HEALTH CARE IN RETIREMENT. GROWTH IN HEALTH CARE COSTS in the U.S. has significantly outpaced. Forces driving growth in health care spending

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1 HEALTH CARE IN RETIREMENT GROWTH IN HEALTH CARE COSTS in the U.S. has significantly outpaced overall inflation. From 1982 to 2013, spending on health care increased at an average of 5.1%, faster than all spending categories other than higher education. 1 In the past few years, however, the pace of health care spending increases has slowed. In 2013, health care spending rose 2.0%, which is still higher than the 1.5% increase in the overall Consumer Price Index. The recent decline, while welcome, does not solve three fundamental problems facing Americans as they plan for retirement: While difficult to predict, health care cost increases may revert to historical averages of 5% per year. People tend to use significantly more health care as they get older. Budget pressures may result in increased future costs for Medicare beneficiaries. A sound retirement strategy must plan for increasing health care expenses. Forces driving growth in health care spending The macroeconomic impact of health care costs can be clearly seen in gross domestic product (GDP) data: In 2011, health care expenditures accounted for 17.2% of GDP, up from 13.8% in 2000 and far more than the 5.2% level that prevailed in There are many drivers of the growth in health care spending, but one of the key contributors is new medical technology, which includes new treatment options and prescription drugs, as well as new diagnostic tests and medical devices (Exhibit 1). For example, while a new drug for Hepatitis C, Sovaldi, offers real hope of curing the disease for more than 90% of patients, the total treatment cost ranges between $80,000 and $100,000 for a typical patient in the U.S.

2 IT IS CRITICAL TO PLAN FOR THE LIKELIHOOD OF INCREASING HEALTH CARE COSTS AND THE INVESTMENT GROWTH NEEDED AS PART OF A WELL- CONSTRUCTED, LONG-TERM RETIREMENT PLAN. Along with new medical technology, other forces that are propelling growth in health care spending include: Increases in provider fees An aging population that consumes more health care and suffers from more chronic conditions: Americans over the age of 75 consume almost twice as much health care as they did between the ages of 65 and 74 2 In 2010, 67% of Medicare beneficiaries had two or more chronic conditions, and 14% had six or more 3 Lack of cost sharing Poor care coordination This last point speaks to a fundamental characteristic of U.S. health care: It is basically a fee-for-service system. Most doctors and hospitals essentially get paid for each increment of health care they deliver and thus are incentivized to provide more services, receive more fees and drive up overall health care costs. For all the significant changes it introduced, the 2010 Affordable Care Act did not eradicate this basic fee-for-service structure. Forces restraining growth in health care spending To be sure, some forces are slowing the growth in health care spending. An increase in the shifting of costs onto patients may result in a reduction in the use of health care. Poor economic conditions also tend to decrease demand for health care. And new technology can reduce expenses by introducing new efficiencies and techniques. For example, the development of surgical techniques and tools that enable minimally invasive surgeries can reduce the length of a procedure and, crucially, reduce the number of days those patients spend in a hospital. On balance, though, new technology does more to drive up costs than it does to reduce them. New payment models are moving from payments for quantity of care delivered to payments for outcomes, or value of care delivered. It s a recent shift, and one that is gaining traction. A growing contingent of providers has developed sophisticated tools to help lower costs without compromising the quality of care. For example, CareMore, a Wellpointowned chronic care program for dual eligible (Medicare and Medicaid) patients, has made notable progress in reducing the length of hospital stays for end-stage renal diseases, among other measures. In recent years, many drugs have gone off patent, replaced by less expensive generics, and this has helped reduce costs overall. The health care sector, however, has already received most of the benefits from patent expiration, and promising new biotech drugs will likely spark new growth in drug costs. EXHIBIT 1: MAIN DRIVERS OF GROWTH IN HEALTH CARE SPENDING New technology: innovation Lack of cost sharing Aging population Chronic disease Dual Medicare/Medicaid eligibility Poor care coordination Poor health behaviors Good economic conditions Good health behaviors Increased cost sharing Poor economic conditions Provider price increases Source: Containing the Growth of Spending in the U.S. Health System, Health Policy Center, Urban Institute, October Health care spending and the Medicare Program, Medicare Payment Advisory Commission, June 2013 Databook. Center for Medicare and Medicaid Services, Medicare and Medicaid Research Review, 2013, Vol 3, No 3. Kaiser Family Foundation, Medicare s Role for Dual Beneficiaries, April J.P. Morgan Asset Management analysis.

