Health is the variable that can reorder a plan faster than markets ever will. What coverage costs before and after 65, how Medicare surcharges are triggered, and how to plan for care without either ignoring it or being sold something.
If you stop working before 65, you're buying coverage in the individual market with no employer subsidy, at an age when it costs the most. That period is frequently the single largest line in an early retirement plan, and it's also where the plan interacts with tax decisions, because the income you report affects what the coverage costs. The real number tends to be larger than assumed.
Medicare covers a great deal and is not comprehensive. It doesn't cover most dental, vision, or hearing, and critically it does not cover extended custodial care, which is the expense most likely to be large. Supplemental coverage closes some of the gap. It doesn't close that one.
Medicare premiums are income-based, and the income they look at is from two years earlier. That single detail turns it from a bill into a planning problem: a Roth conversion, a business sale, or a large realized gain in one year raises premiums two years later, and the increases arrive as cliffs rather than a gradual slope. The jumps matter more than the amounts, and there is an appeal process most people don't know exists.
It's the largest uninsured risk on most large balance sheets, and the one families are worst at discussing. Self-funding genuinely works for some households and is a poor decision for others, and the calculation isn't only about whether you could write the checks. It's about what happens to the surviving spouse, and who ends up managing the care.
Hybrid policies changed the decision meaningfully by removing the use-it-or-lose-it objection to traditional coverage. The options and the tradeoffs are worth walking through before you need them, because pricing and eligibility both move with age and health.
Healthcare sits inside a broader question about what your insurance actually covers now that your balance sheet has grown. Liability limits set years ago, disability coverage that replaces a fraction of current income, and life insurance that was bought for a purpose that no longer applies. Coverage tends to lag net worth by several years.
None of this is medical or insurance advice for your circumstances. If you'd like help sizing these costs inside your own plan, we're happy to work through it with you.
