Linda Carruthers, 62, is trying hard to keep her health insurance. The premium in her group plan will rise more than 45 percent in January, to $9,336 a year. She lives on a fixed income and worries how she can afford to live.

Her insurer, Independence Blue Cross, says the premiums are climbing because the costs of care for retirees in her plan exceeded premium payments last year.

A Wharton School insurance expert says Carruthers, who is relatively healthy, might find a cheaper individual plan on the open market, but she is reluctant to leave the security of her group plan.