For the past 16 years, the investment advice firm Fidelity Investments has released an annual estimate of healthcare costs for retirees. The company has an obvious motivation for doing this, aside from reminding you how little money you have saved up for the future: They want you to use their investment services. Regardless of Fidelity’s intentions, this year’s report found that a 65-year-old couple retiring this year should have $280,000 saved up to cover the costs of medical expenses “throughout retirement,” i.e., until they croak. In 2002, the first year Fidelity did such a report, that figure was $160,000.

Sure, the point of this is to scare you into getting retirement insurance, but it’s also a reminder that healthcare costs in the United States are absurdly high. Americans spend nearly twice as much on healthcare as people in other advanced industrialized countries, according to a 2016 study published in Health Affairs. This doesn’t mean that healthcare here is any better — it’s just more expensive. And since people are living longer, that means they’ll probably need to tuck away more money for when you’re old. (By the way, more than half of Americans have less than $1,000 in savings, which makes it no surprise that medical bills are the biggest cause of personal bankruptcy in the U.S., according to a 2018 study by NerdWallet.)

The solution to this, of course, is not to call up Fidelity for investment advice. After all, less than half of American workers in the private sector even have a 401(k) plan. And as the number of “gig economy” freelance jobs and involuntary part-time workers rises, it’s likely that a growing number of people won’t be able to plan for retirement at all.