Health-care costs increasingly are hurting family efforts to save for retirement.

Thirty-six percent of Americans in 2006 -- up from 25 percent in 2004 -- say they cut retirement savings due to rising health-care costs. That's according to a survey by the Employee Benefit Research Institute and Mathew Greenwald and Associates Inc., of Washington, D.C.

This is bad news.

But there are ways for families to fight back against increasing health-care and insurance costs. The key: Save as much as possible and try to improve any health insurance coverage you get from employers.

Fred Brock, author of "Health Care on Less Than you Think" (Times Books), suggests weighing the following steps against added costs and benefits:

Get secondary coverage if possible. If you and your spouse both have group health insurance available at your jobs, each can sign up for the insurance and list the other as a dependent. Coordinated benefits under the two plans will almost always cover 100 percent of the bills.

"This strategy usually works only with employer-based group insurance, not with individual policies," Mr. Brock said. "It may cost you more in premiums each month, but can really pay off in the event of a serious illness or accident."

However, if the premiums are very high on one or both policies, you need to evaluate any extra expense in relation to benefits.

Does your spouse work and have a better or less expensive company health care plan than you do?

If so, consider skipping your coverage. Instead enroll yourself and any children under your spouse's plan as dependents. Be sure to ask your employer if there's a cash reward for declining the coverage at your company if you can show you have credible coverage elsewhere.

Consider keeping your coverage and letting your spouse and children get coverage under your spouse's employer coverage.

Does your employer pay for most of your coverage, but charge a lot for your spouse and children? If so, keep your employer coverage. But consider buying less expensive individual policies for the rest of your family. Caution: This strategy works only if your spouse and children are healthy with no pre-existing conditions.

Individual policies can be surprisingly inexpensive as long as you don't live in Maine, Massachusetts, New Jersey, New York or Vermont, he says. Individual policies in those states, which have laws protecting residents from being rejected for health insurance due to health reasons, cost more.

On the drug side, there are several ways to cut your expenses.

Shop for generics. Wal-Mart and Target now sell some for just $4 in most states -- not yet Pennsylvania. Check generic drug prices at other pharmacies and big box stores, such as Costco and Sam's Club.

Get your physician to prescribe a higher dosage of a drug, and then buy a pill splitter.

If your health insurance doesn't offer prescription coverage, consider a discount drug plan such as Careington International, www.careington.com, and AmeriPlan USA, www.ameriplanusa.com. Caution: These are not insurance plans. Also, before signing up, make sure they provide benefits in your area.

Many drug companies offer free or low-cost drugs for low-income individuals and families. Each company has its own income guidelines. Drawback: In many cases, the drugs must be sent to your doctor's office.

Be sure to visit www.ahirc.org for a database of several programs that may help with health-care costs.