goes: Annual Costs for a Typical Retiree (2024 Estimates) Expense Category Annual Cost Per Person Medicare Part B Premiums $2,096 Medicare Part D Premiums $660 Medigap Plan G Premium (average) $2,400 Out-of-pocket costs (average) $1,350 Dental (basic care without major work) $900 Vision $300 Hearing $250 (amortized cost of aids) Total Annual Healthcare Cost $7,956 This amounts to approximately $15,912 annually for a couple, which explains how costs can reach $315,000 or more over a 20-25 year retirement period—and that’s before accounting for inflation or major health events. The Impact of Inflation on Healthcare Costs Healthcare inflation has historically outpaced general inflation by 1.5-2 percentage points annually. This means that while your other retirement expenses might increase at 2-3% per year, your healthcare costs could grow at 4-5% annually. The result? A healthy 55-year-old couple today might actually need closer to $450,000-$500,000 for healthcare by the time they complete their retirement, when factoring in healthcare-specific inflation. Supplementing Medicare: Essential Coverage Options To address Medicare’s coverage gaps, most retirees utilize one or more supplemental insurance options: Medigap (Medicare Supplement Insurance) ● Private insurance that helps pay the “gaps” in Original Medicare coverage● Standardized plans (labeled A through N) with varying levels of coverage● Most comprehensive plans (F, G, and N) cover most or all of Medicare’s deductibles and coinsurance● Monthly premiums range from $70 to $500+ depending on location, age, and plan level● Does not include prescription drug coverage (requires separate Part D plan)  Medicare Advantage Plans ● Alternative to Original Medicare that often includes Part D drug coverage● May offer additional benefits like dental, vision, and hearing coverage● Usually have network restrictions (HMO or PPO structure)● May have lower premiums but higher out-of-pocket costs when services are used● Annual out-of-pocket maximum for covered services ($8,850 in 2024)  Standalone Dental, Vision, and Hearing Plans ● Specific coverage for services Medicare doesn’t cover● Premiums typically range from $20 to $80 monthly depending on coverage level● Often have waiting periods for major services● May have annual benefit maximums (typically $1,000-$2,000)  Long-Term Care Insurance ● Covers custodial care needs not addressed by Medicare● Can protect against catastrophic costs of extended nursing home or home care● Traditional policies have annual premiums of $2,000-$8,000 depending on age at purchase and coverage level● Hybrid life insurance/LTC policies offer additional benefits but typically require larger investments Special Healthcare Considerations for Early Retirees For those planning to retire before age 65 (Medicare eligibility), healthcare planning becomes even more critical: Bridge Coverage Options ● COBRA: Continue employer coverage for up to 18 months, but often at full cost (average of $7,500 annually for individuals)● Affordable Care Act (ACA) Marketplace: Income-based subsidies may be available● Spouse’s Employer Plan: May be the most cost-effective option if available● Part-time Employment: Some employers offer health benefits for part-time workers● Private Insurance: Can be expensive but bridges the gap until Medicare eligibility  Health Savings Accounts (HSAs): A Triple Tax Advantage Health Savings Accounts offer a powerful way to prepare for retirement healthcare costs, providing: ● Tax-deductible contributions● Tax-free growth● Tax-free withdrawals for qualified medical expenses In 2024, contribution limits are $4,150 for individuals and $8,300 for families, with an additional $1,000 catch-up contribution allowed for those 55 and older. Strategy Tip: If possible, pay current

Social Security represents one of the most important retirement resources for most Americans, providing a foundation of inflation-protected, guaranteed lifetime income. However, many people claim these valuable benefits without understanding the long-term implications of their claims decisions. The difference between an optimal claiming strategy and a suboptimal one can amount to tens—or even hundreds—of thousands of dollars in lifetime benefits. At American Assurance, we believe that informed Social Security decisions are crucial to a secure retirement. This guide will help you understand the strategies that could maximize your lifetime benefits. Understanding the Basics: How Social Security Works Before diving into specific maximization strategies, it’s important to understand some fundamental concepts about Social Security benefits: Eligibility To qualify for retirement benefits based on your own work record, you generally need 40 “credits” (roughly 10 years of work) paying into the Social Security system. Spouses can qualify for benefits based on their current spouse’s record (spousal benefits) or deceased spouse’s record (survivor benefits), even if they have limited or no work history of their own. Full Retirement Age (FRA) Your Full Retirement Age is when you’re eligible to receive 100% of your earned benefit. For people born between 1943 and 1954, FRA is 66. For those born after 1954, FRA gradually increases until it reaches 67 for people born in 1960 or later. Early vs. Delayed Benefits ● You can claim benefits as early as age 62, but your monthly benefit will be permanently reduced (up to 30% less than your full benefit).● If you delay claiming beyond your FRA, your benefit increases by 8% per year (2/3% per month) until age 70, creating a potential 24-32% increase compared to claiming at FRA.