Affluent Americans are concerned that health care and long term care costs will wipe out much of their wealth, according to a survey by the PNC Financial Services Group Inc., Pittsburgh.

The survey found 36% of nearly 1,500 affluent adults fear health care costs eventually will devour a major part of their financial assets. The worry is highest among those aged 45 to 64 (43%) and those with less than $1 million in investable assets (44%). Among those over 65, 25% admit to this concern.

Although economic issues such as stock market performance and inflation were respondents’ top financial fears, health care also was seen as among the biggest threats to their family’s wealth.

For example, 42% feared Medicare would eventually become insolvent. Among those with less than $1 million in investable assets, 49% expressed that fear. Among those aged 45 to 64, 49% feared Medicare failure.

Thirty-six percent also feared they would ultimately need expensive medical treatment or long term care. This was a concern for 42% of those with under $1 million in investable assets, but even 32% of those with more than $1 million had that fear. By age group, devastating health costs were feared by 37% of those 18 to 44, 42% of those 45 to 64 and 28% of people over 65.

For those with children under 18, 14% expressed the fear that their own children would ultimately have to pay for the parents’ long term care. The concern was greater for women (18%) than for men (12%). It was highest for those 18 through 44 (28%).

Of those with living parents, 24% were worried about their parents’ lack of LTC insurance.

Yet 69% of all respondents did not have any LTC insurance, including 74% of those aged 18 to 44, 73% of those aged 44 to 65 and 62% of those over age 65.

The top reasons respondents cited for not buying LTC coverage: the possibility they would never use it (36%) and cost (22%).

Even where individuals did not foresee illness or injury devouring their wealth, health was still a top concern, with 52% citing that as among their top two financial concerns, just ahead of sustaining and increasing their wealth (47%).

Other top financial issues: providing for family security and having enough money to support their lifestyle (both cited by 41%), and affording family health care costs (38%).

Apparently, none of these grim concerns was convincing many affluent Americans to do more financial planning, PNC notes. Its survey found asset protection planning lags even in wealthy households. For example:

o 69% said they do not have a comprehensive financial plan.

o 75% have written a will, but 39% have no health care proxy, which specifies medical treatment if one is incapacitated.

“The cost of health care is rising much faster than inflation, and the effect on family assets should be factored prominently into retirement planning and wealth preservation activities for all Americans,” said Thomas Melcher, a managing director of PNC’s wealth management unit. “Without proper financial planning, many people end up leaving a bankrupt legacy to the next generation.”

Melcher said the survey showed a widespread need for a number of asset-protection solutions for affluent individuals, including a health care proxy to spell out treatment desires and a health savings account to set aside tax-advantaged money for medical needs, estate plans, life insurance and grantor trusts.

The survey was conducted online in October and November by Harris Interactive Inc., Rochester, N.Y., among adults with annual incomes of $150,000 or above and at least $500,000 of investable assets if employed or, if retired, with at least $1 million of investable assets.