Vanguard Releases New Model For Estimating Healthcare Costs In Retirement

New research provides framework to plan for health and long-term care expenses

VALLEY FORGE, PA (June 19, 2018)—Vanguard today announced a new framework, jointly developed with Mercer, that helps pre-retirees and retirees better understand the financial planning implications of annual health care costs and long-term care expenses. The comprehensive research paper, Planning for healthcare costs in retirement, outlines key health care cost factors and personal considerations, as well as frames health care expenses as an annual cost rather than a lifetime lump sum. Vanguard believes framing healthcare costs in this constructive and familiar way helps investors better understand total annual expenditures and plan accordingly during their retirement years.

“Most analyses available in the marketplace today point to a daunting out-of-pocket healthcare expense over the lifetime of a retiree. These large dollar values can be demotivating for investors from a psychological and behavioral perspective,” Jean Young, co-author and senior research associate in the Vanguard Center for Investor Research, said. “Instead, our model focuses on the more manageable task of planning for incremental, annual healthcare costs, while separately considering and integrating the potential for long-term care expenses.”

Understanding what impacts healthcare costs

Based on the joint analysis, Vanguard recommends several important changes to the way healthcare costs are typically discussed and modeled, and recommends that investors focus on five key areas: health care cost factors, replacement ratios, annual cost framing, substitution effects, and long-term care.

One of the most impactful inputs in understanding potential costs is the volume of healthcare services a person may consume in retirement, which can be estimated based on pre-existing chronic conditions and family health history. Another significant influencer on out-of-pocket healthcare costs is the type of Medicare coverage that a retiree selects, and whether their income dictates additional surcharges. Individuals retiring before age 65 will need to have a financial strategy to bridge their healthcare coverage until Medicare eligibility begins.

“The model we have developed with Vanguard has enabled us to take a fresh look at existing industry data, complement it with new findings, and build a forecasting model that more clearly identifies variations in the estimated annual healthcare costs expected in retirement,” Derek Guyton, Partner, in Mercer’s Health business, said. “We think this flexible, actionable approach to healthcare cost framing can lead to better planning and better outcomes for retirees.”

Planning for incremental healthcare costs in retirement

Due to the variations in a person’s life and health status year over year, the research encourages investors to focus on factors they can control and plan accordingly using the following guidelines:

  • Understand costs. Individuals should understand how their health status and other personal factors might affect their annual health care costs. Coverage choices should be informed by health status, retirement age, and income.
  • Understand employer subsidies. Individuals should understand the difference in the health coverage cost they pay now with the help of any employer subsidies, and what they will have to spend in retirement. Having a clear picture can help avoid potential “sticker shock” and better prepare retirees for their out-of-pocket healthcare expenses.
  • Target higher replacement ratios. Some retirement savers may encounter a large incremental change in health care costs when they retire due to the loss of generous employer subsidies or declining health, and may want to save at higher rates now to offset these factors in the future.
  • Consider health savings accounts. Health savings accounts can be used as a means to save, in a highly tax-efficient manner, for unforeseen healthcare expenses in retirement. Investors can save in these accounts today, and reduce the impact of future health care costs by having earmarked tax-free savings.
  • Weigh Medicare enrollment options carefully and revisit annually. Decisions involving the choice between traditional Medicare coverage only, traditional Medicare with a supplement, or Medicare Advantage depend on each retiree’s needs and circumstances. Retirees should assess their situation each year and make adjustments accordingly. However, the opportunity to adjust may be limited.

The great unknown: Taking charge of long-term care planning

Long-term care costs represent a separate planning challenge given the wide distribution of potential outcomes. Half of individuals will incur no long-term care costs—but 15% could incur expenses exceeding $250,000.1 Even if the probability is low, Vanguard encourages retirees to confront the possibility of an extended, expensive long-term care stay, given the magnitude of the potential cost.

Retirees should first consider unpaid care options such as family support and acceptable types of paid care, as well as Medicaid rules should resources be depleted. Funding for long-term care expenses can take many forms, with the biggest resource being private, out-of-pocket spending. In building a framework for retirement, individuals should have assets that serve as a source of annual income, as well as a contingency reserve to cover long-term care costs or other unexpected expenses. Additional considerations can include home equity, and income annuities for surviving family members.


About Vanguard

Vanguard is one of the world’s largest investment management companies. As of May 31, 2018, Vanguard managed more than $5.0 trillion in global assets. The firm, headquartered in Valley Forge, Pennsylvania, offers 397 funds to its more than 20 million investors worldwide. For more information, visit

About Mercer

Mercer delivers advice and technology-driven solutions that help organizations meet the health, wealth and career needs of a changing workforce. Mercer’s more than 23,000 employees are based in 44 countries and the firm operates in over 130 countries. Mercer is a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC), the leading global professional services firm in the areas of risk, strategy and people. With nearly 65,000 colleagues and annual revenue over $14 billion, through its market-leading companies including Marsh, Guy Carpenter and Oliver Wyman, Marsh & McLennan helps clients navigate an increasingly dynamic and complex environment. For more information, visit Follow Mercer on Twitter @Mercer.

1Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief, Long-Term Services and Supports for Older Americans: Risks and Financing, ASPE Research Brief, revised February 2016, Table 5.

The health care cost forecasting model provides likelihoods of estimated lifetime and annual health care costs expected in retirement, in addition to estimates of long-term care costs. It relies on numerous assumptions and underlying data sources. All estimates are based on the information available at a point in time and are subject to unforeseen and random events. Therefore, any projection must be interpreted as having a likely range of variability from the estimate. Mercer built this model exclusively for Vanguard. Mercer is not responsible for use of this model by any other parties.

The Vanguard Group, Inc. and its affiliates do not make recommendations to purchase insurance policies or products, including health care or long term care policies.