With the dawn of a new year, most Americans have just started a new health insurance coverage period-if they receive their coverage through a job, buy it themselves or have a government plan.

But a new national poll suggests that many people in their 50s and early 60s harbor serious worries about their health insurance status, now and in the future. 45% say they have little or no confidence that they will be able to afford the cost of health coverage  once they retire.

And 27% said they are not sure they would be able to afford their coverage over the next year. One in ten said they had thought about going without health insurance for 2019, though only five percent had actually decided to do so at the time of the poll.

Another 19% of adults age 50 to 64 decided to stay in their current job rather than changing jobs or retiring, just to keep their job-related coverage. For those who changed coverage for 2019, 15% said they were postponing medical procedures until their new coverage kicked in. And 8% of those in their early 60s are putting off medical procedures until they are Medicare age.

The new findings from the National Poll on Healthy Aging also indicate that half of adults age 50-64 closely follow the news about possible changes to the Affordable Care Act, Medicare or Medicaid.

The poll was conducted well before a December court ruling about the Affordable Care Act's constitutionality-but already, 68% said they were concerned about their health insurance might change due to federal potential policy changes.

The poll of 1,024 adults in their pre-Medicare years was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, UM's academic medical center.

Renuka Tipirneni, M.D., M.Sc., a U-M health researcher who helped lead the poll design and analysis, notes that the closer adults get to retirement, the more important it is for them to understand options for coverage and associated costs.

"As people age into the years when many chronic diseases begin to take hold, and when they're still years away from Medicare coverage, it's important to talk with someone knowledgeable about all the options for coverage to bring down out-of-pocket costs and better navigate health care in this critical period," says Tipirneni, a general internist who has studied the public's health insurance knowledge and use.

Sources of insurance

The poll focuses on those approaching the "magic" age of 65 when most Americans qualify for Medicare health insurance. It was conducted in the fall, during the open enrollment period for many employers' insurance plans, and near the start of open enrollment for Medicare and plans available to individuals on federal and state marketplace sites.

Results from a national poll of people age 50-64, when asked about their employment decisions related to health insurance. Nearly two-thirds of those polled said their health insurance comes through their job or another person's job. Around 20% had Medicaid, Medicare or other government-provided insurance, and eight percent said they buy their own coverage.

"The Affordable Care Act was intended to cut down on 'job lock', where a person feels trapped in their job by their need to preserve their health insurance," says Preeti Malani, MD, director of the poll and a professor of internal medicine. at the UM Medical School.

"We were surprised by the low percentage of these adults who made their own coverage through the ACA exchanges , and the relatively high percentage who felt they had to keep a job or delay in order to keep a plan. help adults in this age group navigate their insurance options, "said Malani.