Older Americans generally are worried about medical costs in retirement. Nearly half of them won't talk about it. A survey from the Nationwide Retirement Institute released Wednesday said 45 percent of individuals polled have not discussed these expenses with anyone. And that's too bad, because health-care costs can add up dramatically in retirement. A 65-year-old couple retiring in 2016 can expect to spend an average of $260,000 on medical expenses over approximately 20 years, excluding nursing home costs, according to Fidelity. That reflects a 6 percent increase from 2015. Basic Medicare doesn't cover all of your care expenses, either. Part B — which covers doctor visits and lab tests — will pay for 80 percent of your approved charges. You are responsible for the remaining 20 percent. Nationwide polled 1,316 Americans online, all over age 50, from Sept. 14 to Sept. 22, 2016.

Elderly couple in hospital waiting room. Getty Images

Of those who did confront these expenses, half shared their thoughts with their spouse and 43 percent talked about their retiree medical costs with a financial advisor.

Children were mostly left out of the conversation, as only 19 percent of the participants spoke with their descendants about these expenses. Older Americans' reluctance to discuss this topic is worrisome because it suggests they aren't preparing for those higher costs — and they are leaving out family members who are often the first line of defense when care is needed.

"This is a real call to action; this is a family discussion," said John Carter, president of Nationwide Retirement Plans. "Doing nothing will give you the least amount of control over the situation."

Sharing the burden

Retirees and near-retirees avoid the conversation about health-care costs for a variety of reasons — privacy concerns are often a major factor. Forty-eight percent said they don't speak to their financial advisor about these costs because "it is a personal issue," the survey said. Meanwhile, more than half of the participants with children kept their offspring in the dark about these expenses because "I do not want them to worry about me."

The reality is that families have every reason to be anxious about retiree medical costs.

More than half of the participants said that they were "very or somewhat concerned" that these expenses would deplete assets they had hoped to leave for their children. Half also said that they were worried about becoming a burden to their family members as they age. Some took drastic steps to control their expenses: Three out of 10 participants admitted to taking "negative" steps to reduce their health-care expenses, including trimming grocery spending, skipping wellness visits and cutting pills in half to stretch their medication.

The true dollar cost

It's difficult to plan for health care if you're not sure how much you'll need to get by. Sixty percent of those polled weren't able to estimate how much they and their spouse would have to pay out-of-pocket for health care for each year in retirement. Three-quarters of the participants were similarly uncertain about the cost of long-term care.

Elder-care expenses vary from one state to the next. Nationally, the annual median cost of a private room in a nursing home is $92,378, reflecting a 1.24 percent increase from 2015, according to Genworth, the largest provider of long-term care insurance. See below for details on assisted living expenses across the country.



It doesn't help that a third of the older individuals Nationwide polled said they would be unable to pay for an unplanned expense that's as low as $500.

Broach the topic