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As medical advances extend the average lifespan, projected health care saving requirements likely will have to rise accordingly.

Planning for retirement usually means budgeting for food, travel and other expenses. Don’t forget to include $220,000 for health care costs. 

That’s how much the average 65-year-old couple will spend on medical expenses through their retirement, according to the latest estimates from Fidelity Investments.

If you’ve set your sights on retiring earlier, plan on squirreling away an even bigger savings pile. The average couple hoping to retire at 55 will spend $744,800 on out-of-pocket health costs if they both live to age 85, according to a separate study released Wednesday by the Society of Actuaries.

That’s if you’re relatively healthy later in life. Those averages don’t include the cost of treating chronic diseases like cancer or heart disease.

“People with those conditions spend about twice what the aver age population does,” said Dale Yamamoto, the author to the Society of Actuaries study. “So you need to take these numbers and double them.”

Those numbers also don’t include the cost of long-term care like a stay in a nursing home, which isn’t typically covered by Medicare.

The latest estimates for the average health care tab is likely to come as something of a sobering surprise to most people planning for – or in - retirement. In a separate survey, Fidelity found that nearly half of people aged 55 to 64 planning for retirement figured they would need just $50,000 to pay for health care costs.

Estimating those costs is the thorniest wild card in any retirement plan, largely because longevity and illnesses are so difficult to predict. Those variables are further complicated for Americans by the ongoing reform of medical insurance coverage in the U.S., both through the Affordable Care Act and proposed changed to Medicare.

“It’s more difficult today to try and give people meaningful guidance because the individual insurance market is going to change dramatically,” said Sunit Patel, senior vice president of Fidelity's benefits consulting group. “But we still expect the (retirement health cost) number to be significant.”

Uncertainty over the cost of insurance coverage is further complicated by the potential rise in the cost of health care itself. Fidelity’s projection for how much would-be retirees need to save has fallen 12 percent from its high of $250,000 in 2010.

That drop largely reflects a sharp drop last year in Medicare spending, which rose just 0.4 percent per enrollee last year, and just 1.9 percent between 2010 and 2012. That’s well below the seven percent average annual increases between 1985 and 2009.

Overall, U.S. healthcare spending has been rising just 3.9 a year since 2009. That year, healthcare spending jumped 6.6 percent.

Part of the slowdown is the result of a weaker economy, according to economists. Spending increases have also slowed as many of the most common brand name drugs are now available in cheaper generic versions. The Affordable Care Act is slowing the rate of payment increases to hospitals, physicians and health plans. It remains to be seen whether those trends will continue.

Regardless of the changes in coverage and costs, the ultimate unknown is how long you’re going to live. As medical advances extend the average lifespan, projected health care saving requirements likely will have to rise accordingly.

The Society of Actuaries study, for example, found that a couple that expects to live until age 90 would need an average of $441,200 to meet out-of-pocket healthcare costs –  more than double the cost of living to age 80.

Reuters contributed to this report.

It’s well known that U.S. medical costs are more than double that of other developed countries, which is why, in a bid to lower insurance premiums, companies encourage their employees to be healthy.

Exercise, they urge workers, eat fresh fruits and vegetables, limit fast food and – above all – don’t smoke.

Sometimes this encouragement takes the form of a wellness plan – maybe offering $25 gift certificates to those who meet personal goals – but some companies take a more aggressive approach. This week, CVS Caremark made waves when it told employees to reveal their weight – or pay a monthly $50 penalty.

The drug retailing company is not alone, and as many TODAY readers pointed out – is mild compared to what they’ve gone through to lower health care premiums. Dozens said they had to give blood samples, although not all were upset by the requirement.

“My company already does something similar to this and I don't see the big deal,” said one reader. “Technically it isn't mandatory. You can either submit the basic info (BMI, glucose, cholesterol, blood pressure) and pay a discounted monthly rate, or not submit anything and pay the full monthly rate. It's just a discount for submitting the info – just like for my car insurance I get a discount for submitting my mileage and for being a ‘good driver.’"

One reader, self-described as 50 and “in relatively good health,” wrote: “We had to give information of weight, height etc., then the ‘plan administrators’ came back and told us what is wrong with us. … They even had a pedometer tethered to my hip for over 3 months to monitor my physical activity.”

But many readers lambasted CVS for invasion of privacy.

Wrote one: “This is a MASSIVE invasion of privacy that is headed towards your employer tell you what and how much food you can eat, the number of beers you can consume and what activity, i.e. motorcycling, rock climbing or anything that might even remotely be considered risky.”

