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A CRNA’s Guide to Healthcare in Early Retirement (How to Manage ACA Subsidies)

December 13, 2023

Early retirement is a dream for many CRNAs, and it can come with a number of financial challenges. One of the biggest concerns for early retirees is the mounting cost of health insurance. If you retire prior to age 65 and haven't qualified for Medicare yet, you'll need to find ways to provide (and afford) healthcare. Luckily, with advance planning, you can prepare for a successful life after anesthesia that includes affordable healthcare.

In March 2010, Congress passed the Affordable Care Act (ACA) with the goal of making affordable health insurance available to more people through subsidies (premium tax credits). Before diving into strategies, it's essential to grasp how the ACA subsidy system works. Health insurance subsidies are available to those with incomes between 100% and 400% of the federal poverty level. The lower your income, the higher your subsidy, which can significantly reduce your healthcare costs. In this article, we'll explore how you can strategically minimize your income during early retirement and benefit from ACA subsidies to minimize your healthcare costs.

  1. Leverage Tax-Advantaged Accounts
    One of the most effective ways for CRNAs to control income during early retirement is by withdrawing from tax-advantaged accounts like Roth IRAs and HSAs (Health Savings Accounts). Roth IRA withdrawals are tax-free, while HSA distributions for qualified medical expenses are also tax-free. By utilizing these accounts for living expenses in retirement, CRNAs can keep taxable income low.

  2. Diversify Your Income Sources
    Diversifying your income streams can help CRNAs manage overall income. Consider investments that generate capital gains, which are generally taxed at a lower rate than ordinary income. Additionally, allocating your investments into tax-efficient funds or ETFs can help minimize the tax impact of investment gains.

  3. Timing is Everything
    In early retirement, the timing of withdrawals and income generation can be critical. By strategically planning when you receive income, CRNAs can control overall annual income. This might mean taking larger distributions in years with lower market gains to maintain a steady, low taxable income.

  4. Part-Time Work
    Engaging in part-time work or freelance opportunities during early retirement can provide a reliable source of income while allowing you to control the amount you earn. This way, you can limit your earnings to stay within the ACA subsidy thresholds.

  5. Minimize Non-Essential Capital Gains
    Be cautious with large asset sales that could trigger substantial capital gains. Timing these sales can make a difference to your overall income for the year. Consider spreading out such sales to keep your income below subsidy thresholds.

  6. Consider Social Security Strategically
    Delaying your Social Security benefits until later can help reduce your overall income in the early years of retirement. This can be a valuable tactic to maximize ACA subsidies.

  7. Stay Informed and Reevaluate Annually
    Keep in mind that the income thresholds for ACA subsidies can change annually. It's essential to stay informed about any updates and make adjustments to your income management strategy accordingly.

Retiring early and navigating the complexities of healthcare costs can be challenging, but by strategically managing your income in retirement, you can make the most of ACA subsidies. With careful planning, wise investment decisions, and an understanding of the subsidy structure, CRNAs can enjoy the benefits of early retirement without sacrificing access to affordable healthcare.

With decades of experience working exclusively with CRNAs, CRNA Financial Planning® has the knowledge to help you save more of your hard-earned money and plan for life after anesthesia. Schedule an introductory phone call to discuss your current situation and needs. You can also call our office at 855.304.3748 or email us at