If you're nearing retirement, make sure one of the most important and expensive aspects of your golden years—your future health-care needs—is not overlooked.
"You might start out just needing some help for a few hours a day, but that can progress to where your level of needed care increases significantly," said certified financial planner Avani Ramnani. "It can add up quickly."
Blowing through hundreds of thousands of dollars for medical expenses in retirement is a reality for many people.
According to data from Fidelity Benefits Consulting, a 65-year-old couple retiring this year will need about $220,000 to cover medical expenses throughout retirement, not including the cost of long-term care. This is unchanged from last year, but down from a peak of $250,000 in 2010.
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"Our clients are watching parents in their 80s or 90s deal with health-care costs," said Ramnani, director of financial planning and investment management for Francis Financial. "Because of that, they are getting more serious about health-care needs for themselves."
A Merrill Lynch study shows that Americans age 50 or older, regardless of wealth, peg medical costs in retirement as their biggest financial concern. Yet most of them have not factored those costs into retirement planning, and 70 percent of couples that age haven't discussed how much they should save to fund those expenses.
While health care is a key part of any financial plan, regardless of age, Ramnani and other advisors say workers within 10 years of retirement should take a detailed look at their anticipated medical costs in retirement. Included in that evaluation: your anticipated coverage, whether you face a gap between employer-sponsored insurance and Medicare, your current medical expenditures and whether you need long-term care insurance.
"The closer you are to retirement, the better an idea you have of your situation," Ramnani said.
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One tricky period has been the gap between employer-based insurance and Medicare, which kicks in at age 65. In 1997, 28.9 percent of early retirees were offered medical coverage through their ex-employers, according to the Employee Benefit Research Institute. By 2010, that number had dropped to 17.7 percent and is expected to continue dropping.
That gap is when the Affordable Care Act, aka Obamacare, can be a boon to some early retirees.
Certified financial planner David Jackson has a client who wanted to retire early several years ago, but the estimated $600 monthly expense for medical insurance was prohibitive. The ACA made it possible for her to retire this year at age 61 because her monthly premium is about $150.
As of this year, the ACA sets limits on how much insurers can charge older buyers, and insurers can no longer reject people due to preexisting conditions or charge them more because of one.
Additionally, if your income is within 400 percent of the federal poverty level, you might qualify for a subsidy. Most people see their income drop when they retire, so this provision in the law can be helpful for early retirees.
"The ACA might not help a high earner that much, but for ordinary people making $50,000 or $60,000 a year, it makes a huge difference," said Jackson, an advisor with Waddell & Reed.
Once Medicare kicks in at age 65, picking a plan differs little from choosing a plan at work or on an ACA health-care exchange. Different plans offer different coverage, but the Employee Benefit Research Institute says that in general, Medicare covers about 60 percent of the cost of heath-care services, not including long-term care.
Ramnani said that to arrive at an accurate number, her firm estimates what kind of coverage might be chosen by clients and by what they pay out of pocket currently.
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"They might be using out-of-network providers or have specific health-care needs not being covered by insurance," she said. "We assume those expenses will continue."
The biggest costs come from co-payments, deductibles and excluded benefits, along with out-of-pocket costs for prescription drugs and the cost of premiums for Medicare Part B (basic coverage) and Part D (prescription drug benefits). Premiums for Medicare are based on income; the higher your income, the more you'll pay. Beyond basic coverage, there also are other options that come with additional costs.
On top of all that are long-term care needs that arise from chronic illness, disabilities or other conditions that require daily assistance. Medicare doesn't pay for continuing care in nursing homes, assisted living or home-based aides.
That's where long-term-care insurance comes in. The cost is based on many factors, including your age when you purchase the policy and particular choices in coverage.
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Financial advisors recommend closely examining your options—especially because chances are that medical expenses will increase as you age.
"It's [typically] the end of life when you have the really bad stuff that costs a lot of money," said Ray Benton, a certified financial planner with Lincoln Financial Advisors.
That's where powers of attorney and a living will can come into play. A medical power of attorney gives an appointed person the right to make decisions about your medical care if you cannot. A living will makes it clear what measures you are or are not okay with when it comes to keeping you alive.
"You ultimately save money, but it's really more helpful for family members because they know what your wishes are," Benton said. "Without it, it's an emotional thing and a very hard decision for family members."
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The most important thing to remember, say advisors, is that medical care falls into the bucket of nondiscretionary spending. You can forego a vacation or a dinner out, but you can't avoid paying for health care.
"It's just part of your cash-flow planning," Bention said. "You should address it as you would any other necessary expense that will carry over into retirement."