PhotoIf you are 65 years old, or approaching that milestone, you might not think much about medical costs in retirement.

After all, you're going on Medicare and you might expect your health care costs would be lower. Well here's a wake up call – Fidelity Investments estimates the average couple will need more than a quarter of a million dollars to cover medical costs during retirement.

The breakdown, based on an analysis of the Medicare database, pegs the out-of-pocket cost at $135,000 for a woman and $125,000 for a man – the higher amount due to a woman's longer life expectancy.

One of the biggest chunks of those costs comes in the form of Medicare Part B and Part D premiums and out-of-pocket prescription drug costs, especially speciality drugs to treat chronic diseases.

For many people, the premium costs don't seem like costs because they are often deducted from the retiree's Social Security payments. However, they are out of pocket costs just the same.

What Medicare doesn't cover

According to the Fidelity breakdown, the premiums for Medicare Part B and Part D make up 36% of the typical retiree's health care costs. Since Part B covers only 80% of medical costs, the retiree either writes a check for the other 20% or obtains a supplemental policy, which carries a monthly premium.

That premium or out-of-pocket 20%, along with the uncovered medical expenses for vision and hearing, add up to 40% of a retiree's medical costs over retirement.

The uncovered cost of prescription drugs makes up 24%, and Fidelity says that's the area that has been growing the fastest. In fact, after several years of remaining stable, Fidelity's estimate of needed health care funds rose sharply this year, in part because more seniors are accessing health care services and in part due to the surging price of prescription drugs.

To help meet these medical costs, Fidelity recommends retirees consider a supplemental health policy. Premiums are generally affordable, and in many medical procedures and services, the retiree incurs no out-of-pocket expense.

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