Big Medical Costs for Retirees

https://www.wsj.com/health/healthcare/retirement-medical-costs-unexpected-68d48f68?mod=hp_trendingnow_article_pos2

Three Big Medical Costs That Retirees Often Underestimate

Drugs, remote locations and concierge care can add tens of thousands of dollars to healthcare costs in retirement

By Gail MarksJarvis, The Wall Street Journal, June 8, 2025

Key Points

  • Unexpected healthcare costs can arise in retirement, such as uncovered drugs, isolation and concierge care.

  • Medicare Part D may not cover all drugs, potentially leading to high out-of-pocket expenses for uncovered medications.

  • Retirees may face unexpected travel costs for medical care based on retirement location, or feel compelled to pay for concierge medical care.

Americans tend to go into retirement in relatively good health and well aware they will pay premiums for such things as Medicare, supplemental Medicare insurance and Medicare drug plans and even long-term-care insurance. One widely used estimate for such healthcare costs—from financial-services titan Fidelity—pegs them at $330,000 for the average couple throughout retirement, or $165,000 for an individual, and those figures don’t include long-term-care insurance…

Uncovered drugs

A new federal requirement for Medicare drug insurance, known as Part D Medicare, says that people using Medicare drug plans won’t have to pay more than $2,000 out of pocket for the drugs covered by their drug insurance each year.

But there is a catch. The $2,000 cap applies only to drugs that a Medicare Part D insurance or Medicare Advantage company tells patients up front each year will be covered through what’s known as the “formulary list.”…

[This is a HUGE risk. A healthy person who isn’t taking any prescriptions naturally wants to minimize the cost of Medicare Part D. The plans from different companies vary widely in cost. It’s almost impossible to get the formularies when choosing and in any case the insurance companies can change them during the year. Many chemotherapy drugs aren’t in the formularies and are incredibly expensive. Like tens of thousands of dollars a month. I didn’t realize that the $2,000 limit only applies to drugs in the formulary. The late trenchrat said that treating his cancer caused his money to “melt away like ice cream on a Florida sidewalk.” – W]

Medical isolation

In isolated, rural areas such as much of Alaska, people realize that even routine medical care is likely to depend on air travel to cities, so it is a way of life to budget for small private planes and multinight hotel stays…When picking a retirement location, McClanahan says, “You have to decide whether lifestyle or the best medical care matters most to you.”

[Our home in Sequim, WA is 2.5 hours away from Seattle. We have some local care but for major problems (such as open-heart surgery) I want the best. This entails travel and hotel bills. There are plenty of beautiful retirement areas which are much further away from top-notch medical care. – W]

Concierge care

In some areas of the country with large affluent retiree populations, doctors increasingly are turning away patients on Medicare and accepting new patients only if they pay an annual fee for concierge medicine. So retirees can feel as if they have little alternative than to pay thousands of dollars a year for the security of a reliable doctor… [end quote]

When we moved to Sequim in 2003 we were under age 50. Even so, I immediately made an appointment for a checkup, just to enroll in a medical practice. Doctors can refuse to take a patient but they never (as far as I know) throw an existing patient out of a practice.

This doesn’t include the potential cost of long-term care. We have already discussed that topic on METAR.
Wendy

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That’s not true. If you require a medically necessary drug not on your Part D formulary, you can request an exception and it will be covered for the remainder of the year under the umbrella of the $2,000 annual out-of pocket cap. So that covers the situation of someone getting cancer in June, and the $10,000/month drug required to treat it isn’t on the formulary. Of course, in the next year you’ll have to choose a Part D drug plan with the cancer drug on the formulary, probably at a higher premium.

It’s very easy to get screwed out of tens of thousands of dollars if you don’t understand the Medicare rules. You can’t use trenchrat’s unfortunate experience to inform current year decison making.

intercst

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Thanks for sharing this information which contradicts the WSJ. Please post a link.
Wendy

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If the drug is ruled “medically necessary” for you, it’s covered under the $2,000 annual out-of-pocket limit.

Apparently you can even get a high priced drug moved to a lower tier, if that’s the only drug that works for you. For example, my Part D plan dispenses 5 or 6 blood pressure medications at the lowest tier which is a zero dollar co-pay. If I tried all the cheap drugs and my blood pressure was only controlled by an expensive medication, I might be able to get that one moved to a lower tier if I can prove “medical necessity”.

intercst

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The system is ever more idiotically
RubeGoldbergian

PettyThievery-ing
and Buck Passing optimizing.

That it is ever less effective and ever more pushing citizens and government towards bankruptcy is no surprise.

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