Money is apparently no protection from the terror that strikes at the hearts of Baby Boomers contemplating health care costs in retirement, according to the third annual Nationwide Retirement Institute survey.

A majority of survey respondents (72%)—all with at least $150,000 in household assets—say one of their top fears in retirement is health care costs going out of control. More than half (55%) believe the Patient Protection and Affordable Care Act (ACA) will increase those costs.

Fear has done little to inspire these pre-retirees to take action, however. More than one-quarter of employed affluent Baby Boomers (26%) say they believe they will never retire. More than two in five (45%) say they would delay their retirement if they had to buy their own health insurance.

Just two years ago, most affluent Boomers surveyed expressed little concern over health care costs in retirement. Last year, that number rose to 30% and jumped a bit higher this year, to 44% saying they believe it will be the biggest expense throughout retirement.

These concerns can be positive, says John Carter, president of Nationwide’s retirement plans business. On the one hand, they increase the conversations around health care costs in retirement, being a great starting point for advisers to help retirement plan participants assess and plan for these costs.

“We believe there is a lack of clear understanding around the Affordable Care Act,” Carter tells PLANSPONSOR, with four in 10 consumers saying they believe the ACA will increase health care costs in retirement. People just do not fully understand the entire benefits landscape, he feels, a picture that includes Medicare, Social Security benefits and long-term care. Nor do they fully understand how much they will need, to meet expenses in retirement.

“Their underestimate of what health care costs in retirement can lead to these fears,” Carter says, and in the wake of fear and misunderstanding, they fail to plan. According to the survey, just 23% of Boomers have discussed health care costs with a financial adviser. “It’s not just about the assets you accumulate,” Carter says.

More than three in five affluent pre-retirees (61%) say they wish they had a better understanding of Medicare coverage. Nearly two-thirds of affluent pre-retirees enrolled in Medicare were unaware the program does not cover long-term care costs. “There is room for us to educate more,” Carter says.

The survey yielded few surprises, Carter says, but it did highlight that a lack of knowledge around how to plan for the costs of health care in retirement continues to be a challenge for pre-retirees. He recommends using all available expense planning tools—such as Nationwide’s Personal Health Care Assessment—and calculators that can help remove the complexity.

As for Boomers who declare they simply will not retire, Carter notes that many say they will postpone retirement or forego it altogether, but only 3% of workers actually do that. For a range of reasons, including unexpected health issues and changes in work situation, the plan is undependable. “We don’t always have a say in the exact date when we’ll retire,” he says.

According to Carter, Nationwide is seeing individuals have more desire to learn how to create an income stream in retirement and how it can match up against liabilities. Since health care costs are a substantial liability, Nationwide’s goal is to move the needle, Carter says. “Not enough people are having these conversations.”

The online survey was conducted between October 6 and 14 by Harris Poll and surveyed 801 Americans aged 50 or older with at least $150,000 in household income.