Use your actual plan documents and local provider prices. Annual gap = expected annual price minus insurance or allowance.
| Cost line | Frequency | Expected price | Coverage/allowance | Annual gap |
|---|---|---|---|---|
| Dental exams and cleanings | $ | $ | $ | |
| Major dental work reserve | Annual | $ | $ | $ |
| Eye exam/refraction | $ | $ | $ | |
| Frames, lenses or contacts | $ | $ | $ | |
| Hearing exams/devices | $ | $ | $ | |
| Device upkeep/replacement | Annualized | $ | $ | $ |
| Foreign travel medical reserve | Annual | $ | $ | $ |
| Short-term paid help at home | Hours × rate | $ | $ | $ |
| Other uncovered services | $ | $ | $ | |
| TOTAL ROUTINE ANNUAL GAP | $ | |||
| MONTHLY SINKING-FUND TARGET (TOTAL ÷ 12) | $ | |||
| Scenario | Local monthly cost | 3 months | 6 months | 12 months | Planned payment source |
|---|---|---|---|---|---|
| Home caregiver | $ | $ | $ | $ | |
| Assisted living | $ | $ | $ | $ | |
| Nursing home | $ | $ | $ | $ |