Most baby boomers haven’t saved enough to live even a modest, middle-income lifestyle after work ends [1,2]. Unexpected post-retirement expenses can quickly overwhelm resources – especially medical expenses.
“Maintenance” medication expenses often take retirees by surprise as they transition to Medicare. Many don’t realize that Medicare has its own costs and, unlike private insurance, it has NO caps on most out of pocket expense. Even with supplementary insurance, some medical expenses never really go way – especially for drugs.
Typical maintenance medications are designed to treat diseases of lifestyle – illnesses that are heavily associated with the nutritional and exercise choices we make earlier in life. Baby boomers (including this writer) grew up in a pro-obesity, pro-diabetes, pro-cancer, pro-dementia, pro-atherosclerotic haze of misinformation and heavily processed food.
The consequences can be huge.
A Georgetown University study showed that 75 percent of adults ages 50-64 fill an average 13 prescriptions per year, rising to 20 per year for ages 65-79. Chronic disease patients fill a lot more (examples, across all age groups, include 34 prescriptions for diabetes and 30 for heart disease) .
The same study also showed that we pay more prescription costs out of pocket as we age – adults ages 65-79 pay 56 percent on their own costs and this rises to 67 percent by age 80.
And those percentages assume Medicare drug benefits are in force. The dollars alone strongly argue for diet and lifestyle changes.
Medicare Wasn’t Meant to Cover Everything
Whole books have been written about Medicare. Websites like Medicare.gov and CMS.gov (Centers for Medicare and Medicaid) have thousands of pages of information that is beyond the scope of this post. I’m just going to touch on some highlights which are current for 2019.
While Medicare is a valuable public program assisting millions, it is only partial coverage. There are startling out-of-pocket leftovers.
Medicare Part A (hospital)
$1341 deductible, per illness. $341 copay per day after 60 days, then $682 per day after 90 days .
Medicare Part B (outpatient)
After your annual deductible you pay 20% of all costs…forever. There is no cap .
Medicare Part D (drugs)
This is the hardest to nail down since most benefits are dictated by the private insurer you select.
The maximum annual deductible is $415 , but then cost sharing can vary . Once your plan has paid $3,820 in benefits you enter the “coverage gap” and can pay:
- Generic copay: 37% (no cap)
- Brand name copay: 25% (no cap)
Catastrophic level: These coverage gaps are in place until you’ve paid $5,100 . AFTER $5,100.00 of “eligible expenses” are paid in the plan year, coverage reverts to low copay but, again, without any cap .
Then there’s the question of whether your drug is on the plan formulary (list of approved drugs)? If so, does it get favorable “low tier” reimbursement? Some drugs don’t get full coverage, or any coverage.
The coverage gap is supposed to “close” in 2020 – but the current legislative trend is not pro-retiree, or even pro-consumer. Scheduled Medicare changes in the Affordable Care Act, designed to help retirees could be modified, delayed or even reversed by the current administration.
Will drug costs delay your retirement?
This glimpse of Medicare’s out of pocket expenses can be quite sobering the first (or even the 100th) time you see the big picture – especially if you retire on a modest budget while taking several prescriptions.
If you’re currently still working, you may be on generous group or individual health insurance through your job and not really notice your drug costs. But at some point, most of us lose our pre-retirement insurance plans and have to scramble for some combination of Medicare and supplementary coverage.
There is no guarantee that your medication(s) – or other medical treatment – will be covered the same way as before retirement.
Will you be part of the group that simply can’t retire due to drug costs? A 2018 Consumer Reports survey reviewed during a Senate Special Committee hearing on Aging in 2019, showed 12 percent of respondents delayed retirement specifically due to prescription costs .
Another survey showed that many older adults, especially in median income households, either delay or simply choose not to receive needed medical care due to cost .
Not surprisingly, unanticipated medical expenses are a leading cause of bankruptcy, especially for retirees .
There’s even a case of a retiree who robbed banks to pay for his medications !
