MoneyRx for CRNAs and NPs

Brett Fellows, CFP®
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Go behind the scenes with host Brett Fellows, CFP®, as he explores the unique opportunities and challenges facing Certified Registered Nurse Anesthetists and  Nurse Practitioners along the path to financial independence.  In each episode, Brett shares expert financial insights and actionable advice to help you lower taxes, invest smarter, and retire on your terms.

  1. 1D AGO

    Backdoor Roth vs Mega Backdoor Roth for Nurses: Which Strategy Fits?

    If you're a CRNA or nurse practitioner earning over the Roth IRA income limits, you're locked out of one of the best retirement accounts available. But there's a legal workaround. In this episode, Brett Fellows explains two powerful tax strategies that can save you hundreds of thousands of dollars over your career. In this episode, Brett covers: How the backdoor Roth IRA works and why it's been IRS-approved since 2010The exact step-by-step process to execute a backdoor Roth conversionWhat the pro-rata rule is and how to avoid the biggest mistake that trips people upHow the mega backdoor Roth lets you contribute up to $72,000 annually to tax-free accountsWhether your employer plan allows mega backdoor Roth contributions (and what to ask HR)Real-world examples showing how nurses can accumulate $4.5 million tax-freeCommon mistakes to avoid when executing these strategiesTax reporting requirements and which forms you need to fileHow self-employed CRNAs can maximize these strategies with a solo 401(k)Whether you're just starting out or nearing retirement, these strategies can help you build millions in tax-free savings and potentially save over $1 million in taxes throughout your career. Key Timestamps: (0:45) Why "High-Earners" Are Locked Out of Roth IRAs (2:54) The Backdoor Roth IRA: A Simple 2-Step Process (4:54) The Pro-Rata Rule: Avoiding the #1 Backdoor Mistake (7:09) Step-by-Step: How to Execute a Clean Backdoor Conversion (8:59) What is a Mega Backdoor Roth? (11:49) Two Must-Have Features Your 401(k) Plan Needs (15:44) Common Mistakes: From Missing Conversions to Paperwork Messes (17:49) The $43,000 Strategy: Can You Do Both? (21:19) Case Study: Saving $1 Million in Taxes Over a Career (24:49) What to Do if Your Plan Doesn't Allow the "Mega" Strategy #CRNA #TaxStrategies #RothIRA #Nurse For more information and resources related to this episode, please visit the show notes.

    29 min

  2. FEB 10

    Social Security Strategies for High Earning CRNAs & NPs

    "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 benefitsUnderstand why delaying gives you a guaranteed 8% annual return (worth $216,000 over 20 years)Maximize Your 35-Year CalculationCoordinate spousal benefits strategically when one spouse earns significantly moreUse the bridge strategy to retire early while delaying Social Security to 70Don'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 premiumsConsider Roth conversions and QCDs during your low-income "gap years"Understand the earnings test if you plan to work while claiming earlyWhether 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.

    18 min

  3. FEB 3

    Pre-Retirement Checklist: 10 Action Steps for Nurses 5 Years Before You Retire

    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 outHow to calculate your true retirement spending instead of just replacing your incomeThe hidden Medicare cost shock (IRMAA) that high-earning nurses need to understandWhy your 403(b) might be a tax time bomb and how Roth conversions can helpHow to bridge the health insurance gap if you retire before age 65The guaranteed 8% return from Social Security and how to decide when to claimA smarter withdrawal strategy to stay in lower tax bracketsWhy your beneficiary designations matter more than your willYour 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.

    16 min

  4. JAN 27

    Why CRNAs and NPs Should Say NO to the 4% rule

    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.

    30 min

  5. JAN 20

    Top 10 Investing Mistakes That Keep CRNAs & NPs Working Longer Than They Need To

    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.

    22 min

  6. JAN 13

    Medicare Part B Premiums, IRMAA - What Nurses Need to Know

    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.

    13 min

  7. JAN 6

    New Year, New Financial Strategy: 5 Money Moves Advanced Practice Nurses Should Make in 2026

    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 flexibilityHow to use a "match first, then flexibility funding" strategy to build options before age 59.5Why Social Security isn't just a check but longevity insurance, and how to model your claiming strategyThe five year paycheck buffer framework that protects you from sequence of returns riskAsset location strategies that give you the same risk with better tax efficiencyHow to win the tax game during your gap years with Roth conversions and capital gains harvestingBy 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.

    23 min

  8. 12/29/2025

    We Have a $3 Million Portfolio. How Much Can We Spend?

    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 outcomesHow to calculate your true baseline spending (hint: it's more than you think)The role Social Security plays in reducing portfolio pressureSequence of returns risk: why timing matters more than disciplineThe hidden dangers of both lifestyle inflation and accidental underspendingWhy flexibility beats precision in retirement planningHow to build a resilient plan that adapts without panicFind 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.

    22 min
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Ratings & Reviews

5
out of 5
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About

Go behind the scenes with host Brett Fellows, CFP®, as he explores the unique opportunities and challenges facing Certified Registered Nurse Anesthetists and  Nurse Practitioners along the path to financial independence.  In each episode, Brett shares expert financial insights and actionable advice to help you lower taxes, invest smarter, and retire on your terms.

Information

  • Creator
    Brett Fellows, CFP®
  • Years Active
    2024 - 2026
  • Episodes
    76
  • Rating
    Explicit
  • Copyright
    © 2026 MoneyRx for CRNAs and NPs
  • Show Website
    MoneyRx for CRNAs and NPs

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