Rodney Brooks, USA TODAY

Many people nearing retirement don't have a good feeling about whether they have saved enough to make it through retirement.

Add to that worries about health care costs in retirement, and those concerns are off the chart. They should be.

"I've seen people pay as much as $5,000 to $15,000 a month for their medical care in retirement," says Katherine Dean, managing director of Wells Fargo Bank.

According to the Employee Benefit Research Institute's annual survey, more than half of retirees surveyed this year are not confident that they have saved enough to pay their medical expenses during retirement.

EBRI says the average 65-year-old couple in retirement should expect to pay $163,000 in out-of-pocket expenses for health care, excluding long-term care. And even then, they have only a 50% chance of covering their actual costs. Add to that the annual rate of inflation for medical expenses of 5% to 7% for health care expenses.

So, how do you plan for that?

Start with two simple steps, Dean says. "There needs to be a better acknowledgement that paying for health care in retirement is a pretty major issue and something they need to incorporate as part of their (financial) plan. The next step is to do an estimate as to what these costs will be and incorporate it into the plan."

What Dean says you need to consider in your estimate: how soon you want to retire, how long you can expect to live, your current health status, the cost of medical care in your area, whether you will receive any employer health benefits and inflation.

Start with an honest assessment of your current health care costs. "Break it down," says Kimberly Foss, founder of Empyrion Wealth Management in Roseville, Calif., and author of the book Wealthy by Design. "If you are 55 or 58 and you have significant health issues, you need to figure out what those costs are now and apply them to retirement."

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How to plan for health care costs in retirement