3 EXHIBIT 2: ESTIMATED ANNUAL OUT-OF-POCKET HEALTH CARE COSTS FOR A 65-YEAR-OLD RETIRING IN 2014 Dollars 20,000 15,000 10,000 5,000 $7,214 90th percentile 50th percentile $14,288 $10,586 IT IS REASONABLE TO ASSUME A 7% ANNUAL RISE IN HEALTH CARE COSTS WHEN PLANNING FOR RETIREMENT. 0 $4, Age Source: Employee Benefit Research Institute (EBRI), January 17, Based on national average cost estimates for Medicare Parts A, B, D and Medigap Plan F. EBRI derived inflation estimates from US CBO estimates. On average, health care costs are estimated to increase 5.0% for the 50th percentile and 3.5% for the 90th percentile. Vision, dental and long-term care expenses are not included. Assumes continued implementation of the Patient Protection and Affordable Care Act. The costs at 90th percentile actually dip down in 2019 due to the implementation of the Medicare prescription drug donut hole being filled in as applied to Medicare prescription drug costs. For illustrative purposes only. Realistic spending projections, sound retirement plans While it is difficult to predict the forward path of U.S. health care costs, we believe that they will continue to increase at a pace faster than overall inflation. For traditional Medicare with prescription drug coverage and a comprehensive Medigap policy, median national health care costs for a 65-yearold non-smoker total about $4,000 a year, while costs for someone with high prescription expenses may be close to $7,000 per year. 4 For a 65-year-old retiring in 2014, the Employee Benefit Research Institute (EBRI) projects that out-of-pocket costs for the median retiree will more than double by age 85 (Exhibit 2). It is reasonable to assume a 7% annual rise in health care costs that begins when a person starts Medicare. A host of powerful forces, led by an aging population and advances in medical technology, will propel that growth even as some innovative insurers are increasing efficiencies to alleviate some of the pressure. In addition, changes in employer-provided insurance and eventual changes to Medicare could shift more of the cost burden to individuals, particularly individuals who use more care or who use expensive types of care. Taking all these factors into account, both younger and older individuals should be prepared to pay more for health care. Part of that preparation will involve the design of investment portfolios aimed at outpacing health care cost inflation and bolstering funds for unexpected health care expenses. We can engage in healthier behavior that may lower our future health care bills. Still, we cannot know what medical issues we may confront or how long we will live. We do know that older people tend to use more health care than their younger counterparts. This makes it critical to plan for the likelihood of increasing health care costs and the investment growth needed as part of a well-constructed, long-term retirement plan. Visit jpmorganfunds.com/ri to access the Health care costs in retirement paper and video, featuring Retirement Strategist Sharon Carson, or contact your J.P. Morgan representative for more information. 1 Bureau of Labor Statistics, Consumer Price Index, J.P. Morgan Asset Management. Data represents annual percentage increase from December 1981 through December Ellen Meara, Chapin White and David M. Cutler, Trends in Medical Spending by Age, Health Affairs. Represents combination of household surveys and total spending data to analyze trends in medical spending from Centers for Medicare & Medicaid Services, Chronic Conditions among Medicare Beneficiaries Chartbook: 2012 Edition. 4 Employee Benefit Research Institute (EBRI), January 17, 2014; proprietary data file sent to J.P. Morgan Asset Management.

4 VARIATION IN HEALTH CARE COSTS: TRADITIONAL MEDICARE Across the U.S., health care costs in retirement vary significantly from state to state. Advisors and plan sponsors who help craft retirement savings strategies need to appreciate these sometimes dramatic differences. For those with traditional Medicare and a comprehensive Medigap policy (standardized plans that cover co-pays and deductibles associated with traditional Medicare policies), average costs for a 65-year-old range from less than $3,750 in Texas to more than $4,500 in Florida and New York. Medicare Advantage plans, which are private market plans sold with a government subsidy, often carry lower premiums than traditional Medicare. But they also tend to have narrower provider networks, and government rules prohibit the sale of these plans with a Medigap policy to fill in co-pays and deductibles. Similar trade-offs inform many decisions in retirement planning. Advisors and plan sponsors who understand the nuances and complexities of health care costs in retirement will be best able to help their clients and plan participants prepare for this sometimes challenging life chapter. AVERAGE ANNUAL MEDICARE COSTS AT AGE 65 WA OR NV CA ID AZ UT MT WY CO NM ND SD NE KS TX OK MN WI IA IL MO AR MS LA IN MI TN AL KY OH GA WV SC PA VA NC VT NH NY MA CT NJ DE MD ME RI < $3,750 $3,750-$4,500 > $4,500 FL Location matters For those with traditional Medicare and a comprehensive Medigap plan,* average costs vary depending on where you live in retirement. For those with a Medicare Advantage** plan, health status is the main driver of cost variation. *Medigap plans are standardized plans that cover co-pays and deductibles associated with traditional Medicare policies. **Medicare Advantage is an alternative to traditional Medicare offered by private insurance companies. Source: SelectQuote, Traditional Medicare costs are based on national average cost estimates for Medicare Parts A, B, D and Medigap Plan F. Vision, dental and long-term care expenses are not included. Not shown on the chart: costs for Medicare Advantage. Medicare Advantage costs may vary from less than $500 per year to more than $10,000 per year. Data for Alaska and Hawaii not available.

5 This material has been prepared for informational and educational purposes only. It is not intended to provide, and should not be relied upon for investment, accounting, legal or tax advice. J.P. Morgan Asset Management is the marketing name for the investment management businesses of JPMorgan Chase & Co. and its affiliates worldwide. Those businesses include, but are not limited to JP Morgan Chase Bank, N.A., J.P. Morgan Investment Management Inc., Security Capital Research and Management Incorporated and J.P. Morgan Alternative Asset Management, Inc.

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