But are your medications (or your nursing home stay) really necessary?
Conservative financial advice recommends saving $275,000 to $500,000 just for out of pocket medical expenses in retirement. Yet, a large percentage of baby boomers haven’t even saved that much to live on.
These households simply can’t pay high medical costs on top of normal living expenses. This is especially true long-term facility care, which is not covered beyond 60 days by Medicare or any Medicare supplementary insurance.
Absent from most “conservative financial advice” is the idea that many of us can make lifestyle changes that could minimize or prevent future medical expenses.
Please reread that sentence.
The widespread availability of inexpensive, unhealthy food has led to a current “global pandemic of obesity and chronic diseases” that afflict many retirees including metabolic syndrome, diabetes, atherosclerosis, cancer, Alzheimer’s and other dementia . These conditions account for a large percentage of medication use (and drug-intensive nursing home admissions.)
Our lifetime of “harmless” habits (including pancakes, donuts, bagels, PBJ, chips, cookies, crackers, toast, breakfast cereal, fried or processed food, sugar, corn syrup, questionable food additives, and pesticides) is closely linked to numerous chronic diseases—and related treatment costs [13,14,15].
While pre-retirees might find it inconvenient or challenging to make significant dietary changes, modest-to-median income households may wish they had done so much earlier.
Saying NO to Permanent Patient status
A naturally low-carbohydrate, nutrient-dense, whole food diet—like the Paleo Diet®—is an important step in the journey away from “lifestyle” chronic disease. Many Paleo adherents, including this writer, report improved health as well as weight loss and improved energy. All of which can reduce medication usage.
Some examples include:
Diabetes: in one study, a Paleo Diet dramatically outperformed the recommended American Diabetes Association diet with respect to glucose control and lipid profiles .
Heart health: numerous studies, including this one, demonstrate that Paleo dieting offers strong control of hyperlipidemia compared to “traditional grain-based, heart-healthy diet recommendations” .
Alzheimer’s: a growing body of research shows that Paleo- (or even ketogenic-) style dieting is can arrest or even reverse cognitive decline. .
Coupled with regular exercise , a dedicated Paleo Diet can strongly massage health outcomes in your favor.
To understand what this can mean in potential medical cost savings, here’s one example. Alzheimer’s patients survive, on average, 3-11 years after diagnosis . Full-blown care in a nursing facility, based on 2018 figures, averages $100,380 per year . This means that healthy lifestyle changes have the potential to save $301,140 to $1,104,180. Only some of which would have been covered by Medicare.
While no diet alone can guarantee you’ll never get sick, responsible lifestyle choices now – even if you’re already retired and on maintenance medications – can improve your well-being and protect your bank account.
- Backman, Maurie. “Baby Boomers Are Overwhelmingly at Risk of Falling Short in Retirement -.” The Motley Fool, 30 Dec. 2018, https://www.fool.com/retirement/2018/12/30/baby-boomers-are-overwhelmingly-at-risk-of-falling.aspx.
- Nova, Annie. One-Third of Baby Boomers Had Nothing Saved for Retirement at Age 58. 7 Nov. 2018, https://www.cnbc.com/2018/11/07/one-third-of-baby-boomers-had-nothing-saved-for-retirement-at-age-58-.html
- Inpatient Hospital Care Coverage. https://www.medicare.gov/coverage/inpatient-hospital-care.
- Part B Costs | Medicare. https://www.medicare.gov/your-medicare-costs/part-b-costs.
- Yearly Deductible for Drug Plans | Medicare. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/yearly-deductible-for-drug-plans.
- Copayment/Coinsurance in Drug Plans | Medicare. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/copaymentcoinsurance-in-drug-plans.
- Costs in the Coverage Gap | Medicare. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap.
- “2019 Changes to Medicare Part D Coverage | Simplefill Prescription Assistance.” Simple Fill | Prescription Assistance, RX Assistance, Astrazeneca Patient Assistance – Portland, OR, 9 Oct. 2018, https://simplefill.com/heres-need-know-2019-changes-medicare-part-d-coverage/.
