New Update: Healthcare Costs Increasing by Over 60% in Some States. Will you be impacted?

Charting Hidden Medical Costs: Essential Insights for NiSource Employees

“For NiSource employees approaching retirement, proactively incorporating a 10–15% buffer for less-obvious medical expenses—such as prescription gaps, out-of-network care, and concierge fees—can help preserve long-term financial stability.”– Wesley Boudreaux, a representative of The Retirement Group, a division of Wealth Enhancement.

“NiSource employees can strengthen their retirement preparedness by using health savings accounts, annual supplemental plan reviews, and strategic budgeting to cover prescription, out-of-network, and concierge medicine costs.”– Patrick Ray, senior financial advisor at The Retirement Group, a division of Wealth Enhancement.

In this article we will discuss:

The rising costs of prescription drugs
Challenges of care accessibility in secondary homes
The impact of concierge medicine memberships

Among the biggest and most erratic retirement expenses are health care expenditures. For NiSource employees approaching or in retirement, these costs can pose unique planning challenges. According to Fidelity Investments, a retired couple will spend about $330,000 on health care during their retirement—or $165,000 per individual. ¹ However, this estimate frequently ignores a number of important spending categories that can raise lifetime medical costs by tens of thousands of dollars.

Costs of Prescription Drugs

Although many prescription drugs are covered by Medicare Part D, out-of-pocket costs can mount quickly for NiSource retirees. Known as “donut holes,” coverage gaps could expose beneficiaries to the full cost of specific therapies. Without complete insurance, specialty drugs—especially those used to treat long-term illnesses like multiple sclerosis or rheumatoid arthritis—can cost more than $5,000 a month. ² Depending on formulary tiers and supplementary plan designs, seniors who take multiple prescriptions may have annual drug expenses ranging from $2,000 to over $10,000. ³

Care Accessibility in Secondary Homes

Medicare Advantage plans sometimes limit coverage to a single geographic service region, yet many NiSource retirees divide their time between primary and seasonal residences. If a retiree spends summers near family in another state or winters in warmer locations, their plan’s provider networks may not cross state lines. Regular specialists or emergency services rendered outside the network may therefore be charged at full fees—often thousands of dollars per incident. A single out-of-network emergency department visit, for instance, may cost more than $2,500 before any insurance reimbursement. ⁴

Memberships for Concierge Medicine

Over the past five years, seniors seeking quick access to doctors have increased their use of concierge medicine. Depending on the degree of access and services offered, annual fees for these individualized practices average between $2,000 to $5,000 per person. ⁵ Concierge care can improve continuity and reduce wait times, but neither Medicare nor most employer-sponsored retiree plans cover these fees, making them an extra ongoing cost that may need to be factored into a retirement budget.

The Value of Thorough Planning

According to Wealth Enhancement senior financial advisor Patrick Ray, “standard retirement forecasts often fail to capture the cumulative impact of these less-visible costs.” He notes that patients often show astonishment when their medical expenses surpass initial estimates by as much as 15% to 20%. NiSource staff can reduce the risk of early asset depletion by building a cautious buffer into long-term income strategies—adding 10% to 15% to expected yearly medical expenses.

Techniques for Mitigating Risk

To help maintain financial stability in retirement, NiSource employees should:

Compare Supplemental Plans Every Year: Review Medicare Supplement (Medigap) products and Part D formularies each autumn to obtain the best coverage and costs.
Use Health Savings Accounts (HSAs): If you have an HSA balance upon retiring, these tax-advantaged funds can cover qualified medical expenses—including premiums for long-term care insurance—tax-free.
Plan for Travel-Related Care: Consider multi-state or national network plans, such as certain Medicare Advantage PPO options, to keep out-of-pocket costs lower when spending time away from your primary residence.
Examine Concierge Options Carefully: Before enrolling, estimate how many enhanced services you’ll actually use to decide whether membership fees are worthwhile.

