"I've been earning $200,000 or more a year for most of my career. Social Security is going to be a drop in the bucket." If that's what you're thinking, you could be leaving hundreds of thousands of dollars on the table.

In this episode, Brett Fellows walks through nine critical Social Security strategies specifically for high-earning CRNAs and nurse practitioners. Using a real-world example of David and Sarah, both age 62 CRNAs with $1.8 million saved, he explains how to maximize lifetime benefits while minimizing taxes.

Brett Covers:

• Know your full retirement age and how early claiming permanently reduces benefits
• Understand why delaying gives you a guaranteed 8% annual return (worth $216,000 over 20 years)
• Maximize Your 35-Year Calculation
• Coordinate spousal benefits strategically when one spouse earns significantly more
• Use the bridge strategy to retire early while delaying Social Security to 70
• Don't forget survivor benefits (delaying can mean $162,000 more for your surviving spouse)
• Watch out for IRMAA surcharges that could cost $10,000+ per year in Medicare premiums
• Consider Roth conversions and QCDs during your low-income "gap years"
• Understand the earnings test if you plan to work while claiming early

Whether you're planning to retire at 62, 65, or 70, this episode shows you how to turn Social Security from an afterthought into a strategic anchor for your retirement income.

#CRNAs #NursePractitioners #SocialSecurity #RetirementPlanning #FinancialPlanning #MoneyRx

Key Timestamps:

(0:18) Welcome to Money RX: Social Security for High-Earning CRNAs and NPs

(1:28) Case Study: David and Sarah’s $200,000 Income Strategy

(2:44) #1: Know Your Full Retirement Age

(3:51) #2: Why Delaying Pays Off (The Guaranteed 8% Return)

(4:17) #3: Maximize Your 35-Year Calculation

(7:11) #4: Coordinate Spousal Benefits Strategically

(8:13) #5: Use the Bridge Strategy

(9:33) #6: Do Not Forget Survivor Benefits

(11:01) #7: Watch Out for IRMAA Surcharges

(12:16) #8: Consider Roth Conversions and QCDs

(14:09) #9: Understand the Earnings Test

(15:18) Summary: How a Strategy Adds Hundreds of Thousands in Value 

For more information and resources related to this episode, please visit the show notes.

The five-year window before you stop working is the most critical period for your financial future. While many CRNAs and nurse practitioners (NPs) focus solely on saving, the transition to retirement requires a shift toward strategy. In this episode, Brett Fellows, CFP®, shares a 10-point checklist designed specifically to help both CRNAs and NPs manage health insurance gaps, mitigate IRMAA surcharges, and turn decades of savings into a sustainable retirement paycheck.

Brett covers:

• Why strategy matters more than accumulation when you are five years out
• How to calculate your true retirement spending instead of just replacing your income
• The hidden Medicare cost shock (IRMAA) that high-earning nurses need to understand
• Why your 403(b) might be a tax time bomb and how Roth conversions can help
• How to bridge the health insurance gap if you retire before age 65
• The guaranteed 8% return from Social Security and how to decide when to claim
• A smarter withdrawal strategy to stay in lower tax brackets
• Why your beneficiary designations matter more than your will

Your retirement paycheck should include your hard-earned money, without the tax trap. #Retirement #NP #CRNA #RetirementPlanning

Key Timestamps:

(0:20) The Critical Five-Year Window

(2:19) Step 1: Set Your Target Retirement Date

(3:19) Step 2: Know Your True Retirement Expenses

(4:44) Step 3: Take Inventory of Your Accounts

(5:50) Step 4: Health Insurance Before Medicare

(6:54) Step 5: Start Learning About Medicare & IRMAA

(8:19) Step 6: Understand Your Social Security Options

(9:33) Step 7: Consider Roth Conversions

(11:11) Step 8: Create a Withdrawal Strategy

(12:18) Step 9: Simplify Your Accounts

(13:06) Step 10: Get Your Estate Documents in Order

(13:58) Case Study: The Five-Year Transformation

For more information and resources related to this episode, please visit the show notes.

The 4% rule is a staple of retirement planning, but for high-income CRNAs and nurse practitioners, it is often the wrong tool for the job. Relying on a rigid, one-size-fits-all percentage can lead to psychological stress, tax blindness, and the mistake of underspending during your healthiest years.

In this episode, Brett Fellows, CFP®, explains why APRNs should move away from static rules of thumb in favor of a "Work Optional" guardrails plan. This approach replaces spreadsheet fantasies with a dynamic system that accounts for changing life seasons, tax sequencing, and the unique ability of clinicians to use income levers if markets get rough.

Brett explains how to:

- Identify the 5 core problems with the 4% rule, from linear spending assumptions to ignoring Medicare surcharges.

