How healthcare needs shape retirement and estate planning

On the topic of longevity, baseball great Mickey Mantle once quipped: "If I knew I was going to live this long, I'd have taken better care of myself."

Of course, the Mick was referring to his health as opposed to his finances, but the sentiment still applies as healthcare can have a huge ripple effect on estate and legacy planning, especially later in life. Retirees need to make decisions about specialized plans, life insurance, and even where to buy real estate for access to top-notch medical systems.

And it’s more than a simple matter of money. Advisors say even affluent families face meaningful risks around long-term care expenditures, medical inflation, and the possibility of multiyear chronic-care scenarios that require layered support.

Eugenia Amador, director of estate services at EP Wealth Advisors, for one, says healthcare is a critical dimension of estate planning for high-net-worth retirees because longevity, rising care costs, and increasing complexity of medical needs can materially influence how wealth is preserved and ultimately transferred. Integrating healthcare planning into estate planning ensures that retirees maintain autonomy and comfort while also safeguarding the legacy they intend to pass on.

Proactive planning may include modeling long-term care costs, establishing tax-efficient funding vehicles, such as Health Savings Accounts or irrevocable trusts designed to protect assets from future care expenses, and aligning powers of attorney and advance directives with the family’s broader estate goals.

“When healthcare contingencies are thoughtfully addressed, clients can gain confidence that current and future medical needs will not compromise their ability to provide for heirs, philanthropy, or other legacy priorities,” Amador said.

In Amador’s view, advisors should frame discussions around “life-first” planning. This means building cash-flow strategies that support today’s lifestyle and healthcare needs without neglecting trusts, gifting strategies, and tax-efficient investment approaches to preserve wealth for future generations.

“Scenario and stress testing are invaluable here. Advisors should prepare adaptable plans for sudden healthcare events or shifting market conditions. Planning ahead for the worst- and best-case scenarios empowers clients to make intentional decisions. The goal is to avoid underspending out of fear or overspending due to a lack of planning,” Amador said.

Elsewhere, Griffin Geisler, vice president and wealth strategist at RBC Wealth Management-US, highlights long term care as an area where even HNW clients can see a significant amount of their assets exposed to risk. These assets that had been earmarked in their plan to legacy could now have to be depleted to fund long term care expenses, derailing their well-intentioned plans. 

Another area to consider is health insurance and Medicare decisions at retirement. This is often the one chance clients have to make irrevocable decisions related to Medicare supplement plans and paths to health insurance coverage, according to Geisler.

“Often clients focus on short term financial benefits of cheaper policies rather than the long-term risk of having difficulty in changing that coverage later when health issues begin to emerge and out-of-pocket costs increase. Often then it can be too late to make changes. This can impact longevity, quality of care, relocation flexibility, and ultimately the preservation of estate assets,” Geisler said, adding that the balance between short term lifestyle and long-term planning should really begin with a “client values conversation.”