Retirement health care expenditures are not only significant but also highly unpredictable. By identifying and budgeting for prescription medication gaps, out-of-network services, and concierge fees, NiSource retirees can preserve their financial resources and maintain control over their medical decisions.

Learn how to make the most of HSAs, compare supplemental plans annually, and safeguard savings from rising medical bills. You can also uncover hidden retirement health care costs, such as Medicare Part D prescription gaps, out-of-network expenses in secondary residences, and concierge medicine fees—all critical areas for NiSource employees to consider.

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Sources:

1. Fidelity Investments. ' Fidelity Investments Releases 2024 Retiree Health Care Cost Estimate as Americans Seek Clarity Around Medicare Selection .' 8 Aug. 2024.

2. MedCity News. ' Managing the Specialty Drug Cost Challenge: Is Your Pharmacy Benefits Strategy Ready for 2025? ' by Stanley Crittenden. 19 Nov. 2024.

3. USA Today. ' Medicare caps seniors drug expenses: What you need to know ,' by Ken Alltucker. 7 Jan. 2025.

4. GoodRx. ' Using the ER for Non-Emergencies Is Expensive - Here Are Other Options ,' by Geoff Williams. 23 Mar. 2023.

5. PartnerMD. ' Concierge Medicine Costs: What You'll Pay and What to Expect ,' by Melissa Gifford. 1 May 2025.

Other Resources:

1. Centers for Medicare & Medicaid Services. Understanding Medicare Advantage Plans . Publication no. 12026, 19 Feb. 2025, www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/downloads/12026-stateavgadj2010.pdf .

2. Hallie Levine. “What to Know About Concierge Medicine.” AARP , 15 Apr. 2019, www.aarp.org/health/medicare-insurance/info-2019/concierge-medicine.html .

3. Internal Revenue Service. Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans . 19 Jan. 2025, www.irs.gov/pub/irs-pdf/p969.pdf .

4. Kaiser Health News. “Doughnut Hole Is Gone, But Medicare’s Uncapped Drug Costs Still Bite into Budgets.” Kaiser Family Foundation , 17 Jan. 2018, www.kff.org/medicare/issue-brief/doughnut-hole-is-gone-but-medicares-uncapped-drug-costs-still-bite-into-budgets/ .

5. Trish, Erin, and Sean Dickson. “National Health Expenditures in 2023: Faster Growth As Insurance Coverage Expands.” Health Affairs , 5 Dec. 2024, www.healthaffairs.org/content/forefront/national-health-expenditures-in-2023-faster-growth-as-insurance-coverage-expands .

As an employee of National Grid, what are the key eligibility criteria for participating in the Pension Plan specifically for Niagara Mohawk Power Corporation employees? How might these criteria impact your personal retirement planning and the benefits you expect to receive upon retirement from National Grid?

Eligibility Criteria for Niagara Mohawk Pension Plan: Employees of Niagara Mohawk Power Corporation who are represented by Local Union 97 of the IBEW and work at least 20 hours per week or accumulate 1,000 hours in a Pension Plan year are eligible. Participation begins automatically on the first day of employment. These criteria directly impact retirement planning by determining when employees begin accruing pension benefits and how much they will receive at retirement(National_Grid_2023_Niag…).

Within the framework of the National Grid Pension Plan, how does the cash balance formula work in calculating retirement benefits, and what implications does this have for employees of Niagara Mohawk Power Corporation when considering their long-term financial outlook?

Cash Balance Formula: The National Grid Pension Plan for Niagara Mohawk employees uses a cash balance formula that provides monthly pay-based credits (starting at 4% and increasing with years of service) and interest credits. These accumulate in a hypothetical account, growing until retirement, allowing employees to track their retirement benefits much like a savings account. This formula impacts financial outlook by providing predictable growth tied to service and pay(National_Grid_2023_Niag…).

For employees at National Grid, what are the specific rights and options available during the pension benefit application process? How do these rights protect the interests of individual employees and ensure they receive fair treatment under the Niagara Mohawk Pension Plan?