- Build a retirement paycheck timeline that maps out income sources like Social Security and RMDs as distinct seasons.

- Implement dynamic guardrails to know exactly when it is safe to increase spending or when to briefly cut back.

- Leverage the "Clinician Advantage" by using PRN or consulting work as a strategic buffer against market volatility.

- Master the tax window between stopping full-time work and starting forced distributions.

This episode can help you avoid costly mistakes while understanding how to adjust your spending without feeling stuck. 

#CRNAs #NursePractitioners #RetirementPlanning

Key Timestamps:

(0:18) Why the 4% Rule is the Wrong Tool

(3:24) What the 4% Rule Is (and Is Not)

(5:19) The Comfort Trap: Why We Use Rigid Rules

(7:47) 5 Core Problems with the 4% Rule

(12:30) Reframing Retirement as "Work Optional"

(14:30) Step 1: Your Retirement Paycheck Timeline

(15:52) Step 2: Finding Your Baseline Lifestyle Number

(16:48) Step 3: Using Dynamic Spending Guardrails

(17:52) Step 4: The Clinician Advantage (Optional Levers)

(19:54) Case Study: Alicia and Jordan’s Guardrails Plan

(22:14) The Elephant in the Room: Tax Strategy & RMDs

(26:14) The Truth About Annuities 

For more information and resources related to this episode, please visit the show notes.

You've worked long shifts, held everything together in high-stress situations, and saved diligently for 25 years. You think you're on track for retirement. But what if investment mistakes you don't even know you're making could force you to work five to seven more years?

In this episode, Brett Fellows reveals the shocking truth about a CRNA couple with nearly $2 million in their 403(b) accounts who discovered they'd need to work an extra five to seven years because of investment decisions they'd made over the years. That's five to seven more years of night shifts, five to seven more years of being on call, all because of mistakes that could have been avoided..

Today's episode walks through the 10 biggest investment mistakes that cost nurses real years of their lives. 

Brett covers::

Mistake #1: Trying to time the market (costs 3-4% annually, nearly $1M over 30 years)

Mistake #2: Letting emotions drive your decisions

Mistake #3: Not having proper diversification

Mistake #4: Paying excessive fees and costs (a 1% fee difference costs $600,000+ over 30 years)

Mistake #5: Chasing past performance

Mistake #6: Not reinvesting dividends

Mistake #7: Ignoring tax efficiency

Mistake #8: Active stock picking instead of evidence-based investing

Mistake #9: Not rebalancing your portfolio

Mistake #10: Investing before addressing financial basics

If you're making these mistakes, you might be adding years to your working life without even realizing it. This episode will show you exactly what to fix and how to get your retirement back on track. 

#CRNAs #NursePractitioners #RetirementPlanning #InvestmentMistakes 

Key Timestamps:

(0:18) Welcome and Introduction

(4:18) Mistake #1: Trying to time the market

(5:50) Mistake #2: Letting emotions drive your decisions

(7:20) Mistake #3: Not having proper diversification

(8:55) Mistake #4: Paying excessive fees and costs

(10:20) Mistake #5: Chasing past performance

(11:40) Mistake #6: Not reinvesting dividends

(12:41) Mistake #7: Ignoring tax efficiency

(14:08) Mistake #8: Active stock picking instead of evidence-based investing

(15:30) Mistake #9: Not rebalancing your portfolio

(16:40) Mistake #10: Investing before addressing financial basics

(18:40) Actionable steps and conclusion

For more information and resources related to this episode, please visit the show notes.

If you are a high-earning nurse making $120,000 as NP or over $200,000 as a CRNA, you probably think Medicare will be simple and affordable because you have paid your taxes for decades. However, many nurses are shocked to receive premium notices for $649 per month instead of the standard $202. This episode breaks down the "IRMAA" surcharge and why your income from two years ago dictates what you pay for Medicare today.

Brett explores:

• The definition of IRMAA and why it treats high-earning nurses as if they haven't paid their fair share.
• Why your 2026 Medicare premiums are based on your 2024 tax returns.
• The specific 2026 income thresholds for single and married filers.
• Five specific strategies to potentially reduce or eliminate these surcharges.
• How to use the appeals process if you have recently retired or seen a drop in income.

By the end of this episode, you will have a roadmap to avoid the "tax bomb" in retirement that triggers these expensive surprises.