One reader was sarcastic, noting that CVS sells cigarettes: “I wonder if CVS will eliminate their candy display and other unhealthy items they carry?”

Other readers argued that people need tough love: “It seems like the only way to do this anymore is to hit people where it matters ... in their wallet.”

CVS Caremark has put its employees on notice that they need to reveal their weight or pay a monthly $50 penalty. 

“Avoid the $600 annual surcharge,” CVS warns its employees who use the company’s health insurance plan. They’ve been told they are required by May 1 to show up to a doctor for an annual WebMD Wellness Review and submit to tests for blood sugar, blood pressure, cholesterol and body mass and body weight.

“Going forward, you'll be expected not just to know your numbers - but also to take action to manage them,” the CVS policy states.

“There are no penalties based on the results of a wellness screening,” a CVS spokesman told NBCNews via email. “Choosing not to have a screening will result in a $50/month increase.” 

While many employers have been pushing its workers to get healthier, it’s usually through incentives rather than penalties. “This is about as coercive and blunt as I’ve ever seen,” said Dr. Deborah C. Peel, the founder of Patient Privacy Rights, a nonprofit organization based in Austin, Texas. 

“Many employers want to do something for their workers, but very few of them are stupid enough to say give us the information and sign this form and say it’s voluntary,” Peel said. 

Smokers working for CVS are also warned: “You must either be tobacco-free by May 1, 2014, or participate in the WebMD tobacco cessation program.” Defiant smokers can avoid penalties if they are healthy enough in other categories specified by the company. 

Despite the company’s promises, Peel worries if CVS and WebMD will be able to keep the employee records completely private. Peel said people are already declining to get health treatment for issues ranging from psychiatry to sexual diseases, for fear the information will not be kept private. 

In a statement, CVS said the employee health data will be kept private and it defended its new policy. CVS, which is based in Rhode Island, also said the company would never see the test results.

“The use of health screenings by employer-sponsored health plans is a common practice. According to a National Business Group on Health survey, 79 percent of employers offered a health assessment in 2011 and 76 percent of those employers offered incentives for completion. Also, 62 percent of large employers offered biometric screenings and 52 percent of those employers offered incentives for completion),’ the CVS  statement reads in part. 

“CVS Caremark is committed to providing medical coverage and health care programs for our colleagues and our benefits program is evolving to help our colleagues engage more actively to improve their health and manage health-associated costs. An initial step to accomplish this goal is a health screening and wellness review so that colleagues know their key health metrics in order to take action to improve their overall health, if necessary.” 

WebMD did not immediately respond to a request to comment on its program. 

The CVS policy was first reported Tuesday by the Boston Herald.

You want to please the boss? Put down the pastry. 

If there was any doubt that the Scotch-and-a-smoke days of "Mad Men" corporate culture are over, a new survey draws a picture in which large companies are rewarding employees for lowering their cholesterol and submitting to monitoring from a "primary nurse case manager."

Companies started building gyms and banning smoking on corporate campuses years ago, but their demands now go beyond getting on the treadmill or cutting out cigarettes. According to the survey by the consulting group Towers Watson, more than a third of employers penalize workers for not meeting health requirements, or plan to by next year. Some 80 percent plan to affect changes using rewards of up to $400 annually.

You might want to tell your significant other to drop the doughnut, too: Sixty percent of companies said they will extend such incentives to spouses. 

The survey of 538 midsize to large companies was conducted from November to January.

Measures aimed at reducing the per-employee cost of providing benefits coincide with slowing growth in health coverage expenses. Employers expect the average active employee to cost $12,136 this year. That's up 5.1 percent but is the lowest rise since the late 1990s.

Companies have controlled costs largely by pushing some of them onto workers. Employee health care contributions have climbed faster than those of employers in the past five years and are approaching 40 percent of the total cost, including premiums and co-pays.

But with salaries increasing slowly, there is a limit to what workers can handle, leaving benefits administrators searching for ways to reduce costs by keeping employees from needing health care in the first place. 

The survey found that corporations are also expecting more from providers: Forty-seven percent of respondents said they are or would soon tie payments to performance.

There's something to be said, of course, for your employer encouraging a healthier, happier you, whatever its motives. For younger workers at the upper end of the ladder, the next few years of rapid change will mean, at worst, paying closer attention to the options being offered.

Besides watching your waistline and potato chip consumption, you'll have to deal with tighter rules about whether your spouse's or your insurance pays for doctor visits. (You also may soon have to pay a higher premium for including your dependents at all on your plan.)

The picture is muddier for retirees and lower-wage workers, thanks to the health exchanges that were included in the Affordable Care Act of 2010 but don't go into effect until next year. 