Pension Benefit Application Process: National Grid employees must apply for their pension benefits by submitting the required forms at least 90 days before retirement. Spousal consent is required if opting for any form of payment other than the default. This ensures employees understand and select the best payment option for their circumstances, protecting their interests under the Niagara Mohawk Pension Plan(National_Grid_2023_Niag…).

Given the different types of credits that contribute to the pension benefit for employees of National Grid, how are Pay-based Credits and interest credits calculated? What strategies might Niagara Mohawk Power Corporation employees employ to maximize these credits before retirement?

Pay-based and Interest Credits Calculation: Pay-based credits are determined by years of service, starting at 4% of pay and increasing to 8% after 20 years. Interest credits are based on an annual interest rate tied to the Treasury securities and corporate bond rates. Employees can maximize these credits by continuing to work and contributing to their pension balance(National_Grid_2023_Niag…).

How do pension benefits work for Transition Group Employees specifically within National Grid's framework, and what unique provisions apply to them under the Pension Plan as compared to regular employees of Niagara Mohawk Power Corporation?

Pension Benefits for Transition Group Employees: Transition Group Employees under the National Grid Pension Plan have benefits calculated using both the former final average pay formula and the cash balance formula, with the greater benefit being paid out. This differs from regular employees who only receive benefits calculated under the cash balance formula(National_Grid_2023_Niag…)(National_Grid_2023_Niag…).

What are the repercussions for National Grid employees in terms of benefit loss or limitation if they have not met the Vesting requirements under the Niagara Mohawk Pension Plan? How can understanding these repercussions influence an employee's decision-making regarding their career and retirement?

Impact of Vesting Requirements: Employees must complete three years of service to become vested in the Niagara Mohawk Pension Plan. If they leave before vesting, they lose all accrued pension benefits. Understanding vesting requirements is crucial for career and retirement planning, as it ensures employees retain their pension benefits if they meet the criteria(National_Grid_2023_Niag…).

As a current employee at National Grid, what does the termination of the Pension Plan imply for accrued benefits under the Niagara Mohawk Pension Plan? Specifically, how do federal protections through ERISA and the Pension Benefit Guaranty Corporation come into play for employees seeking assurance regarding their retirement funds?

Termination of Pension Plan and Federal Protections: If the Niagara Mohawk Pension Plan is terminated, accrued benefits are protected by ERISA and insured by the Pension Benefit Guaranty Corporation (PBGC). Employees can feel assured that their benefits will be secured up to the PBGC's limits in case of plan termination(National_Grid_2023_Niag…).

How does the National Grid Pension Plan accommodate the unique situations of employees during times of disability or military service, and what steps should Niagara Mohawk Power Corporation employees take to ensure their benefits continue during these periods?

Disability and Military Service: Niagara Mohawk employees receive service credits during periods of disability or military leave, ensuring continuous pension accrual. Employees should ensure their disability or military status is properly documented with the company to avoid interruptions in their pension benefits(National_Grid_2023_Niag…).

When considering the various forms of pension payments available to retirees from National Grid, what are the potential advantages and disadvantages of choosing an annuity versus a lump-sum payment for employees from Niagara Mohawk Power Corporation?

Annuity vs. Lump-Sum Payment: Retirees at National Grid have the option to choose between an annuity, providing a steady income for life, or a lump-sum payment. The annuity provides financial stability, while a lump sum offers flexibility. The choice depends on individual financial needs and retirement goals(National_Grid_2023_Niag…).

For those looking to gain further clarity on the nuances of the Niagara Mohawk Pension Plan, what are the most effective ways for employees to contact National Grid for assistance? How can engaging with the Pension Service Center enhance an employee's understanding of their benefits and rights?

Contacting National Grid for Pension Assistance: Employees seeking more information about their Niagara Mohawk Pension Plan can contact the National Grid Pension Service Center or use the online pension modeler. Engaging with the Pension Service Center provides personalized guidance, helping employees understand their benefits and make informed decisions(National_Grid_2023_Niag…).