Yesterday, we unpacked the trap of Required Minimum Distributions and how forced withdrawals can upend your tax plan. But what if you’re planning to retire early—say, before age 65?

You might be mentally ready, your portfolio might look solid—but unless you’ve accounted for health insurance costs, you could be walking into a financial buzzsaw.

Here’s the problem: Medicare doesn’t kick in until age 65. If you retire at 60, that’s five years where you’re on your own when it comes to health coverage. And unless you have retiree health benefits (which are increasingly rare), you’re likely shopping on the private market.

And the private market isn’t cheap.

According to the Kaiser Family Foundation, the average annual premium for a 60-year-old on the ACA exchange is around $11,000—and that’s just for the base plan. If you want a lower deductible or better coverage, the price climbs. Factor in copays, out-of-pocket maxes, prescriptions—and you’re looking at $15,000 to $20,000 a year just to stay insured.

That’s a huge hole in many early retirement budgets.

Now, some folks try to bridge the gap with COBRA, which lets you stay on your employer’s plan for 18 months after you leave. But COBRA is often even more expensive than a private plan because you’re paying the full premium—plus a 2% administrative fee.

Another strategy? Health care sharing ministries. These aren’t insurance, but for some early retirees they offer a lower-cost alternative, though they come with coverage limitations and aren’t regulated the same way.

A third option is to structure your income carefully in early retirement. Some retirees keep taxable income low enough to qualify for ACA subsidies, which can dramatically reduce premiums. But that requires a tight rein on distributions and taxable investments.

Others look at part-time work with benefits—a growing trend among early retirees. Even 20 hours a week at the right company can give you access to group coverage and save you thousands.

The elites? They don’t sweat this stuff. They’ve got private concierge coverage, corporate retiree plans, and tax-free trusts picking up the tab. But for the rest of us, retiring before 65 without a health insurance strategy is risky business.

So if early retirement is your goal, don’t just plan for your vacations and hobbies. Get crystal clear on how you’ll handle health care. One illness, one accident, or even one prescription plan can derail your dream if you’re not ready.

Tomorrow, we’ll explore another major concern: how to build a retirement income stream that lasts as long as you do—and how annuities can help or hurt.