Though the exchanges were designed to provide low-cost options and subsidies for people whose employers don't offer it or who can't otherwise afford it, companies are watching to see how they develop. A third of respondents told Towers Watson they view the exchanges as a possible solution for retired workers, and that percentage is expected to rise as the exchanges become active.

Lower-wage workers, even those on their company's plan, also may find themselves being off-loaded onto exchanges. 

"Some employers will be eliminating part-time coverage or structuring their plans to make the employer plan 'unaffordable' under the law so that low-wage workers can access the subsidies," said Randall Abbott, a senior health care consulting leader at Towers Watson. 

As health benefits become an increasingly precious commodity, they are evolving into "a proposition that attracts, retains and motivates employees," according to the Towers Watson report—and not a standard slate of goodies that automatically comes with the job. What kind of benefits you get may become the best sign of how much a company values you.

Think about that the next time you get up to make the doughnuts.

Wealthy women expect to be more active than their male counterparts in their retirement years, but they’re also more worried about outliving their retirement funds, according to a Bank of America Merrill Lynch study released Monday.

The study, which looks at affluent Americans’ concerns and financial priorities associated with retirement, found that most affluent baby boomers -- defined as the more than 75 million Americans born from 1946 through 1964 -- believe their retirement will be more active and prosperous than that of their parents.

Seventy percent of respondents said they expect to work, at least part time, to fund a more dynamic retirement, in which they expect to take up activities such as learning a new trade, or starting a new business. Bank of America spoke to 1,000 Americans with at least $250,000 in investable assets for the study.

Bank of America also found that affluent women expect to be more active than their male counterparts when they retire.

Eighty-six percent of women plan to travel, compared with 75 percent of men, while 64 percent of women plan to be involved in their community (only 43 percent of men said they plan to take a more active role in their communities). The study also found that 62 percent of women plan to dedicate more time to philanthropic endeavors, compared to 41 percent of men, but 24 percent of men plan to start their own business in retirement, compared with just 14 percent of women.

Women are also more concerned about the high cost of healthcare and worry their retirement funds won’t last through their lifetime, the study shows.

Seventy percent of women said they are worried about the cost of healthcare and 63 percent of women expressed concern about the longevity of their retirement assets, compared to 57 percent and 52 percent of men respectively.

If it seems like health insurance costs are eating up a bigger chunk of your paycheck than a decade ago, here’s one reason why.

The cost of family health insurance premiums grew much faster than most workers’ wages between 1999 and 2009, according to new data from the Economic Policy Institute.

The think tank compared the rise in premiums to the increase in wages for nonsupervisory and production workers, the bulk of the private sector work force.

They found that the health insurance premiums more than doubled over the 10-year period, while workers' earnings rose by about 38 percent. Overall inflation rose by nearly 30 percent during the period.

Most companies share the burden of health premiums with their employees, so it’s likely both you and your boss are grappling with the disproportionate jump in costs.

Related:

Your boss is feeling the pain of rising health care costs, too

Health care costs for retirees could top $100k

Mercer

Your healthcare costs are going up, but so are your employers'.

Employers shelled out $9,562 per employee, on average, for healthcare benefits this year, a 6.9 percent increase over last year, according to a survey of employers released Wednesday.

That's up from a 5.5 percent increase in 2009 and the largest percentage increase since 2004, according to consulting firm Mercer, which compiled the annual survey.

The Mercer survey, which this year included 2,836 employers with 10 or more employees, reported that costs rose most for companies with 500 employees or more. For those employers, costs went up by 8.5 percent, versus 4.4 percent for smaller employers.

Big companies are more likely to be self-insured, meaning they pay out of pocket for their employees’ health expenses.

Beth Umland, Mercer’s director of health and benefits research, said the bigger increase for those large employers is partly because healthcare treatment costs rose during the year. She said employees also may have sought out more healthcare treatments in 2010 after putting them off in 2008 and 2009 because of the recession.

Of course, employees also are feeling the pinch of rising healthcare costs. Mercer reports that the average deductible for PPO plans rose by more than $100 in 2010, to a whopping $1,200. PPO plans now make up around 70 percent of all employee benefit plans, according to Mercer.

Employers are finding other ways to cut their healthcare costs. Mercer said more employers are adding high-deductible options such as consumer-directed healthcare plans, and fewer companies are offering medical plans for early retirees.

A separate study, released by the Kaiser Family Foundation in September, found that workers are paying almost $4,000 on average for healthcare coverage this year, up 14 percent from a year earlier.