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By John W. Schoen

Planning for retirement usually means budgeting for food, travel and other expenses. Don’t forget to include $220,000 for health care costs.

That’s how much the average 65-year-old couple will spend on medical expenses through their retirement, according to the latest estimates from Fidelity Investments.

If you’ve set your sights on retiring earlier, plan on squirreling away an even bigger savings pile. The average couple hoping to retire at 55 will spend $744,800 on out-of-pocket health costs if they both live to age 85, according to a separate study released Wednesday by the Society of Actuaries.

That’s if you’re relatively healthy later in life. Those averages don’t include the cost of treating chronic diseases like cancer or heart disease.

“People with those conditions spend about twice what the aver age population does,” said Dale Yamamoto, the author to the Society of Actuaries study. “So you need to take these numbers and double them.”

Those numbers also don’t include the cost of long-term care like a stay in a nursing home, which isn’t typically covered by Medicare.

The latest estimates for the average health care tab is likely to come as something of a sobering surprise to most people planning for – or in - retirement. In a separate survey, Fidelity found that nearly half of people aged 55 to 64 planning for retirement figured they would need just $50,000 to pay for health care costs.

Estimating those costs is the thorniest wild card in any retirement plan, largely because longevity and illnesses are so difficult to predict. Those variables are further complicated for Americans by the ongoing reform of medical insurance coverage in the U.S., both through the Affordable Care Act and proposed changed to Medicare.

“It’s more difficult today to try and give people meaningful guidance because the individual insurance market is going to change dramatically,” said Sunit Patel, senior vice president of Fidelity's benefits consulting group. “But we still expect the (retirement health cost) number to be significant.”

Uncertainty over the cost of insurance coverage is further complicated by the potential rise in the cost of health care itself. Fidelity’s projection for how much would-be retirees need to save has fallen 12 percent from its high of $250,000 in 2010.

That drop largely reflects a sharp drop last year in Medicare spending, which rose just 0.4 percent per enrollee last year, and just 1.9 percent between 2010 and 2012. That’s well below the seven percent average annual increases between 1985 and 2009.

Overall, U.S. healthcare spending has been rising just 3.9 a year since 2009. That year, healthcare spending jumped 6.6 percent.

Part of the slowdown is the result of a weaker economy, according to economists. Spending increases have also slowed as many of the most common brand name drugs are now available in cheaper generic versions. The Affordable Care Act is slowing the rate of payment increases to hospitals, physicians and health plans. It remains to be seen whether those trends will continue.

Regardless of the changes in coverage and costs, the ultimate unknown is how long you’re going to live. As medical advances extend the average lifespan, projected health care saving requirements likely will have to rise accordingly.

The Society of Actuaries study, for example, found that a couple that expects to live until age 90 would need an average of $441,200 to meet out-of-pocket healthcare costs – more than double the cost of living to age 80.

Reuters contributed to this report.