FRIDAY, Feb. 7, 2020 (HealthDay News) -- A large fraction of Americans nearing retirement age are worried they can't afford health insurance now, much less when they quit working to enjoy the good life, a new survey shows.

One in every four people between 50 and 64 are not confident they'll be able to afford health insurance during the next year, and nearly half worry they won't be able to afford coverage once they retire, researchers report.

"That number was a lot higher than I thought it would be," said study author Dr. Renuka Tipirneni, an assistant professor of internal medicine at the University of Michigan.

The innovations and protections created by the Affordable Care Act, also known as Obamacare, do not appear to have eased people's concerns about insurance costs, Tipirneni added.

"I thought that more people would have access to health insurance and perhaps for that reason they would be more confident about affording health insurance," she said.

These numbers come from the National Poll on Healthy Aging, an online survey of more than 1,000 Americans in their 50s and early 60s conducted in late 2018. The survey was sponsored by AARP and the University of Michigan.

The poll occurred shortly after the Republicans' plan to repeal the Affordable Care Act failed in Congress, at about the same time as the open enrollment period for employers' insurance plans, Medicare, and plans sold through federal and state marketplaces.

High out-of-pocket costs associated with health plans could be one reason why people fret about affording medical care, researchers found.

About 1 in 5 people said out-of-pocket costs had prompted them to not receive care for a health problem or skip filling a prescription during the past year, survey results showed.

Further, people in fair or poor health were four times more likely to have avoided care. Those who purchased an insurance plan on their own, rather than through an employer, were three times more likely to have not received care or not filled a prescription due to cost.

"When people are talking about affording health insurance in retirement, I think they're not just thinking about premiums," Tipirneni said. "They're thinking about other costs they'd have to pay out of pocket, like copays for medications, being able to afford the copays when you see the doctor. Even if you have health insurance and it's a good plan, there are still a lot of costs."

The political uncertainty surrounding the Affordable Care Act is also driving some of this worry, the survey found.

Two-thirds of the survey respondents said they were concerned how potential changes to national health care reform could affect them.

These concerns aren't trivial -- they've had real consequences on people's decisions regarding retirement.

Nearly 1 in 5 people said they've kept a job in the past year to maintain their employer-sponsored health insurance, and 15% of those working say they've either delayed retirement or thought about it to preserve their insurance coverage.

"This is a serious issue and has been for many years," said Cheryl Fish-Parcham, director of access initiatives for Families USA, a health care consumer advocacy group. "Before the Affordable Care Act, COBRA was the only real option for people in this age group to keep meaningful insurance if they had a health condition -- but the expense was out of reach for many.

"Now, people can get good individual insurance that will cover their conditions, and get subsidies if their incomes are up to 400% of poverty -- but coverage is still often unaffordable to people just over that income guideline," Fish-Parcham said. "Some federal proposals would extend subsidies to people 400%-600% of poverty, and California is starting such a subsidy program this year. This is one promising step to solving a very real problem."

There are several other political proposals being floated that could ease some of these worries, including an early buy-in for Medicare, a public option for marketplace plans, and even the controversial Medicare-For-All, Tipirneni said. But in today's political climate, it's hard to say whether any of these might gain any traction.

People aren't powerless in the face of these costs, though.

Folks can work with their human resources department or a health insurance navigator to make sure they've got the most affordable plan available to them, based on their individual health needs, Tipirneni said.

Keep in mind the most affordable plan for you might not be the plan with the lowest premium.

"That could be a plan that may have a higher up-front premium but then for your specific health conditions or medications will have lower out-of-pocket costs for the types of specialists you need to see or the types of prescriptions you need to take," Tipirneni said.

People also should talk to their health care team about ways to control costs.

"Studies show that people talk very infrequently to their health care professionals about costs of care," Tipirneni said. "Oftentimes when they do, there could be alternatives like a lower-cost medication that would work just as well or a different treatment pathway that would have lower out-of-pocket costs."

More information

The American College of Physicians has more about health care reform.