#CRNAs #NursePractitioners #Medicare #IRMAA #RetirementPlanning

Key Timestamps:

(0:38) Welcome to Money RX for CRNAs and NPs

(1:22) The $10,000 Medicare surprise: A real-life case study

(2:25) What is IRMAA? The income-related surcharge explained

(4:03) Why the two-year look back catches nurses off guard

(6:10) 2026 Medicare Part B premium brackets and thresholds

(7:49) Strategy 1: Appealing due to life-changing events

(8:21) Strategy 2: Using Qualified Charitable Distributions (QCDs)

(8:50) Strategy 3: Strategic Roth conversions in gap years

(9:25) Strategy 4: Leveraging 403(b) and 457 plan contributions

(9:39) Strategy 5: Donor Advised Funds for tax deductions

(11:05) Conclusion: Integrating Medicare into your retirement strategy 

For more information and resources related to this episode, please visit the show notes.

If you're a nurse around age 50 thinking you can do this for about 10 more years, then this episode is for you. Burnout from nursing changes the game. When you're tired, you don't want more complexity in your life. You want a plan that creates options.

Today, we're talking about five money moves to make in 2026. Not theory, not vague motivation, but real moves that you can implement. Each of these moves is designed for someone who is already responsible and a saver, but feels like the finish line keeps moving away from them.

Brett explores:

• The "qualified rich, cash poor" trap and why maxing out retirement accounts can accidentally limit your flexibility
• How to use a "match first, then flexibility funding" strategy to build options before age 59.5
• Why Social Security isn't just a check but longevity insurance, and how to model your claiming strategy
• The five year paycheck buffer framework that protects you from sequence of returns risk
• Asset location strategies that give you the same risk with better tax efficiency
• How to win the tax game during your gap years with Roth conversions and capital gains harvesting

By the end of this episode, you'll have a roadmap for making work optional in the next 10 years without being too afraid to spend what you've saved.

#CRNAs #RetirementPlanning #FinancialFreedom #TaxPlanning #MoneyRX

Key Timestamps:

(0:37) Welcome to Money RX for CRNAs and NPs

(2:35) Move 1: Avoiding the "Qualified Rich, Cash Poor" trap

(4:40) The Flexibility Funding Plan: Building a second bucket

(7:10) Move 2: Strategic Social Security planning beyond the "vibe"

(9:20) Estimating benefits at age 62, FRA, and 70

(10:19) Move 3: Building your retirement paycheck first

(11:15) The five-year paycheck buffer framework

(14:25) Move 4: Using asset location for better tax efficiency

(18:05) Move 5: Winning the tax game in your "gap years"

(19:30) Selective Roth conversions and ACA healthcare planning

For more information and resources related to this episode, please visit the show notes.

What if the biggest risk to your retirement isn't running out of money, but spending too little? When you've accumulated $3 million through decades of hard work and discipline, the fear shifts from "Can we afford to retire?" to "How much can we spend without getting this wrong?"

Brett covers:

• Why identical portfolios can lead to completely different retirement outcomes
• How to calculate your true baseline spending (hint: it's more than you think)
• The role Social Security plays in reducing portfolio pressure
• Sequence of returns risk: why timing matters more than discipline
• The hidden dangers of both lifestyle inflation and accidental underspending
• Why flexibility beats precision in retirement planning
• How to build a resilient plan that adapts without panic

Find out why the most successful retirements aren't built on rigid withdrawal rates but on intentional decisions that align your money with your values. Your portfolio is a tool (not a limiter) for the life you want to live.

#RetirementPlanning #FinancialPlanning #CRNA #PortfolioManagement 

Key Timestamps: 

(0:38) Welcome to Money RX for CRNAs

(2:23) Case Study: David and Anne’s $3M Portfolio

(3:38) Determining True Baseline Lifestyle Spending

(5:03) How Social Security Reduces Portfolio Pressure

(5:37) Reframing Retirement as an Annual Cashflow Problem

(7:27) Introducing Susan: Sequence of Returns Risk

(10:03) Karen’s Story: The Risk of Structural Lifestyle Inflation

(12:02) Tom’s Story: The Cost of Accidental Underspending

(14:22) Kevin and Laura: Building a Resilient vs. Precise Plan

(15:58) Retirement as a System of Behavior and Alignment

(20:13) Conclusion: $3 Million is a Tool for Choice, Not a Limit

For more information and resources related to this episode, please visit the show notes.

"I can't retire early because of healthcare." If this is the voice holding you back, this episode changes everything.

Healthcare costs terrify so many CRNAs approaching early retirement. You've saved enough money, you're burned out, and these are your good health years. But one fear keeps you working: what if healthcare costs blow up your plan?

In this episode, Brett reveals why healthcare shouldn't delay your early retirement and shows you the one number that simplifies everything. Once you know how MAGI (Modified Adjusted Gross Income) works, healthcare becomes predictable math instead of an expensive mystery.

