Dec 23, 2025
While many in the U.S. are looking forward to a financially secure retirement, the reality is that some may not be prepared for the costs associated with serious illness that may come on in later years. But planning for such circumstances can be necessary if you want to make the most out of your golden years.
One retired journalist returned to the pages of The Wall Street Journal to explain how his meticulous retirement plans went up in smoke when his wife was diagnosed with Alzheimer’s just four years after their mutual retirement.
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“When I left The Journal and Karen retired from teaching, we were about as confident as any new retirees could be. We had our blueprint. We had our nest egg. We had our health,” Glenn Ruffenach wrote in a story published Nov. 22. (1) “All that was left was to toast our good fortune and enjoy the ride.”
However, he now spends his days caring for all his wife’s basic needs, including toileting, showering and brushing her teeth. His nights are spent worrying about what lies ahead and how long he’ll be able to care for her on his own. Right now, all costs going toward her care come out of the couple’s nest egg.
“The cost for quality care in our area starts at about $12,000 a month,” Ruffenach wrote.
With such huge expenses at hand, those who are near retirement are advised to get serious about saving for health care expenses, including funding an HSA, pricing out long-term care insurance plans and understanding how much a final illness may cost your family.
Even retirement experts make mistakes
Ruffenach has been caring for his wife Karen for six years since her diagnosis. Despite spending many years at The Journal writing about retirement and retirement planning, even writing a book on the subject, he found himself unprepared for many of the issues he now faces.
“Our experiences also have highlighted — for me, the supposed retirement expert — several lessons about retirement,” he wrote. “It’s one thing to study and write about later life; it’s quite another to live it and see things I wish I had done differently.”
Specifically, Ruffenach advised other retirees to consider the following:
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Downsizing: Ruffenach and his wife discussed moving to a small, easier-to-manage home or community where they could “age in place,” but they never got around to it. Now, her illness and his lack of free time have made it nearly impossible to consider.
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Long-term care insurance: “I think it’s critical for would-be retirees to have some kind of plan to pay for long-term care,” Ruffenach wrote, noting that he began researching the subject too late, by which time his wife no longer qualified for coverage.
Ruffenach pointed to a Department of Health and Human Services study published in 2019 that found 70% of adults who live to age 65 will need long-term services or support before they die — although it should be noted these are pre-pandemic figures.
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Today, a 65-year-old retiree can expect to spend an average of $172,500 in health care and medical expenses throughout their retirement years, according to Fidelity Investments (2). Note that figure doesn’t include long-term care, and it’s the average — a severe illness may push up costs.
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Preparing for your future health expenses
To prepare for health care expenses in old age, there are a number of steps you can take. First, try to get ahead of potential issues by getting regular physicals and keeping on top of your screening appointments. As Ruffenach noted, he worries that he missed the early signs of his wife’s condition and regrets not taking action sooner.
Next, try to boost your contributions to your IRA or 401(k) so that you have more funds for your retirement years. Many savers are also opting for an HSA, or health savings account. These funds are triple tax-advantaged: contributions are tax-free, investment growth is tax-free and withdrawals for qualified medical expenses aren’t taxed. Withdrawals for non-qualified medical expenses are taxed as income, and come with an extra 20% penalty before age 65. HSAs require a high-deductible health plan and are subject to contribution limits set by the IRS.
Retirees are also often advised to boost the cash in their emergency fund from the typical three to six months’ worth of expenses to a full year or more. This extra stash of cash is meant to cover you if the market takes a downturn and your investments are worth less than usual. An emergency fund can protect you from having to withdraw during a market slump.
Finally, be sure you understand the benefits and drawbacks of long-term care insurance, and are prepared to invest in coverage while you’re still young. You should also be familiar with your options within Medicare and Medicaid, including what’s covered and what’s not. Some Americans don’t realize these programs often don’t cover the cost of long-term care unless you are in serious financial difficulties.
Make a retirement plan that focuses on a number of potential outcomes. As Ruffenach wrote: “I recognize, of course, that life isn’t fair and that many families are grappling with circumstances far crueler than ours. That said, I can’t help but wonder about what might have been.”
Article sources
We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines.
The Wall Street Journal (1); Fidelity Investments (2)
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Rebecca Holland is dedicated to creating clear, accessible advice for readers navigating the complexities of money management, investing and financial planning. Her work has been featured in respected publications including the Financial Post, The Globe & Mail, and the Edmonton Journal.
