When it comes to thinking about how much money we all need to retire comfortably, it gives us a headache. I just need to say that upfront before telling you the latest news, which is sure to scare you even more about retirement.

You probably know that health care is likely to be among your largest expenses. But how much?

In its annual look at medical expenses for retirees, Fidelity Investments said a couple, both 65, retiring in 2013 would probably need $220,000 to cover health-care expenses if the husband lives to 82 and the wife to 85, the average life expectancies.

Oh, and in case you’re thinking, “Why yes, that makes sense if you add in possible nursing-home costs or long-term care expenses” — think again.

The estimate does not include those costs. It applies to retirees with traditional Medicare insurance coverage.

But there’s an upside. The $220,000 is an 8 percent drop from last year’s $240,000 estimate.

“These numbers matter because health-care-related costs will eat up a good portion of one’s savings in retirement, but it seems to be the cost that individuals have the least amount of awareness of,” said Brad Kimler, executive vice president of Fidelity Benefits Consulting.

Fidelity’s estimate assumes that an individual does not have employer-provided retiree health-care coverage. And this assumption is for a good reason. Another report released last year from the Employee Benefit Research Institute found that fewer private-sector employers are offering retiree health benefits. Between 1997 and 2010, the percentage of non-working retirees over 65 with retiree health benefits fell from 20 percent to 16 percent.

EBRI says that even the employers who are still offering retiree health benefits have made changes to their plans that have raised premiums, tightened eligibility, limited or reduced benefits, or some combination of all these.

“Because employers are under no obligation to provide retiree health benefits, except to current retirees who can prove that they were promised a specific benefit, and because (unlike defined benefit pension plans) employers are not under any obligation to pre-fund retiree health benefits, it is likely that employers will continue to make changes to those programs, especially for future retirees,” the ERBI report said.

Fidelity’s calculation takes into account deductibles and coinsurance associated with Medicare Part A, which covers hospital care, and Part B, which covers services such as lab tests and doctors’ visits. It also considers the premiums for prescription drug coverage under Medicare Part D and out-of-pocket costs, including services that aren’t covered by Medicare.

The estimate does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care.

Here’s how Fidelity’s retiree health-care cost estimate breaks down:

44 percent for Medicare cost-sharing expenses such as co-payments, coinsurance and deductibles. This would include the costs of a doctor’s office visit or outpatient services and expenses that aren’t included in Medicare, such as vision and hearing exams, eyeglasses and hearing aids.

33 percent for monthly outlays for Medicare Part B and D premiums, assuming enrollment in the standard Medicare Part D prescription drug coverage. It does not include the higher income-related premiums.

23 percent for prescription drug out-of-pocket expenses, such as co-pays and amounts not covered by Medicare Part D.

Medicare generally covers only about 60 percent of the cost of health-care services (not including long-term care) for beneficiaries 65 and older, according to EBRI.

You might dismiss the Fidelity survey as self-serving. The company wants your investment business. But regardless of the messenger, the message remains the same. You have to prepare for health-care costs.

Or just don’t plan on getting sick.

I was being facetious with the last point. But one of the reasons there was a decrease in the lifetime health-care cost is that people weren’t seeking treatment, Fidelity said. “The economic downturn that began in 2008 led to a decrease in utilization of health care services as many Americans were faced with financial challenges,” the company said when it releasing its data.

Although Fidelity’s annual retiree health-care cost estimates have been more than $200,000 since 2006, a poll of people age 55 to 64 found that nearly half of them believed they would only need $50,000 to pay for health-care costs in retirement.

“Unlike other needs like housing or food, many drastically underestimate health-care costs and therefore don’t incorporate it into their overall retirement plan,” Kimler said. “These numbers aren’t meant to scare people but to educate people on the reality so they can take the necessary steps to plan for them while they are still working and saving.”

So, you’ve got some saving to do.

Readers may write to Michelle Singletary at The Washington Post, 1150 15th St. NW, Washington, D.C. 20071 or singletarym@washpost.com. Personal responses may not be possible, and comments or questions may be used in a future column, with the writer’s name, unless otherwise requested. To read previous Color of Money columns, go to postbusiness.com.