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Seniors often face higher health care costs than they planned for, even those with Medicare insurance. But managing medical expenses can be a bigger financial burden for those who live alone.
Why? Absent a second income — and physical support from a spouse or partner — single retirees may:
- Lack the economies of scale that are derived from shared expenses.
- Allocate a larger percentage of their retirement income to health care costs.
- Rely more heavily on paid long-term care services.
“For single retirees, the challenge is not just that health care costs tend to rise with age,” said Duston Ladieu, a wealth management advisor with Synergy Private Wealth in Wellesley, Massachusetts. “It’s that there is no second income to help absorb those increases.”
Planning ahead for potentially higher future health care costs can help solo seniors protect their financial security and independence as they age.
Solo agers are more vulnerable to illness and injury
According to an analysis of 2023 government data by KFF Health News (KFF), roughly 28 percent of Americans age 65 and older live alone, a stark increase from about 10 percent in 1950.1
For these individuals, the need for retirement savings is often greater. KFF found that nearly 40 percent have significant health complications, including vision and hearing loss, difficulty caring for themselves, and cognitive or physical decline.
Solo agers are also more vulnerable to depression due to social isolation, as well as injuries due to falls late in life.2
If help at home isn’t available when needed — with post-surgical recovery, managing symptoms, and maintaining proper nutrition — being alone can magnify these difficulties and contribute to worsening health, which may result in a higher frequency of hospitalizations.
Single seniors pay relatively more for health care
Even for those with Medicare, the federal health insurance program for eligible Americans aged 65 or older and individuals with certain disabilities, health care costs can consume a significant portion of their retirement income.
According to Fidelity Investments, a 65-year-old who retired in 2025 can expect to spend roughly $172,500 on out-of-pocket health care costs during retirement. That includes co-pays and deductibles, unreimbursed prescription drug costs, and premiums for Medicare Part B and Part D. It does not include long-term care (LTC) services.3 (Related: Medicare pitfalls in retirement)
Other research indicates that the median retiree spends roughly 29 percent of their Social Security benefit and 22 percent of their total income on out-of-pocket medical spending, not including LTC.4
When you're managing a household alone, however, you lack the economies of scale that may benefit your married peers. You can't pool resources for medical bills, or split the cost of internet for telehealth appointments, home modifications for aging in place, or transportation to medical facilities.
Thus, medical costs can consume a larger percentage of a single senior's monthly income.
Singles may be more likely to need assisted living services
Single seniors who do not have an informal support network nearby may also experience higher caregiving costs in their twilight years when the need for assisted living services becomes greater.5
According to the American Association for Long-Term Care Insurance, 51 percent of unmarried people over age 65 require paid long-term care during their lifetimes versus 43 percent of married people.6
The national median cost for assisted living services is $6,200 per month, while the median monthly cost of a private room at a nursing home is $10,798.7
“If you have a spouse or partner, they can often provide some level of care in the early stages of a health event,” said Andrew Klein, a managing partner with LWS Financial in New York. “They help with recovery, with logistics, and with day-to-day needs. A single person may not have that. So, the need to pay for professional care tends to be more immediate and more certain.”
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Medicare income-related surcharges hit harder
Another reason single seniors may pay more for health care? Medicare's Income-Related Monthly Adjustment Amount (IRMAA).
This surcharge, which is determined by your income tax returns for the prior two years, is added to Medicare Part B and Part D premiums. Unbeknownst to some, it uses different thresholds for singles versus couples.
In 2026, IRMAA surcharges kick in at $109,000 for single filers, and $218,000 for married couples filing jointly. Thus, singles can potentially hit higher premium tiers with less household income.
Single women often have higher health care costs
It bears noting, too, that higher health care costs during retirement disproportionately affect women, who live an average of five years longer than men and are far more likely to need paid care during their twilight years.
Consumer Affairs reports that older women account for approximately 70 percent of all residents in assisted living facilities as of 2026.8
According to the Milliman research group, women spend an average of about $38,000 more than men on health care costs as they age.
- A healthy 65-year-old male who retired in 2025 and lives to age 88 is projected to spend approximately $275,000 on health care expenses during his retirement.
- A healthy 65-year-old female who retired in 2025 and lives to age 90 is projected to spend approximately $313,000 on health care expenses during her retirement.
Women also typically collect smaller Social Security benefits than men due to lower lifetime earnings, which is often attributed to the gender pay gap and more time out of the workforce for caregiving responsibilities. The average monthly Social Security benefit for women is approximately 25 percent less than men's.9
The net result is that women often face higher lifetime health care costs with lower lifetime income.
What you can do to help save for health care costs in retirement
Those who are on course to retire single can help provide for their future health care costs in a number of ways:
- As a pre-retiree, they should run projections with higher-than-expected health care spending during retirement to reveal savings gaps early, when there is still time to make changes to their savings strategy, Ladieu suggests.
- Those who are eligible should also consider funding a health savings account (HSA) at work to help pay for medical costs in retirement, said Klein. An HSA is a pre-tax savings account that must be paired with a qualified high-deductible health insurance plan. You need not deplete your HSA at the end of the year. Your savings are allowed to accumulate. In many cases, you can also invest a portion of your contributions in an investment portfolio to pursue growth. Once you turn age 65, those savings and earnings can be used tax free to pay for qualified medical expenses. (Learn more: What is a health savings account (HSA) and what are its tax benefits?)
