The out-of-pocket costs for a couple in retirement look daunting, but our strategies can ease the pain. By Kimberly Lankford, Contributing Editor June 13, 2014 I saw the report that 65-year-old couples will need more than $200,000 for health care costs during retirement. Why is the amount so steep, and what can I do to lower these costs?Fidelity’s annual retiree health care cost estimate found that couples retiring this year at age 65 will need $220,000 for health care costs during retirement (the same figure as last year’s study). The cost assumes the couple has traditional Medicare and pays deductibles and coinsurance for Part A and Part B (plus the premiums for Part B, which are currently $104.90 per month for most people). It also includes Part D prescription-drug coverage premiums and out-of-pocket costs. It does not include long-term-care costs. That’s a lot of money, but put those health care costs into context before you panic. And consider these five strategies to help you reduce the price tag. See Also: A Reality Check on Health Care Costs for Early Retirees 1. Build tax-free retirement health care savings. Even though you can’t contribute to a health savings account after you sign up for Medicare, you can still use the money you have accumulated in the account tax-free to pay medical expenses after age 65. That includes your Medicare Part B and Part D and Medicare Advantage premiums (but not medigap) and a portion of long-term-care expenses, in addition to co-payments, deductibles and other out-of-pocket health care costs. If you have an HSA-eligible health insurance policy with a deductible of at least $2,500 for family coverage or $1,250 for individuals, you can contribute up to $6,550 to an HSA for the year (or $3,300 for individual coverage), which can grow in the account and be used tax-free for medical expenses in any year. See FAQs About Health Savings Accounts for more details. Advertisement 2. Become a better health care shopper. If you have to pay any deductibles or co-payments yourself, you can save a lot of money by, for example, getting x-rays at a stand-alone radiology center rather than in a hospital, going to an urgent-care clinic rather than the emergency room, and seeing if your doctor will perform a procedure you need at a less-expensive outpatient surgery center. See 31 Ways to Cut Your Health Care Costs for more information. 3. Cut prescription-drug costs. Medicare Part D prescription-drug plans help reduce the cost of medications, but you’ll still need to pay for part of the cost in the “doughnut hole” coverage gap. (In 2014, you get a 52.5% discount on brand-name drugs in the doughnut hole and a federal subsidy of 28% for generic drugs.) You can save a lot of money by switching to generic medications or asking your doctor if you can use a therapeutic-equivalent drug that costs less. Also see if your plan offers special deals at preferred pharmacies or if you can get a break from mail-order drugs. See Lower Your Prescription-Drug Costs for more information. Also search during open enrollment in the fall for a Part D prescription-drug plan that has lower out-of-pocket costs for your drugs. See Time for Medicare Open Enrollment for more information. 4. Find cheaper ways to fill the Medicare gaps. Most people cover the deductibles, co-payments and other gaps in Medicare with a Medicare supplement policy, and the most common policy is Plan F. But some newer types of policies have lower premiums in return for greater cost sharing. Plan N, for example, covers many of the same expenses as Plan F but doesn’t cover the $147 Part B deductible and charges a $20 co-payment for doctors’ office visits and a $50 co-payment for emergency-room visits. See How to Get a Better Deal on a Medigap Policy. Also consider a Medicare Advantage policy, which provides both medical and drug coverage from a private insurer and can be an alternative to the three-part combo of traditional Medicare plus medigap plus a Part D prescription-drug policy. You’ll usually have a limited network of doctors and hospitals and may have higher co-payments than you would with traditional Medicare combined with medigap, but your premiums may be lower (some plans charge nothing beyond the Medicare Part D premiums). See Medicare Advantage Plans Can Cut Costs and Hassle for more information. 5. Have a plan for potential long-term-care costs. One big number the study doesn’t include is the potential cost of long-term care. The national median rate for a private room in a nursing home is $87,600 per year, according to Genworth’s annual survey, and the median rate for a home-health aide is $20 per hour -- $45,000 per year if you need 44 hours of care per week. Assisted-living costs are $42,000 per year. You can pay for these costs with your savings or long-term-care insurance or a combination of both. See Options for Covering Long-Term-Care Costs for more information. Got a question? Ask Kim at email@example.com.