A medical professional helps a woman with walker © Ocean, Corbis

After years of economic malaise, a surging stock market and rebounding home prices are putting more workers in position to retire comfortably. But many people are working later in life because of one key piece of the retirement puzzle: health care.

Take Richard Ivey, a CPA and the chief financial officer for an eye clinic in Cheyenne, Wyo., who long has dreamed of an early exit from work.

Ivey, 52, once assumed he would stop punching the clock when he turned 59-1/2, the age at which you can tap retirement funds without penalty.

The rising cost of health care has made him question that assumption.

"When I try to factor in paying for my health care," Ivey said, "that blows it out of the water."

Lack of affordable health care insurance is keeping millions of people from retiring. They're stuck in their jobs because they need the employer-provided medical coverage.

That could begin to change later this year, as new health insurance exchanges created by the Affordable Care Act begin ramping up for business.

Liz Weston

Liz Weston

Guaranteed coverage and premium subsidies could encourage fence-sitters at least to dip their toes into the waters of retirement, opening up new opportunities for younger workers, said Paul Fronstin, the director of health research and education for the Employee Benefit Research Institute.

And even if those older workers don't retire completely, "you may see more part-time employees and more people going out on their own, doing more entrepreneurial things," once they're no longer tied to employer-provided coverage, Fronstin said.

"Health care is a factor in retirement decisions," Fronstin said, "and it's a huge factor."

In a recent EBRI study (.pdf file), 82% of those surveyed said access to health insurance was important in their retirement planning, and 71%, said that medical expenses were either "extremely" or "very" important in their planning.

In addition, the study found:

  • More than half of workers polled (53%) said they planned to work longer than they wanted to keep receiving health insurance coverage through their employers.
  • More than one in four (27%) said they would retire earlier if they were guaranteed access to health insurance.

Joyce, who asked that her last name not be used, said she's among those who would bolt the workplace if she could.

"I am 62 and could afford to take early retirement" if she didn't need employer-provided health care coverage, Joyce wrote on my Facebook page. Even with her employer paying a chunk of the premiums, however, her costs keep going up. "I pay $506 a month now for two people, and next year that amount is going up by $139.99, which means my check is coming down by that much."

The vast "Obamacare" law could help in two significant ways.

First, it guarantees coverage by limiting the penalty for being older. Insurance companies won't be allowed to deny coverage based on someone's health status or charge her more because of her medical conditions.

As anyone who's shopped for individual health coverage knows, this is a huge change. Today, finding insurance coverage on your own when you have even minor health problems can be tough and often catastrophically expensive. Insurers will still be able to base premiums on your age, but they won't be allowed to charge older folks more than three times what they charge younger ones.

Second, the law caps costs for low- to moderate-income workers, currently set at just over $62,000 for a typical couple. At that level, premium costs would be capped at 9.5% of income, or about $500 month.

For a couple making half that, or $31,000 a year, premiums would be capped at 6.3% of income, or $163 a month.

You can see how the caps and other factors might affect your coverage by using this TurboTax health care eligibility calculator.)

While coverage under the caps won't necessarily be cheap, it compares favorably with the current cost of employer-sponsored health insurance, which averaged $1,312 a month last year, of which workers contributed an average of $359, according to the Kaiser Family Foundation.