While they worry about how they will pay for their medications, elderly citizens who recently enrolled in Medicare and those nearing retirement age place a high value on the federally funded program to meet their present and future health insurance needs, according to Counting on Medicare, a report published July 21 by The Commonwealth Fund, a philanthropic health care foundation based in N.Y.

The organization's telephone survey of 2,000 adults ages 50 to 70 represents 39 million Americans nearing the Medicare eligibility age of 65, and 11 million more who recently have signed on to receive benefits.

The report shows that one-third of adults from ages 50 to 64 "trust Medicare" over employer-sponsored or individual plans to provide health coverage for people in their age range. More than one-third of Medicare beneficiaries ages 65 to 70 also picked Medicare as the top choice to provide health care for the 50-to-64 age group.

According to the report, one reason why 50-to-64-year-olds trust the program may be the high uninsurance rates and instability in coverage among people in that age range, as well as their increased risk for chronic or disabling health conditions. The survey says 5.6 million of the 39 million men and women in this age group are uninsured.

Confidence in Medicare runs highest among people who have had lapses in health coverage, the survey shows. Half of the uninsured adults in the 50-to-64 age range say they "trust Medicare the most" as a future source of their health insurance.

Nearly 80 percent of the Medicare beneficiaries surveyed rated their overall insurance — including supplemental coverage — as "good" to "excellent." However, more than half of them also say they are "very" or "somewhat" worried that they will be unable to afford necessary medical care, including medicines, when sick. Traditional Medicare does not include a prescription drug benefit.

One in six adults ages 65 to 70 spends more than $100 per month out-of-pocket for prescription drugs, the report shows. On an annual basis the cost adds up, the survey says, and amounts to an estimated 5 percent of income for 20 percent of the adults in this age range.

Lack of prescription drug benefits can leave adults financially strapped, says the Commonwealth Fund. One in 10 Medicare beneficiaries without drug benefits ends up facing a bill collector, according to the report. A similar number has so much difficulty paying medical expenses that they say they have had to change their lifestyles in order to economize.

Americans generally trust in Medicare to provide sound health care services, says Karen Davis, president of The Commonwealth Fund and a co-author of the report. "But many of these people fear for their financial security if they have to set aside so much personal income to pay for drugs needed to maintain good health," she says. "In today's health care environment, the lack of a prescription drug benefit means that even those with health coverage are often underinsured."