MoneyRx for CRNAs and NPs

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.