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The only sure thing about health care in retirement is that the cost will rise over time.

To help with medical bills in retirement, consider opening a health savings account while you’re still working, if you have a high-deductible health insurance policy.

“We sometimes say an HSA is a Roth on steroids,” said Maria Bruno of Vanguard.

You get a triple tax-free benefit: Contributions aren’t taxed, they grow tax-deferred, and the money can be used tax-free for eligible medical expenses. And recent changes in HSA rules for those with chronic conditions make these accounts even more attractive.

For 2019, you can contribute up to $3,500 if you have single coverage and as much as $7,000 for family coverage.

To make the most of the HSA, pay current medical bills out of pocket (if you can afford to), so the account has more time to grow. You can’t contribute to an HSA once you enroll in Medicare, even if you’re still working, but you can use the money at any time to pay medical bills, including Medicare Part B and Part D premiums.

Long-term care, which isn’t covered by Medicare, is another uncertainty that retirees need to address.

You may never need long-term care, but if you do, the bill can be huge. A federal study estimated that nearly half of people who are now 65, or who reached that age in the past few years, will not have any long-term-care costs.

But one-fourth are expected to face long-term-care bills of up to $100,000, and 15% will rack up costs of $250,000 or more.

If you have the assets, you could pay the bills out of pocket. Long-term-care insurance is also an option, although it can be expensive, and you may have a difficult time finding a policy if you have a health issue.

Michael Kitces, a certified financial planner, advises buying a policy while you’re in your 50s, when the cost is lower and you’re likely still healthy enough to qualify for a policy.

Policies today are much more expensive than those issued many years ago, but the higher price also reduces the risk of steep rate hikes in the future, Kitces said.

Some people resist buying long-term-care insurance, thinking it will be a waste of money if they never need care, said Keith Bernhardt of Fidelity Investments.

The solution for them, he said, can be a hybrid policy that combines long-term-care and life insurance benefits. It will cover bills for long-term care, but if you never need care (or need only little of it), your heirs will receive a death benefit when you die.

“It helps to remove that concern that ‘I won’t get a benefit from this,’” Bernhardt said.

Be aware that the policy is doing double-duty, so premiums are significantly higher than if you purchased a stand-alone long-term-care policy.

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