● Once you reach age 70, there’s no financial benefit to further delay, as your benefit amount stops growing. Cost of Living Adjustments (COLAs) Social Security benefits include annual cost of living adjustments to help protect against inflation. These adjustments apply to your benefit amount regardless of when you claim, but larger initial benefits mean larger dollar increases over time. Key Factors That Influence Your Optimal Claiming Strategy Your optimal Social Security claiming strategy depends on several personal factors: 1. Life Expectancy ● If you expect to live longer than average (approximately age 83 for men and 85 for women), delaying benefits often results in greater lifetime benefits.● If you have serious health concerns or a family history of below-average longevity, claiming earlier might be more advantageous.● For married couples, the longer life expectancy of either spouse should be considered, particularly for survivor benefit planning.  2. Marital Status ● Single individuals’ decisions are primarily based on their personal life expectancy and financial needs.● Married couples need to coordinate their claiming strategies, considering both spouses’ benefits and the valuable survivor benefit.● Divorced individuals may qualify for benefits based on an ex-spouse’s record if the marriage lasted at least 10 years and they haven’t remarried.● Widows and widowers have special options, including the ability to restrict applications to certain benefit types.  3. Financial Need ● Your current financial situation might necessitate claiming earlier even if delayed claiming would provide greater lifetime benefits.● Having other retirement income sources (pensions, investments, annuities) provides flexibility to delay Social Security for larger future benefits.  4. Taxation of Benefits ● Up to 85% of your Social Security benefits may be subject to federal income tax, depending on your “combined income” (adjusted gross income + nontaxable interest + half of your Social Security benefits).● Some states also tax Social Security benefits, while others exempt them entirely.● Tax considerations can influence optimal claiming strategies, particularly for those with significant retirement income from other sources. Maximization Strategies for Different Situations Now let’s explore specific claiming strategies for different situations: Single Individuals For never-married, divorced (without claiming on an ex-spouse’s record), or widowed individuals who will only claim on their own record: Strategy 1: Delay to Maximize Monthly Benefits If you can afford to do so, delaying benefits until age 70 provides the largest possible monthly benefit—up to 76% more than claiming at 62. This strategy is particularly valuable for those who: ● Expect to live longer than average● Want to maximize survivor benefits for a younger spouse● Are still working and might face benefit reductions and higher taxation● Have other assets to draw from during the delay period Example: Maria has a full retirement age of 66 and 4 months, with a benefit of $2,000 at FRA. By delaying until 70, her benefit grows to approximately $2,613 per month. If she lives to 90, this decision results in over $100,000 in additional lifetime benefits compared to claiming at FRA, even after accounting for the years of missed benefits. Strategy 2: Break-Even Analysis For those unsure about delaying, consider the “break-even age”—the age at which the cumulative benefits from delaying surpass the cumulative benefits from claiming earlier. ● The break-even age for delaying from 62 to FRA is typically around 77-78.● The break-even age for delaying from FRA to 70 is typically around 82-83. If you expect to live beyond these ages, delaying generally results in greater lifetime benefits. Married Couples Married couples have more complex decisions because they need to coordinate two benefit histories and consider survivor benefits. Strategy 1: Higher-Earner Delays, Lower-Earner Claims Earlier In many cases, the optimal strategy for married couples involves: ● The higher-earning spouse delays claiming until age 70 to maximize their benefit.● The lower-earning spouse claims earlier, especially if their benefit is significantly lower. This strategy works because: ● It provides income earlier in retirement while still maximizing the higher benefit.● It ensures the surviving spouse receives the largest possible survivor benefit, which will be 100% of the deceased spouse’s benefit (including delayed retirement credits). Example: John and Sarah are both 62. John’s FRA benefit is $2,800, while Sarah’s is $1,200. Sarah claims at 62, receiving $900 monthly (reduced for early claiming). John delays until 70, increasing his benefit to $3,680. This maximizes their household income during their joint lifetime and ensures that whichever spouse survives will receive John’s higher benefit for the remainder of their life. Strategy 2: File at Full Retirement Age for Lower-Earning Spouse In some cases,

For many Americans approaching retirement, one question looms larger than almost any other: “Will I have enough income to last throughout my retirement years?” With traditional pensions becoming increasingly rare, longer lifespans, and market volatility always a concern, creating reliable retirement income has become more challenging than ever. Annuities are one potential solution to this retirement income puzzle. Yet despite their potential benefits, annuities remain widely misunderstood and sometimes controversial. At American Assurance, we believe in providing clear, objective information about all retirement options, including annuities, so you can make informed decisions about your financial future. What Is an Annuity? At its core, an annuity is a financial contract between you and an insurance company. You provide the insurer with money—either as a lump sum or through a series of payments—and in return, the insurer commits to making payments to you for a specified period or for the rest of your life. Think of an annuity as creating your own personal pension. You’re essentially transferring the risks of market volatility and outliving your money to an insurance company in exchange for income