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What is the biggest fear in retirement? For many people, the first answer is: running out of money. That makes sense. No one wants to spend 30 or 40 years saving for retirement only to worry that the money may not last.
But according to the new Retirement Fear Index, the #1 retirement fear is even more specific, more emotional, and often more difficult to plan for:
Health care and long-term care costs.
That distinction matters.
Running out of money is a broad financial fear. It is about income, savings, investments, inflation, spending, market risk, and longevity.
Health care and long-term care fear is more personal. It is about what happens when our bodies, minds, independence, and family support systems are tested.
It is not just a spreadsheet fear.
It is a deeply human fear.
Why this fear feels so powerful
For many retirees, health care costs represent the ultimate unknown.
You may have a good retirement plan. You may have Social Security, a pension, an IRA, a 401(k), home equity, or an investment portfolio. You may feel relatively confident about your monthly budget.
Then one health event can change the entire emotional equation.
A diagnosis. A fall. A spouse needing daily care. A surprise prescription cost. A surgery. A $5,000 out-of-network bill. A move into assisted living. A family member suddenly becoming a caregiver.
This is why health care and long-term care costs rise to the top of the fear list. They threaten more than money. They threaten control, independence, dignity, family harmony, and peace of mind.
For retirees in their late 60s, this fear often arrives at a confusing time.
At age 68, many people are still active, capable, and independent. They may be traveling, gardening, helping adult children, volunteering, consulting, exercising, or caring for grandchildren. They do not necessarily feel “old.”
But they are also old enough to know that health can change quickly.
That creates a quiet tension:
“I feel fine now. But what happens later?”
That question sits underneath many retirement conversations.
How this differs from the fear of running out of money
The #2 fear — running out of money — is usually easier to talk about in financial terms.
You can model portfolio withdrawals. You can estimate Social Security. You can run Monte Carlo projections. You can adjust spending. You can review asset allocation. You can work longer, downsize, or reduce travel.
Those are not easy decisions, but they are visible planning levers.
Health care and long-term care costs are different because they combine money with vulnerability.
This fear asks harder questions:
Who will help me if I cannot fully care for myself? Can I stay in my home? Will my spouse be physically and emotionally able to help me? Will I become a burden to my children, nieces, nephews, friends, or community? What happens if I need care for many years? Will I have enough support, not just enough savings?
That is why this fear often feels bigger than the financial numbers alone.
It is the fear of losing agency.
It is the fear of needing help and not knowing where that help will come from.
It is the fear of watching retirement dreams get crowded out by care needs.
Time to tend your our retirement garden
Think about retirement health care planning like gardening.
A good gardener knows they cannot control the weather. There may be too much rain. There may be a dry spell. There may be pests, weeds, poor soil, or a surprise frost.
But a good gardener does not give up because the future is uncertain.
They prepare the soil. They choose resilient plants. They water consistently. They mulch. They prune. They notice small problems early. They build supports before the tomatoes get heavy.
That is the right mindset for health care and long-term care planning. You cannot control every future health event. But you can cultivate resilience.
You can build a stronger retirement “garden” by improving your health habits, understanding your coverage, strengthening your support network, and talking honestly with the people who may be involved in your care.
Uncertainty does not disappear. But it becomes less overwhelming when you have tended the ground.
3 practical retirement coaching tips
1. Create a personal health care reality check.
Start with what is knowable. Review your Medicare coverage, supplemental coverage, Medicare Advantage plan, prescription drug coverage, dental, vision, hearing, and out-of-pocket limits. Make sure you understand what is covered and what is not.
Then look at your personal health risks. What conditions run in your family? What medications do you take? What lifestyle habits are helping or hurting your future independence?
This is not about scaring yourself. It is about replacing vague fear with practical awareness.
A good first step: create a one-page “health care snapshot” with your doctors, medications, insurance information, emergency contacts, and current health priorities.
2. Talk about care before there is a crisis.
Many families avoid long-term care conversations until something happens.
That is understandable. These conversations can feel uncomfortable.
But waiting too long often makes everything harder.
The good news: You likely have the energy, clarity, and independence to shape the conversation on your own terms.
Ask yourself:
Where would I want to receive care if I needed help? Would I prefer to age at home, move closer to family, or consider a continuing care community? Who would be my first call in a crisis? Do they know that? Have I completed the basic legal documents: health care proxy, durable power of attorney, will or trust, and advance directive?
The goal is not to solve every future problem. The goal is to reduce confusion for the people who may one day need to help you.
3. Build your “care circle” now.
Health care planning is not only about insurance.
It is also about people.
Too many retirees wait until they need help to start building support. A stronger approach is to cultivate your care circle while you are still active.
That circle may include your spouse or partner, adult children, siblings, friends, neighbors, doctors, financial advisor, CPA, elder law attorney, care manager, faith community, local senior center, or trusted home service providers. Several retired friends have a great network of acupuncturists, massage therapist, and chiropractors to round out their healthcare team.
For solo agers or retirees without children nearby, this step is especially important.
A care circle does not mean giving up independence. It means protecting it.
Just as a gardener uses stakes, trellises, and fencing before the storm arrives, retirees can build support systems before life gets complicated.
Healthy fear can become a planning signal
The purpose of the Retirement Fear Index is not to make people more afraid.
It is to help us name the fears that are already shaping retirement decisions.
Health care and long-term care costs are the #1 fear because they touch everything: money, family, independence, dignity, housing, caregiving, and quality of life.
But fear does not have to paralyze us.
A healthy fear can become a prompt.
A reason to ask better questions. A reason to update your plan. A reason to have the family conversation. A reason to build your support system. A reason to take one practical step this week.
So here is my question: When you think about retirement, does health care and long-term care cost feel like your #1 fear?
Or is another fear even more powerful for you?
Related: 42% of Home Buyers Are Baby Boomers—Retirement Planning Enters a New Phase