A 65-year-old couple retiring this year will need a quarter of a million dollars to pay for medical expenses throughout retirement, representing a 4.2% increase over last year, according to Fidelity Investments annual Retiree Healthcare Costs Estimate.

The Boston-based company found that even though healthcare costs during retirement are a significant financial concern for people, many are not doing enough to plan for them. Three of 10 retirees who answered the survey identified current health care costs and long-term expenses like paying for a nursing home as their biggest financial concern today. Yet, only three of 10 saved specifically for health care needs in retirement during their working years.

Fidelity’s nationwide study found that health care costs average $535 a month, second only to food, which averaged $659 a month. Furthermore, health care costs account for a fifth of an average couple’s total monthly expenses of $2,842.

“I think the first step for financial advisors is to make sure that people are aware what that liability looks like and how it grows over time,” said Brad Kimler, executive vice president of Fidelity’s Consulting Services business, which calculated the annual health care costs estimate. “I don’t think a lot of people quite understand this liability.

This year’s health care costs estimate is up 56% compared to Fidelity’s first survey in 2002, when the expenses were at $160,000. The survey of 376 married individuals, 65 years or older and not working full time, assumes individuals do not have employer-provided retiree health care coverage, but do qualify for Medicare.

Kimler said that people increasingly have access to health savings accounts through their employers, which is an effective way to save for long-term medical expenses. Employers must play a role in teaching employees how to use the HSAs and help employees fund them.

Although accessing health care coverage has not been an issue for people 65 and older because of Medicare, the health care reform bill signed into law by President Obama on March 23 has created “a much more efficient market for purchasing health insurance before 65,” Kimler said. But people still need to pay for it. Advisors must therefore help clients that are younger than 65 cover health insurance costs, helping them create a bridge to when they are eligible for Medicare.