We retired with a 401(K), Medicare and Social Security but my husband had a stroke, and now I’m thinking of returning to work

These expenses can quickly eat through a retirement nest egg, which is a big problem not just for the stroke survivor but also for their spouse.

Let’s pretend, for example, that Amanda and Jimmy are both 66 and they’ve been retired for a year. They have a 401(k), Social Security, and Medicare coverage, but now that Jimmy has expensive care needs, Amanda isn’t sure they can cover everything.

She’s thinking of going back to work, but does she have to?

What are the costs they’re looking at?

Before Amanda and Jimmy make any big decisions, it’s important to look at the actual costs they’re facing.

Medicare will cover the costs of rehabilitation, as well as durable medical equipment like a walker or a wheelchair. However, long-term custodial care isn’t generally covered at all. So, if Jimmy needs a nurse to come to the house to help him perform basic life tasks, the costs must come out of the couple’s retirement funds.

With aforementioned estimated costs of $77,792 per year, Amanda and Jimmy are looking at paying almost $6,500 per month, not including any equipment or home adaptations.

“There’s a lot of medical expense that comes along with just retrofitting your house, not to mention the extra nursing care and vehicle conversions to allow for wheelchair access, depending on the severity of the stroke,” Christopher Walsh, a financial advisor at Capital Choice Financial Group, told Moneywise.

Even with a 401(k) and Social Security, most retirees really can’t afford to just shoulder that burden.

What will working do to their Social Security?

With bills piling up, Amanda may feel like returning to work is the best move. But there’s something she must consider first. Since she hasn’t yet reached full retirement age for Social Security (which is 67 based on her 1960 birth year), going back to work may come at a cost.

“If your earnings are above $24,480 in 2026, Social Security will withhold $1 of benefits for every $2 earned above $24,480,” Domenick D’Andrea, founder of DanDarah Wealth Management, told Moneywise.

This is the rule if you won’t reach FRA all year. In the year you’ll reach full retirement age, you can earn $65,160, and once you reach FRA, you can work as much as you want.

Eventually, the money you forfeited comes back. “The federal government withholds some of your Social Security benefit for a time and then brings it back to you as a bigger monthly check once you reach full retirement age,” said Walsh. But that won’t do the couple any good now, since Amanda’s return to work will cost them income elsewhere.

And that’s not the only reason a return to work could be costly. “You also need to look at the Medicare earnings threshold, because with an increase in income you could end up paying a higher Medicare monthly premium,” D’Andrea warned.

Consider working vs. caregiving responsibilities

It’s also worth considering whether caregiving costs would go up if Amanda does return to work. Amanda might not be capable of providing all the care Jimmy needs, but she’d inevitably end up doing less if she was out of the house at work all day.

“If you need to hire a caregiver while you are at work, are you making more than enough to cover those costs?” D’Andrea said.

He also pointed out that if the caregiver takes time off, or doesn’t show up for some reason, Amanda might have to call out from her job. This could make earning enough to justify the costs of the extra care even more difficult.