What are Americans most concerned about when it comes to retirement? Those age 65 and over ranked health as their greatest source of worry, according to a recent survey from Merrill Lynch and Age Wave. This represents a switch compared to Americans under age 65, who ranked finances as their top concern.

Of the over-65 group, 81 percent ranked health above all other considerations for a happy retirement, far higher than financial security, which garnered 58 percent of the vote. The vast majority of retirees (86 percent) said maintaining or improving their health could help them manage their out-of-pocket medical expenses in retirement.

But while most retirees know the steps they should take to improve their health, they don’t always get around to adopting those steps.

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For example, more than three-quarters report their retirement could be better if they took much better care of their health. The Merrill Lynch/Age Wave study found that compared to those who reported their health as fair or poor, retirees who reported their health as excellent or very good were twice as likely to exercise, eat nutritiously, maintain a health weight and stay socially connected.

Alzheimer’s is by far the scariest condition of later life, as 54 percent of respondents reported, more than all other diseases (cancer, stroke, heart disease, diabetes and arthritis) combined. Note that the health-oriented steps mentioned above can also help prevent, postpone or mitigate all of these conditions.

If you’re not taking all of these steps, what are you waiting for?

If you let your health slide, it will cost you financially. Indeed, health care costs are the biggest financial worry of many retirees. Half of those surveyed reported they’re concerned that they won’t have enough money to pay for out-of-pocket health expenses.

That fear is well-placed. If a married couple wants to have a 90 percent certainty they can cover their out-of-pocket health expenses in retirement, they’ll need $259,000 in savings, according the Merrill Lynch/Age Wave report. That’s more than the average home equity in the U.S. and more than the median net worth of Americans age 65 and older.

Almost half of retirees erroneously believe that Medicare will cover nearly all of their health care expenses in retirement. In reality, Medicare has substantial deductibles and co-payments, and it doesn’t cover most long-term care costs.

The best thing you can do is learn all you can about Medicare and supplemental health plans (also called Medigap plans) and avoid common traps for people who aren’t wary about the pitfalls. If you haven’t yet attained the Medicare eligibility age of 65, you’ll want to explore your options for health care coverage. If you haven’t taken these steps, you’re not ready to retire.

Course corrections

Here are the health-related steps survey respondents reported they’re willing to take to have a more financially secure retirement:

91 percent would make healthier choices now to save money later.

91 percent would use more generic medications and health supplies.

83 percent would reevaluate their health insurance plan.

77 percent would increase their use of free or low-cost community health programs.

74 percent would buy insurance for out-of-pocket health expenses, such as a Medigap or Medicare Advantage plan.

68 percent would purchase long-term care insurance.

63 percent would put off nonessential medical treatments or procedures.

58 percent would spend down assets to be eligible for Medicaid.

The first six steps are good options to explore, but frankly, the last two are just bad ideas. Putting off nonessential treatments has the potential to turn a mild condition into a serious one, moving the treatment you need from nonessential to essential. And to be eligible for Medicaid, you’ll need to spend down virtually all of your assets, and you’ll lose a lot of control over your finances and your life.

If you’re still working and are approaching your retirement years, you’ll want to get serious about participating in your employer’s health wellness program. They’re free for most employees, and you can get a customized plan to improve your health. Many programs offer financial incentives for you to take the right steps.

If you’re approaching your retirement years, consider that you have a new job: spending some time and effort planning for the next few decades of your life. After all, a happy, healthy retirement won’t just happen by itself. Taking steps to improve your health and ability to pay for health-related expenses should be at, or near, the top of your retirement to-do list.