Sixty-nine percent of them would be interested in deducting those earnings from their paychecks to be placed in a special account for health care costs not paid by Medicare, the Commonwealth Fund said Tuesday.

The Washington-based private foundation's survey of 2,000 boomers and older adults also found that 73 percent favor allowing people in their 50s and early 60s to buy into Medicare through a higher monthly premium.

'Ideas with Legs'

"We learned that people aged 50 to 70 fear they won't have enough income and savings to retire and afford needed medical care," said Karen Davis, president of the foundation, which supports research on health issues.

The foundation suggested the savings accounts and early Medicare buy-ins as solutions to older adults' health insurance woes when it took the survey late last year, Ms. Davis said. Neither has been fashioned into a legislative proposal.

"These are ideas with legs and worth considering," said John Rother, director of policy and strategy for AARP.

As more employers scale back health coverage for retirees, people who leave the workforce before 65 are vulnerable to high medical costs, said Sara Collins, one of the survey's authors.

Many older adults try to go without health coverage until they qualify for Medicare at 65. Others attempt to buy individual health insurance policies that still leave them underinsured.

Ms. Collins said half of the older adults who can afford individual insurance policies pay more than $3,600 a year in premiums. A quarter of them spend more than $6,000 annually for coverage.

Serious Hardships

The Commonwealth Fund survey said large out-of-pocket medical expenses are creating serious hardships for the uninsured and underinsured. Some older adults delay filling prescriptions and seeing their doctors.

"If people don't seek treatment for their chronic health conditions in their 50s and early 60s, they'll enter the Medicare program at age 65 in deteriorating health and require much more costly care," Ms. Collins said.

Mr. Rother said the survey should sound alarms for aging boomers.

"Boomers may be in a far more precarious position than their parents because many will have neither the retiree health benefits nor the defined-benefit pensions that the previous generation did," he said.

Ms. Davis said people who bought into Medicare early would pay substantially more than if they waited until 65. Without any public subsidy, the monthly premium would cost $300, she estimated.

Subsidies or tax credits could be linked to a person's income to encourage buy-ins, the survey suggested. Lower-income participants might pay no more than 5 percent of their income for coverage, while higher-income participants might pay up to 10 percent.