NEW YORK (CNNMoney.com) - An average couple retiring this year will need $200,000 to cover their healthcare costs for 20 years in retirement, not including the expense of long-term care should they need it.

That's according to Fidelity Investments, which released its fourth annual estimate of retiree medical expenses on Monday.

The $200,000 cost estimate is a 5.3 percent increase over last year's estimate of $190,000. It reflects the costs for an average couple who do not have any employer-provided retiree health coverage, which is increasingly typical.

Moreover, the average couple's healthcare costs in retirement are likely to be the same whether you're a low-, middle- or high-income retiree, said Brad Kimler, senior vice president of Fidelity Employer Services Company in a conference call.

Fidelity's estimate can be broken down into three parts:

• The cost of premiums for Medicare Parts B and D
• Out-of-pocket costs for prescription drugs
• The ever-amorphous category "other." This category includes copayments, coinsurance and deductibles for doctor visits, out-patient services and other hospital costs; some preventative care; routine vision and hearing exams complete with glasses, contacts and hearing aids.

When it comes to planning for retirement, "most people don't plan for healthcare costs separately," Kimler said.

One thing those with many years until retirement can do, Kimler said, is to treat health savings accounts (HSAs) as more of a long-term vehicle for healthcare savings rather than just a tax-advantaged account to pay for their current out-of- pocket healthcosts.

HSAs, created in 2003 but not yet widely offered by employers, are accounts to which you and your employer may make tax-free contributions up to a cap. Money in the account may be used to pay for eligible out-of-pocket medical expenses that you would incur to meet your health insurance plan deductible. Money invested in the account that you don't use may remain in the account and grow tax-free.

In order to have an HSA, you must sign on to a high-deductible health insurance plan that covers you in the event of a serious medical condition or catastrophe. Premiums for high-deductible plans typically are lower than they are with more traditional plans.

Given how new the accounts are, arguments for and against them are not borne out yet by much hard data. But a recent study by the Employee Benefit Research Institute found that those with HSAs spend more money out-of-pocket on healthcare expenses than those in more traditional healthcare plans.

It also found that those with HSAs are more likely to avoid, skip or delay healthcare.

HSAs as a long-term savings vehicle may make the most sense if you have few healthcare needs today or a lot of disposable income to pay for them. If you're uninsured or have a hard time meeting your healthcare costs -- to say nothing of putting money away for retirement – that may make them less advantageous.

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