401k calculator question (and money spend in retirement)

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Obviously that can change dramatically with health, needing home health etc etc. but am I missing some thought process there?

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I think you just answered your question.

Healthcare expenses are highly likely to skyrocket as you get into your 70s and certainly in your 80s.

I just write excel spreadsheets, and project for each year. It doesn't take long. You can then use different rates of return and different spending amounts for each year if you want to. You will never be correct in your projections doing this, however, you will get an idea of how major spending events affect your assets, and then you can consider ways to adjust to those events. Even the most sophisticated calculators assume linear spending, and usually a linear rate of return. In just the last two years or so we've seen the return on cash go from less than 0.75% to 5%+. That ought to give you an idea about how linear the real world is.

My plan is to use a variable percentage withdrawal strategy (VPW). Boglehead person came up with a good VPW spreadsheet.

With it you are meant to update once per year in retirement and it will tell you much to take out for that year. I will use this as a guide to help me determine my actual withdrawal. The spreadsheet supports before retirement as well to help forecast etc.

https://www.bogleheads.org/wiki/Variable_percentage_withdrawal

https://www.bogleheads.org/forum/viewtopic.php?t=284519

Also, I'm planning to buy this later this year which is more sophisticated to help model what different retirement income scenarios look like etc.

https://pralanaretirementcalculator.com/pralana-gold/

It's $99 but now that I'm in sight of early retirement; it's worth it for me. Also, I can use it for my mom as I manager her finances & investments too. She's now at the point where I have to watch out for IRMAA penalties for RMDs, Roth conversions, SS etc.

Inflation feels pretty damn important. 150k today may be 250-300k in 20 years (or whenever you’re retiring).

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But as my healthcare skyrockets, my monthly spend will also decrease as well (very likely at a greater rate) if my health is in decline.

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"Sky rocketing" healthcare expenses can be plateaued and managed with Medicare and a Supplemental Gap Plan or an Advantage plan. The bigger concern would be Long Term Care expenses.