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Chances are, health care will be one of your biggest expenses in retirement. Qualifying for Medicare coverage at age 65 will quell some cost and coverage worries. Although Medicare is far more affordable than private health insurance coverage for seniors, the government health insurance program still leaves retirees with significant out-of-pocket costs.Consider this: A typical 65-year-old married couple without chronic conditions will need $197,000 to pay for out-of-pocket medical costs throughout retirement, according to new calculations by the Center for Retirement Research at Boston College. That figure includes insurance premiums, services not covered by Medicare and home health care expenses, but it excludes nursing home care. Retirees also have a 5% chance that health care costs that are not covered by insurance will exceed $311,000, according to the study, which was underwritten by Prudential.

“Regular ongoing out-of-pocket costs can really cumulate over the years,” says Anthony Webb, the associate director of research at the Center for Retirement Research and a co-author of the study. “There is no substitute to having a lot of money stashed away.” Other researchers have come up with similarly large numbers. Fidelity Investments estimates that a couple, both age 65 in 2009, will need approximately $240,000 to cover medical expenses throughout retirement. And the Employee Benefit Research Institute determined that a 65-year-old couple in 2009 will need $210,000 to have a 50% chance of affording their retiree health expenses and $338,000 to have a 90% chance of being able to pay all their medical bills.

These eye-popping numbers are generally a tally of small expenses that add up throughout retirement. Here are the latest estimates of the health expenses most Americans will face:

Premium prices. Insurance premiums are the most predictable retirement health cost. “There’s more certainty to paying a premium than there is to paying your own expenses out of pocket,” says Paul Fronstin, a senior research associate at the Employee Benefit Research Institute.

For most people retiring in 2010, the Medicare Part B monthly premium is $110.50. That price is usually deducted from a beneficiary’s Social Security check before it goes in the mail. Retirees who earn more than $85,000 annually ($170,000 for couples) pay higher premiums, up to $353.60 monthly.

Medicare Part D prescription-drug coverage premiums vary, depending on the plan and coverage level, typically averaging $30 per month. Many retirees also purchase supplemental insurance to Medicare, such as Medigap policies, or arrange coverage through a former employer.

Cost sharing. The amount you will pay for co-pays and co-insurance for medical treatment in retirement is much more difficult to estimate. Retirees without supplemental insurance must pay 20% of the bill (at Medicare-negotiated rates) for physician and outpatient services after meeting a $155 deductible in 2010.

“There is no out-of-pocket limit with Medicare,” points out Sunit Patel, a senior vice president at Fidelity. “When you have no supplemental policy, you could have a lot of volatility from one year to the next.”

Long hospital stays are also not completely covered. For example, a Medicare Part A recipient without supplemental coverage who is admitted to a hospital will be billed a $1,100 deductible for 2010, up $32 from 2009. If the hospital stay is more than two months, beneficiaries must pay an additional $275 per day for days 61 through 90, $550 for days 91 to 150 and all costs after that.

Above-average prescription-drug use could further inflate retiree health expenses, especially if you reach the gap in prescription-drug coverage known as the doughnut hole. Some prescription-drug costs can be controlled by shopping around for the lowest-cost Part D plan that meets your coverage needs annually.

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