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Are you sick over health-care costs?

Planning for retirement, in general, is scary enough. How much will you need for housing, food and other essentials? What will be left over for fun? Simply pondering these basics can be overwhelming, so most people procrastinate and do little planning.

Throw health-care costs into the mix, and heads go even deeper into the sand.

Martin Barraud | OJO+ | Getty Images

Planning for health-care expenses is tough; you can't readily predict future medical problems, and you have little control over health-care costs. Studies from the Employee Benefit Research Institute indicate that the average American will need as much as $210,000 saved for future out-of-pocket medical expenses, not counting potential long-term care costs—and those can be very big numbers.

Fortunately, there are some factors within your control that can mitigate these expenses: your lifestyle, how much you avail yourself of health care, willingness to craft advance health-care directives, and family and social support.

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Lifestyle: How you take care of your health largely determines when and what type of health care you will need. The odds of living a longer, healthier life are improved by taking four steps: maintaining a normal weight, eating a healthy diet, not using tobacco and avoiding toxic people and situations. Will taking these steps decrease health-care costs? It can help reduce future out-of-pocket expenditures, but you'll still need to plan for potential long-term care needs down the road. The end result will be a better and longer life than that of an unhealthy person. Most likely, however, your spending on health care over the long term won't be lower because of increased longevity.

What if you decide not to take care of your health? Chances are, you will have significant morbidity, which will keep you going to the doctor's office often, and you will most likely die at a younger age. So your out-of-pocket medical costs will be much higher, but long-term care expenses may be less of an issue. This is where attitude toward health-care usage and good advance-directive planning come into play.

(Read more: Making your money last in retirement)

Attitude toward health-care usage: Are you the type who appreciates your doctor's input on every muscle ache? According to the book "Your Medical Mind," by physicians Jerome Groopman and Pamela Hartzband, you would be considered a so-called "maximizer" in terms of health-care usage. Others are "minimizers" and avoid going to the doctor at all costs. Some people like to employ the latest, greatest—and more expensive—health-care innovations, while others prefer to go the easiest and cheapest routes.

Attitudes toward health-care usage can affect your pocket. If you are diagnosed with cancer and have a 5 percent chance of surviving six months, will you go to Memorial Sloan-Kettering Cancer Center, then MD Anderson Cancer Center and finally a faith healer in Brazil? Or will you go immediately into hospice? If you know you will go "all out," then plan for higher health-care expenses.

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Advance-directive planning: The most significant health-care costs occur in a short period just before the end of life. Unfortunately, most people do not discuss with family in advance the care decisions they prefer to be carried out in the event they lose the ability to communicate.

When bad things happen, relatives are often left in the difficult position of second-guessing their loved ones. Because of guilt, families tend to "do more" for the patient. Unnecessary care at the end of life can be both painful and costly.

To mitigate this risk, talk with your family about the type of lifestyle after serious illness that would be important to you. If doctors stated you would never be able to communicate with your family again, would you be OK with that or would you want to be moved from curative to "comfort" care?

Another important lifestyle factor to discuss is, for example, the ability to feed and groom yourself. By sharing your wishes, you ensure your family will be able to verify with the doctor whether the treatment offered would bring back the quality of life you desire. And, of course, document your directives with a living will.

(Read more: Planning retirement? Don't forget Medicare costs)

Family and social support: In the past, the elderly were taken care of by large extended families. With today's smaller families, this task falls to fewer individuals. Regardless of family size, it is important to discuss care arrangements in advance. If the family actively decides to help, this will reduce your direct out-of-pocket costs. If help is not available, you need to plan for alternatives, such as continuing-care communities.

These suggestions are not easy to implement, but it is important to do so. A great opening to the conversation can occur on National Healthcare Decisions Day this April 16. Start planning now so you can do your part to control your health-care costs in the future.

—By Carolyn McClanahan, M.D., Special to Carolyn McClanahan is a physician, certified financial planner, and founder and director of financial planning at Life Planning Partners in Jacksonville, Fla.


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