Employers are considering a variety of approaches to better control the cost of health care coverage to pre-Medicare eligible retirees — including shifting to high-deductible plans and moving to private or public insurance exchanges, according to a survey released Tuesday.

For example, 42% of employers surveyed by benefit consultant Towers Watson & Co. say they currently offer the early retirees a high-deductible health care plan linked to health savings accounts, with another 8% saying they are considering adopting such a design in 2016 or 2017.

In addition, 45% of employers said they have placed a dollar cap on how much they will contribute toward the cost of coverage.

Employers also are growing more confident that public exchanges— authorized by the health care reform law— could be a viable alternative to directly providing coverage to pre-Medicare eligible retirees.

While only 8% of surveyed employers now have confidence in the public exchange approach, 35% are sanguine that the approach will be viable by 2017.

In fact, in some cases, pre-Medicare eligible retirees could be better off when obtaining coverage through a public exchange. That is because lower-income, pre-Medicare eligible retirees — those earning less than 400% of the federal poverty level, which comes to $46,680 for an individual or $95,400 for a family of four — are eligible for federal premium subsidies to use to buy coverage in public exchanges.

In fact, in one widely-discussed approach, employers can terminate their early retiree health plans and establish and contribute to health reimbursement arrangements for retirees.

Retirees then have a choice: tap the HRA to pay health insurance premiums purchased through a public exchange or, particularly for lower-income retirees, skip the HRA contribution in favor of a likely larger federal premium subsidy to buy coverage. Alternatively, employers might also make a private insurance exchange available, with the retirees using the HRA contribution to obtain coverage through those exchanges.

The Towers Watson survey is based on the responses of 144 employers.

“Pre-65 retiree medical plan sponsors have been eagerly awaiting options to deliver value to their early retirees,” Trevis Parson, Towers Watson's chief health actuary in Philadelphia said in a statement.