“An HSA is one of the most underrated retirement tools out there,” said Klein. “It is the only account in the tax code that gives you a deduction going in, tax-free growth, and tax-free withdrawals, as long as the money is used for qualified medical expenses. For a single retiree who will bear 100 percent of their health care costs, that is an incredibly valuable bucket to have. It is a real planning advantage.”
- As they begin converting their assets into income during retirement, singles can potentially stretch their savings further by focusing on tax-efficient withdrawals. Financial professionals generally recommend retirees tap their taxable brokerage accounts first, giving their tax-deferred accounts the chance to continue delivering compound growth longer. Withdrawals from brokerage accounts are taxed at your ordinary income tax rate, which may be temporarily lower in the early years of retirement before Social Security and required minimum distributions kick in. That may may help minimize your tax liability. Next, draw from your pre-tax retirement accounts such as your 401(k) and traditional IRA. Then move on to your tax-free accounts, including your Roth IRA and HSA, which are not subject to required minimum distributions. It is important to consult a tax expert for guidance before making decisions about your withdrawal strategy. (Learn more: Reducing taxes in retirement)
“A lot of retirees walk into their 60s having done everything they were told,” said Klein. “They maxed out their 401(k) for 30 years. They followed the rules. And then they realize that most of their wealth is sitting in pre-tax accounts that are going to be taxed as ordinary income at exactly the moment they start drawing it down. For a single person with no spouse to share expenses, that can be a real problem. The tax bite hits harder when it hits one income.” (Learn more: 7 ways to increase your retirement income — without saving more)
- Maximizing their Social Security benefit. By waiting until your full retirement age (67) to claim Social Security benefits, you will collect the full amount to which you are entitled. You can permanently increase your Social Security income further still by delaying benefits even longer. Your Social Security income check will increase by 8 percent per year for each year you delay benefits after your full retirement age until you reach age 70, when delayed credits cease to accrue.
- Utilizing community-based support services may help seniors reduce their expenses as they age. Religious organizations and local nonprofits are often available to assist with things like transportation to doctors, meal programs, in-home assistance, and social and wellness programs. By utilizing the volunteer programs that exist, they may be able to delay the need for more expensive care options and liberate more of their income for medical costs.
- Considering long-term care coverage. For many of his clients, Klein said the cost of traditional LTC insurance coverage can be a “tough pill to swallow,” given the fact that it may be a use-it-or-lose-it expense. But there are hybrid protection products that can potentially help pay for a portion of assisted living services as needed. “More often, I find myself gravitating toward hybrid life insurance and LTC products,” he said. “If eligible, you get permanent life insurance with an LTC benefit built in. If you need care, the benefit is there. If you never do, the death benefit passes to your beneficiaries. Either way, something comes back. That feels more like a balance sheet asset and less like an expense, which is how I prefer to think about these tools.”
Like Klein, Ladieu said solo pre-retirees who are more likely to require paid assisted living services as they age should discuss their insurance needs with a financial professional.
“These products aren’t one‑size‑fits‑all,” he said. “There are factors like overall assets, income stability, health history, and personal preferences that you will take into account with your financial professional.”
Conclusion
Single seniors face the prospect of higher health care expenses as they age. By working closely with a financial professional, however, they can help reduce their exposure to risk.
Strategies that may help protect their financial security include running realistic financial projections, maximizing their Social Security benefit, making tax-efficient withdrawals, and researching community support services.
“The goal is not to predict every future expense, but to reduce the risk that health care costs will crowd out other essential spending later in retirement,” said Ladieu.
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Frequently asked questions about health care costs for singles
Q: Why do single retirees pay more for health care?
A: Single retirees often pay more because they do not have a spouse to share premium costs, split household living expenses, or provide informal caregiving at home. Without this built-in support system, singles are more likely to need paid professional care or assisted living services earlier in retirement.
Q: Does Medicare cost more if you are single?
A: It can. Medicare Part B and Part D premiums are subject to the Income-Related Monthly Adjustment Amount (IRMAA) surcharge. Because the income thresholds for these surcharges are lower for single filers than for married couples, single retirees may hit higher premium tiers with less total household income.
Q: What is the best way for singles to save for medical costs?
A: One potentially effective strategy is to utilize a Health Savings Account (HSA) if you are eligible. HSAs offer a triple tax advantage: contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free, making them an ideal tool for solo agers building a health care reserve.
Discover more from MassMutual…
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1 KFF Health News, “Historic Numbers of Americans Live by Themselves as They Age,” Sept. 17, 2024. 2 Preventive Medicine Reports, “Associations between living alone, depression, and falls among community-dwelling older adults in the US,” December 2020. 3 Fidelity, “Fidelity Investments® Releases 2025 Retiree Health Care Cost Estimate, a Timely Reminder for All Generations to Begin Planning,” July 30, 2025. 4 Center for Retirement Research at Boston College, “How Much Does Health Spending Eat Away at Retirees’ Income? An Update,” Feb. 3, 2026. 5 National Center for Health Statistics, “Life Expectancy,” Feb. 5, 2026. 6 American Association for Long-Term Care Insurance, “Who is Likely to Need Paid Long-Term Care?” July 2024. 7 CareScout, “CareScout Releases 2025 Cost of Care Survey Results,” March 2, 2026. 8 Consumer Affairs, “Assisted living statistics,” Jan. 25, 2024. 9 Yahoo! Finance, “Here’s the Average Social Security Check for Men vs. Women,” March 12, 2025.
