Health care in retirement is a big-ticket item. Experts estimate that an average 65-year-old retired couple in 2021 would need about $300,000 in after-tax savings earmarked for health care costs in their post-work life, even with Medicare, according to Fidelity.

The totals are daunting, but you can take steps to keep costs as low as possible with the right planning, good insurance choices and a healthy understanding of your conditions and coverage. Try these strategies — now and in retirement — to help control your health care bills.

1. TAKE ADVANTAGE OF AN HSA

A health savings account allows you to put pretax money away for medical expenses. You can invest the funds, and both the principal and earnings are tax-free if you use them for eligible medical costs, today or in the future. This creates a powerful savings tool.

To use an HSA, you must have a high-deductible health plan. If that kind of plan makes sense for you, experts recommend saving money to your HSA and leaving it untouched for as long as possible. In 2021, you can save up to $3,600 pretax as a single person or up to $7,200 if you have family coverage.

“These accounts are the most tax-efficient plans available,” says Sallie Mullins Thompson, a certified public accountant and certified financial planner in New York City. “The main thing you need to do is contribute to it religiously whenever you can.”

2. MAKE A PLAN FOR LONG-TERM CARE

A person turning 65 today has about a 70% chance of needing long-term care at some point, according to the Department of Health and Human Services. One of the best ways to approach this issue is to plan for it: How long do you intend to stay in your home? Where will you go when you can’t live there anymore? Who will help you with financial and health care decisions?

“People don’t like talking about it because it’s uncomfortable thinking about getting old and people taking care of you,” says Carolyn McClanahan, a physician-turned-CFP in Jacksonville, Florida. But planning can help you prepare for a change in circumstances.

This could mean buying a traditional long-term care insurance policy, which can cost thousands of dollars per year, according to the American Association for Long-Term Care Insurance. Or you might consider a hybrid insurance product that combines permanent life insurance with a long-term care rider. (You can use the benefit to pass money down to your heirs or — if you need it — you can tap it for long-term care expenses.)

You could also self-insure by setting money aside annually for long-term care expenses. The important thing is to consider your options while you’re in your 50s or early 60s, before products get too expensive.

3. GET THE RIGHT MEDICARE PLAN

Choosing the best Medicare policy once you turn 65 means finding one that includes your preferred doctors and your regular medications, helping you avoid high out-of-network and out-of-pocket costs. You’ll also need to consider whether you want access to all doctors who accept Medicare — as with an Original Medicare plan — or whether you want a plan that comes with extra benefits but a more limited provider network, such as a Medicare Advantage plan.

One way to approach Medicare is to find an agent who can help you compare options. Find someone who’s certified to sell as many carriers as possible, meaning they’ll be able to present the full array of choices in your area, says Matt Chancey, a CFP in Tampa, Florida.

4. ASK QUESTIONS

Be an active participant in your health care, no matter what life stage you’re in. When your medical provider orders tests, which can drive up your medical costs, make sure you understand why they’re being done.

“Say to them, ‘What do you hope to learn from this, and is doing this going to change the treatment?’” McClanahan says. “It’s important to do that, because a lot of times, doctors order things rotely. It’s part of their protocol and they don’t stop and think, ‘Is it really needed in this case?’”

The same goes for prescriptions. Ask your doctor whether there’s something less expensive you could take, or whether there are changes you could make that would help. “A lot of doctors won’t spend the time talking about lifestyle changes, so they throw pills at people,” McClanahan says. “You can avoid a lot of medications just by doing the right thing.” – AP