BOSTON — If things weren't bleak before, they certainly are now. Men and women retiring today will need truckloads of money to pay for health-care expenses over the course of their retirement, according to a new study.

BOSTON — If things weren't bleak before, they certainly are now. Men and women retiring today will need truckloads of money to pay for health-care expenses over the course of their retirement, according to a new study.

And that was the case long before we learned that President Barack Obama plans to cut $313 billion in Medicare and Medicaid spending and reform this nation's health-care system. It's anybody's guess what retirees might need if those reform plans become a reality.

Obama proposed sweeping rule changes for financial products, including mortgage loans and bank accounts. Gail Hillebrand of the Consumers Union says that's mostly good news for consumers.

For the time being, at least, the reality is this: Men retiring at age 65 in 2009 will need from $68,000 to $173,000 in savings to cover health-insurance premiums and out-of-pocket expenses in retirement if they want a 50/50 chance of being able to have enough money, and $134,000 to $378,000 if they prefer a 90 percent chance, according to a study published last week by the Employee Benefits Research Institute.

Meanwhile, women — with their greater longevity — will need even more money. A woman retiring at age 65 in 2009 will need from $98,000 to $242,000 in savings to cover insurance premiums and out-of-pocket expenses in retirement for a 50/50 chance of having enough money, and $164,000 to $450,000 for a 90 percent chance, said Paul Fronstin, an EBRI researcher, in the report.

But it gets worse. Many Americans may need even more money than the amounts cited above, Fronstin said, because his "analysis does not factor in the savings needed to cover long-term care expenses, nor does it take into account the fact that many individuals retire prior to becoming eligible for Medicare."

Simply opening one's eyes to the issue is key, said Stephen Huth of CCH Inc., a Riverwoods, Ill., publisher and unit of Wolters Kluwer. "Just knowing this is a problem is a good first step," he said. "Few individuals plan for retirement at all, and a small percentage of those even think about health-care costs.

"Even with all the talk about health-care reform, little has been said about the looming crisis for many older individuals," he said.

What's the first step if you're 65 and you don't have $250,000 or $500,000 set aside just for health care? What can you do to prepare? Not much, according to Fronstin. If you don't have health benefits sponsored or subsidized by an employer, you don't have savings earmarked for health care and you're 65 now, you will most likely have to pay for health-care expenses, other than what's covered by Medicare, out of current income.

If you're 55 or younger and you have some time to plan, there might be some things you can do. The options aren't all that appealing, but they do beat dying sooner. Experts say you should reduce dramatically your standard of living, save aggressively, consider working longer, and try to stay as healthy as possible for as long as possible.

"It doesn't have to be a death sentence," said Stacy Hammond, director at Charles Schwab. But those actions combined will make paying for health care in retirement all the easier. To be sure, Hammond said, it's easier to control your day-to-day expenses than plan for possible expenses looming far off in the future. "But it's important that you control as much as you can," she said. Check out this Schwab site to learn retirement-planning tips from real people.

Along the way, be sure to fully investigate the following: Medicare and what it covers; Medigap, the supplemental insurance that typically complements Medicare; Medicare Part D, the prescription-drug plan; and long-term-care insurance.

Medigap insurance policies are sold by private insurance companies to fill the gaps in Medicare plan coverage. "Medigap policies help pay some of the health-care costs that the original Medicare plan doesn't cover," according to the government's Medicare.gov site. "If you are in the original Medicare plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health-care costs."

If you're 65 and in good health, it costs $86 to $191 per month to purchase a Medigap Plan F policy. Meanwhile, the average monthly premium for Medicare Part D coverage is $28 in 2009, according to the Centers for Medicare and Medicaid Services. Meanwhile, the standard Medicare Part B monthly premium is $96.40 this year. All in, you're looking at $315 per month just for Medicare-related costs. For his part, Huth suggested checking with AARP, the Blue and major insurers regarding their Medigap policies.

If you're not yet 65, make sure you can get coverage after retirement, Huth said. If you have pre-existing conditions, you may have to go through your state's program for those who cannot get private coverage.

Determining how much money an individual or couple needs in retirement to cover health care is a complicated process, Fronstin said.

"The amount of money a person needs will depend on the age at which he or she retires; length of life after retirement; the availability of health-insurance coverage after retirement to supplement Medicare and the source of that coverage; health status and out-of-pocket expenses; the rate at which health-care costs will increase; and interest rates and other rates of return on investments," he wrote in his report.

While it's possible to come up with a single number for individuals to use to set retirement savings goals, Fronstin said a single number based on averages will be wrong for the vast majority of the population. "It's hard to plan for uncertainty," he said. "But you can't plan for the average." Fronstin's advice? Ask yourself: Do you want to take chances or do you want some certainty? A 50/50 chance means it's no more than a coin toss whether you'll have enough money to pay for medical costs in retirement.

To help your planning, Somnath Basu, director of the California Institute of Finance, suggests using "age banding" to identify specific retirement costs and the rate of inflation associated with those costs.

According to Huth, health-care costs often rise at twice the rate of general inflation, and health care typically represents 12 percent to 14 percent of expenditures for those aged 65 and older.

Also, public-policy changes may affect spending on health care. That's where we now stand.

One thing is certain: Change is coming. That could make planning for health-care costs even harder. In fact, the reform plan as currently proposed does nothing to help those 65 and older, and it could make it worse for seniors enrolled in Medicare Advantage programs. Obama plans to introduce competitive bidding into the Medicare Advantage program — that could make the program less appealing to future retirees, say some experts.

In addition, some legislators are proposing allowing uninsured people age 55 to 64 to buy into Medicare. That could change your plan for health-expenses, too.

Suffice to say, it might make you sick to think about retirement health-care costs now. But not thinking about them could make you even sicker later.

Robert Powell has been a journalist covering personal finance issues for more than 20 years, writing and editing for publications such as The Wall Street Journal, the Financial Times, and Mutual Fund Market News.