guarantees. The Four Main Types of Annuities Not all annuities are created equal. There are several distinct types, each with different features, benefits, and potential drawbacks: 1. Fixed Annuities How they work: Fixed annuities provide a guaranteed interest rate on your money for a specific period, similar to a certificate of deposit (CD) but typically with higher rates. After the accumulation phase, you can convert your balance into a guaranteed income stream. Best for: Conservative investors seeking guaranteed growth without market risk, especially those approaching or in retirement. Key features: ● Guaranteed minimum interest rate● Principal protection (your initial investment is protected)● Tax-deferred growth until withdrawal● Predictable income in retirement  Potential drawbacks: ● Lower growth potential compared to variable annuities● May not keep pace with inflation● Surrender charges for early withdrawals● Less flexibility than some other options 2. Variable Annuities How they work: Variable annuities allow you to invest your money in a selection of subaccounts, similar to mutual funds. Your account value and future income can fluctuate based on the performance of your investment choices. Best for: Investors seeking growth potential who can tolerate some market risk and want lifetime income guarantees. Key features: ● Growth potential through market participation● Tax-deferred growth● Optional living benefit riders that can guarantee minimum income● Death benefits for heirs  Potential drawbacks: ● Market risk can affect account value● Higher fees than many other investments● Complex structure that can be difficult to understand● Surrender charges for early withdrawals 3. Indexed Annuities How they work: Indexed annuities (also called fixed indexed annuities) offer returns tied to the performance of a market index, such as the S&P 500, but with downside protection. They provide some market upside potential while protecting your principal from losses. Best for: Moderate investors seeking a middle ground between fixed and variable annuities, with some growth potential but limited downside risk. Key features: ● Principal protection from market losses● Potential for higher returns than traditional fixed annuities● Tax-deferred growth● Optional income riders  Potential drawbacks: ● Returns are typically capped or limited by participation rates● More complex than fixed annuities● Surrender charges for early withdrawals● May have higher fees than fixed annuities 4. Immediate Annuities How they work: With an immediate annuity, you provide a lump sum payment to an insurance company, and they begin making payments to you right away (or within one year). These payments can last for a specific period or for your lifetime. Best for: Retirees seeking to convert a portion of their savings into guaranteed lifetime income right away. Key features: ● Payments begin immediately● Simple structure that’s easy to understand● Guaranteed income for life option● Peace of mind against market volatility  Potential drawbacks: ● Limited or no liquidity (access to your principal)● Limited or no inflation protection (unless specifically purchased)● No opportunity for growth once purchased● No remaining value for heirs with lifetime-only options (unless a specific rider is purchased) The Role of Annuities in Retirement Planning Annuities can serve several purposes within a comprehensive retirement plan: Creating a Guaranteed Income Foundation One of the most powerful uses of annuities is creating a floor of guaranteed income to cover essential expenses in retirement. By ensuring your basic needs are covered with guaranteed income (from Social Security, pensions, and annuities), you can feel more confident taking appropriate risks with your remaining investments. Managing Longevity Risk Perhaps the greatest financial risk in retirement is outliving your money. With lifespans continuing to increase, many retirees may need to fund 30+ years of retirement. Lifetime annuities transfer this longevity risk to the insurance company, guaranteeing income no matter how long you live. Reducing Sequence of Returns Risk Retiring just before a major market downturn can devastate a portfolio, as withdrawals during down markets can permanently impair your retirement savings. Annuities with lifetime income guarantees can help mitigate this “sequence of returns risk” by providing stable income regardless of market performance. Tax-Deferred Growth All types of annuities offer tax-deferred growth, meaning you don’t pay taxes on earnings until you withdraw them. This can be especially valuable for individuals who have already maximized contributions to other tax-advantaged accounts like 401(k)s and IRAs. Common Misconceptions About Annuities Despite their potential benefits, annuities are often misunderstood. Let’s address some common misconceptions: “Annuities have high fees and poor returns” Reality: While some annuities (particularly certain variable annuities) can have high fees, others—like many fixed and immediate annuities—have minimal or no explicit fees. As for returns, annuities shouldn’t be judged solely on growth potential. Their primary value comes from risk transfer and income guarantees, not maximum growth. “If I die early, the insurance company keeps my money” Reality: This depends entirely on the type of annuity and the options you choose. Many annuities offer death benefits or period certain guarantees that ensure your beneficiaries receive value even if you die earlier than expected. “Annuities lock up my money forever” Reality: While annuities typically have surrender periods during which withdrawals may incur charges, many allow for 10% annual free withdrawals without penalty. Additionally, some annuities offer liquidity options for specific circumstances like nursing home care. “I don’t need an annuity if I have enough saved” Reality: Even individuals with