For all the talk about how uncertain health care insurance is in the near future, there is one thing you can count on: Women continue to face greater financial hardship when it comes to paying for health care, and their challenges only increase after retirement.

In other words — start saving now, if you haven’t already.

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Assuming average longevity for women and men, a recent report by HealthView Services shows that a healthy woman retiring this year at 65 and living to 89 will face health care costs of approximately $235,526 ($153,079 in today’s dollars). That is significantly more than the $199,946 ($135,321) for men, who are expected to live to age 87.

This doesn’t include all out-of-pocket costs. Additional expenses for hearing, vision, and dental bring a woman’s total lifetime health care costs to $314,673 ($205,468), compared to $267,395 ($181,625) for men.

That’s a lot of money!

“For some women under age 65, they forego purchasing health insurance and pay the 2.5 percent penalty for violating the individual mandate of the ACA,” said one health care advocate.

In general, women used to pay 50 to 80 percent more than men did for the same health care coverage, with the insurance industry basing its increased fees on a purely actuarial basis called “gender rating.” Insurers argued that women lived longer and went to the doctor more often than men. While women do access health care more often, this occurs primarily during the childbearing years. After age 55, costs equalize, according to Nancy Scola Lombaer, a partner in HUB International-Midwest in Chicago, Illinois.

At that point, the only difference is that women live an average of two years longer than men.

“Higher health insurance and health care costs translate into the increased feminization of poverty for pre- and post-retirement age women and poorer health outcomes for the affected population,” Dr. Ruth Linden, of Tree of Life Health Advocates in San Francisco, California, told LifeZette. Linden is a former professor at the University of California/San Francisco School of Medicine and Stanford University, and is now a health care advocate who helps clients with serious illnesses navigate the health care system.

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“Some women under age 65 forego purchasing health insurance and pay the 2.5 percent penalty for violating the individual mandate of the ACA,” Linden explained. “For these and other women, who may have health coverage but cannot afford to use it, the high cost of health care may also mean foregoing or delaying needed preventive and/or diagnostic procedures and treatment for life-threatening illnesses. This translates into higher health care costs for everyone, because it is almost always less costly to prevent or treat early-stage disease vs. advanced disease.”

HealthView Services, which provides health care data to financial advisers, found that women need to save an average of 20 percent more than men, due to those two additional projected years of life.

But that can be tough for a lot of women. Independent life and health insurance agent Colleen Callahan in Pleasant Hill, California, said women often have less savings because they work less when their children are young, lose income while on maternity leave, and often take time to care for sick children and elderly parents.

Related: Where Have Our Long-Term Health Benefits Gone? 

“Save more and look for work with companies that offer 401k plans with employer matching,” she told LifeZette. “Make sure to seek regular preventative services, those covered in network with no copay. If a woman waits and goes to urgent care, that will be subject to a deductible, a copay and, thanks to the ACA, very high maximum out-of-pocket expenses.”

According to Nancy Lombaer, if women have a defined benefit pension plan, they will collect more money than men over their longer lifetime — but she agrees women will have to stretch their 401k savings to keep themselves healthy.

Pat Barone, MCC, is a professional credentialed coach and author of the Own Every Bite! bodycentric re-education program for mindful and intuitive eating, who helps clients heal food addictions.