- Bowers, Lois. “Survey Finds That 12% Delay Retirement Due to Drug Costs, Senate Aging Committee Hears – News.” McKnight’s Senior Living, 8 Mar. 2019, https://www.mcknightsseniorliving.com/home/news/survey-finds-that-12-delay-retirement-due-to-drug-costs-senate-aging-committee-hears/.
- Bowers, Lois. “Healthcare Costs Worry Older Adults across Income Levels – News.” McKnight’s Senior Living, 3 Apr. 2019, https://www.mcknightsseniorliving.com/home/news/healthcare-costs-worry-older-adults-across-income-levels/.
- Brockman, Katie. “More Retirees Than Ever Are Filing for Bankruptcy — Here’s Why -.” The Motley Fool, 16 Dec. 2017, https://www.fool.com/retirement/2017/12/16/more-retirees-than-ever-are-filing-for-bankruptcy.aspx.
- Mozaffarian, Dariush, et al. “Role of Government Policy in Nutrition—Barriers to and Opportunities for Healthier Eating.” BMJ, vol. 361, June 2018, p. k2426. www.bmj.com, doi:10.1136/bmj.k2426.
- Thorn , Eric, M. D. “Carbohydrates Are Killing Us.” The Washington Times, https://www.washingtontimes.com/news/2018/jul/8/fatty-foods-dont-cause-heart-disease-bread-and-pas/. Accessed 4 Apr. 2019.
- Livesey, Geoffrey, and Helen Livesey. “Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-Analyses of Prospective Cohort Studies.” Mayo Clinic Proceedings: Innovations, Quality & Outcomes, vol. 3, no. 1, Feb. 2019, pp. 52–69. PubMed Central, doi:10.1016/j.mayocpiqo.2018.12.007.
- Khazan, Olga. “The Startling Link Between Sugar and Alzheimer’s.” The Atlantic, 26 Jan. 2018, https://www.theatlantic.com/health/archive/2018/01/the-startling-link-between-sugar-and-alzheimers/551528/.
- Masharani, U., et al. “Metabolic and Physiologic Effects from Consuming a Hunter-Gatherer (Paleolithic)-Type Diet in Type 2 Diabetes.” European Journal of Clinical Nutrition, vol. 69, no. 8, Aug. 2015, pp. 944–48. www.nature.com, doi:10.1038/ejcn.2015.39.
- Pastore, Robert L., et al. “Paleolithic Nutrition Improves Plasma Lipid Concentrations of Hypercholesterolemic Adults to a Greater Extent than Traditional Heart-Healthy Dietary Recommendations.” Nutrition Research (New York, N.Y.), vol. 35, no. 6, June 2015, pp. 474–79. PubMed, doi:10.1016/j.nutres.2015.05.002.
- Bredesen, Dale E. “Reversal of Cognitive Decline: A Novel Therapeutic Program.” Aging, vol. 6, no. 9, Sept. 2014, pp. 707–17. PubMed, doi:10.18632/aging.100690.
- Booth, Frank W., et al. “Lack of Exercise Is a Major Cause of Chronic Diseases.” Comprehensive Physiology, vol. 2, no. 2, Apr. 2012, pp. 1143–211. PubMed Central, doi:10.1002/cphy.c110025
- EndPlay. “Utah Man Robbed Bank Because He Could Not Afford Medications, Police Say.” WSOC, 8 June 2019, https://www.wsoctv.com/news/trending-now/utah-man-robbed-bank-because-he-could-not-afford-medications-police-say/956430486.
- “Prescription Drugs.” Health Policy Institute, https://hpi.georgetown.edu/rxdrugs/
- “What to Know about the Stages of Alzheimer’s.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448.
- Cost of Long Term Care by State | 2018 Cost of Care Report | Genworth. https://www.genworth.com/aging-and-you/finances/cost-of-care.html.