Planning for Medicare Premiums and Drug Costs Is a Difficult Fact of Life

The Employee Benefits Research Institute (EBRI) published a new EBRI Notes report on the topic of ballooning retiree medical care costs.

Researchers examine the amount of savings couples will require to cover common medical costs accrued later in life. In particular, premiums for Medicare Parts B and D, premiums for Medigap Plan F, and out-of-pocket spending for outpatient prescription drugs are weighed. Taking all of these costs together, the EBRI analysis comes to an eye-popping sum.

“In 2017, a 65-year-old man needs $73,000 in savings and a 65-year-old woman needs $95,000 if each have a goal of having a 50% chance of having enough savings to cover premiums and median prescription drug expenses in retirement,” the analysis states. “If they want a 90% chance of having enough savings, the man needs $131,000 and the woman needs $147,000.”

According to EBRI, a couple with median prescription drug expenses needs $169,000 if they have a goal of having a 50% chance of having enough savings to cover health care expenses in retirement. If the couple wants a 90% chance of having enough savings, they need $273,000.

“For a couple with drug expenses at the 90th percentile throughout retirement who want a 90% chance of having enough money saved for health care expenses in retirement by age 65, targeted savings is $368,000 in 2017,” EBRI says. “From 2016 to 2017, projected savings targets increased between 1% and 6%. In contrast, savings targets declined between 2011 and 2014, but then increased from 2014 to 2016 as well.”

Despite the increase in savings targets since 2014, EBRI finds the 2017 savings targets continue to be lower than they were in 2012 almost across the board.

Where the costs come from

The EBRI analysis goes into some depth in explaining how these large sums add up so quickly. Important to the outcome is that the study assumes that all individuals and couples have Medigap Plan F coverage in retirement, and “thus treats all individuals and couples as having the Plan F premium as an expense,  because this approach takes away the uncertainty related to actual use of specific health care services over one’s lifetime.”

“That is, instead of trying to predict when a Medicare beneficiary may use health care services and thus incur health expenses, which are highly dependent on whether the individual has reached their Medicare Part A and/or Part B deductibles, this study assumes that beneficiaries have the most comprehensive health insurance coverage available that is supplemental to Medicare (i.e., Plan F) and thus pay premiums for this coverage on a regular basis,” EBRI explains.

This study includes estimates on out-of-pocket spending for prescription drugs based on data from the Medical Expenditure Panel Survey (MEPS). EBRI researchers highlight that it is currently possible for new Medicare beneficiaries to purchase Medigap insurance (e.g., Plan F) to completely avoid deductibles and other cost sharing associated with Medicare Parts A and B; but it is not possible to avoid the deductibles and other cost sharing associated with Part D outpatient prescription drugs. “Thus, under Part D, for expenses above the deductible, beneficiaries are responsible for 25% coinsurance on expenses between the deductible and the initial benefit limit. And once the initial benefit limit is reached, beneficiaries are in the donut hole until they reach the catastrophic limit, above which they pay 5% coinsurance. When outpatient prescription drug coverage was added to Medicare in 2006, beneficiaries in the donut hole paid 100 % coinsurance. When ACA was enacted, it included a provision to phase in a reduction in the donut hole to 25 percent coinsurance by 2020.”

The research concludes in no uncertain terms that individuals should be concerned about saving for health insurance premiums and out-of-pocket expenses in retirement. 

“Medicare generally covers only about two-thirds of the cost of health care services for Medicare beneficiaries ages 65 and older, while out-of-pocket spending accounts for 12%,” EBRI states. “Furthermore, the percentage of private-sector establishments offering retiree health benefits has been falling. This is also true in the public sector.”

Read the full report here.