We explore:

• The one number that controls your health insurance costs before Medicare.
• What counts as taxable income and what doesn't in retirement.
• Real-life case studies showing couples retiring before 65, spending six figures, and keeping healthcare affordable.
• How the healthcare subsidy cliff works and recent rule changes you need to know.
• Why being "qualified rich, cash poor" limits your healthcare options.
• The three biggest levers you can pull during the retirement gap years.
• A simple framework to decide if healthcare should keep you working or if you're more ready to retire than you think.

Two people can spend $100,000 per year, but one pays full price for healthcare while the other receives massive subsidies. Same lifestyle, completely different premiums. The difference? Understanding MAGI and structuring withdrawals correctly.

Whether you're in your late 50s or early 60s, this episode gives you the roadmap to make healthcare planning manageable and stop letting it delay the retirement you've earned.

#CRNAs #EarlyRetirement #HealthcarePlanning #MAGI #AffordableCareAct

Key Timestamps:

(0:45) Brett explains why healthcare shouldn't delay your retirement goals.

(2:55) Why the ACA cares about your reported income rather than savings.

(5:10) Breaking down taxable vs. tax-free money buckets for spending.

(7:10) Example of maintaining a six-figure lifestyle with high subsidies.

(10:35) How crossing the subsidy cliff "light switch" can cost thousands.

(11:50) Stress-testing a retirement portfolio against high premium estimates.

(14:15) The danger of maxing pre-tax accounts without tax diversification.

(16:05) Top three levers to pull during the early retirement gap.

(17:15) A practical checklist to evaluate your current retirement readiness.

(20:30) Closing thoughts on taking control of your healthcare math.

For more information and resources related to this episode, please visit the show notes.

Many CRNAs hit the $1 million savings mark and assume they are automatically ready to retire.

While reaching that milestone is a huge achievement, retiring well isn't just about the balance in your accounts. It is about timing, flexibility, and protecting yourself from the hidden dangers that appear in the final decade of your career.

In this episode, Brett Fellows, CFP®, shares five powerful moves you should make before you retire if you have saved over $1 million. These aren't generic tips; they are strategies derived from real-life case studies and years of planning with CRNAs.

Brett explores:

• Why two retirees with the exact same portfolio can have completely different outcomes based on "sequence of returns risk"
• Why the 4% rule is outdated and what to use instead
• The "Freedom Account" strategy that allows CRNAs to retire years before age 59½
• Why you should lock in liquidity (like a HELOC) while you still have W2 income
• How to handle the "Fragile Decade" and guard against lifestyle inflation in your "go-go" years

Key Timestamps:

(0:37) Intro: When does work become optional? 
(2:00) Step 1: Run your numbers early (The Fine-Tuning Stage) 
(2:35) Sequence of Returns Risk explained 
(3:35) Why the 4% Rule is outdated 
(5:30) Step 2: Build a Brokerage Account (The Freedom Account) 
(7:30) Step 3: Lock in liquidity before you retire 
(9:15) Step 4: Tackle big expenses during the "Fragile Decade" 
(11:15) Step 5: Guard against lifestyle inflation 
(12:50) Creating intentional spending guardrails 
(13:25) Recap of the 5 steps

For more information and resources related to this episode, please visit the show notes.

What if you’re making a Social Security benefits mistake that could cost you 5 figures?

It almost happened to a CRNA.

Brett Fellows recently reviewed a retirement plan with a couple where the wife had worked full-time as a CRNA for 25 years while her husband worked part-time to raise their children. 

They assumed that because he had his own earnings history, he could not claim spousal benefits. That single assumption was a mistake that could have cost them tens of thousands of dollars over their lifetime.

In this episode, Brett Fellows, CFP®, breaks down exactly how Social Security spousal benefits work and why they are critical for CRNA couples to understand.

Brett explores:

• The fundamental rules of claiming 50% of a spouse's benefit
• Why CRNAs with "gap years" or early retirement dates are specifically affected
• Three real-world scenarios: The Traditional Family, The Dual High-Earner Couple, and The Career Gap Situation
• The "Social Security Tax Tsunami" and how spousal benefits impact provisional income
• The four biggest mistakes couples make, including claiming too early and failing to coordinate with tax planning

Key Timestamps:

(0:45) The costly mistake Sarah and Mark almost made 

(2:05) Fundamentals: How spousal benefits actually work 

(2:53) The 50% cap and full retirement age rules 

(4:05) Why the primary earner must claim first 

(5:35) Why this matters specifically for CRNAs 

(8:00) Scenario 1: The Traditional CRNA Family 

(9:45) Scenario 2: The Dual High-Earner Couple 

(10:35) Scenario 3: The Career Gap Situation 

(11:40) The Social Security Tax Tsunami 

(14:15) 4 common mistakes CRNA couples make

For more information and resources related to this episode, please visit the show notes.