Ford has secured a deal with its main union that will help it save an annual $850m (£498m) in healthcare costs.
All three big US car producers are aiming to reduce healthcare costs
The vote by members of the United Auto Workers (UAW) union was however close, with only 51% voting in favour.
Under the change, both retired and current Ford workers will have to pay extra for healthcare provision.
The Ford agreement was closely modelled on a similar deal achieved by rival General Motors. Fellow US car firm Chrysler is also seeking such a move.
All three firms are trying to reduce their giant healthcare obligations in the face of tough trading conditions.
As each has seen sales hit by increased competition from Japanese rivals and reduced consumer spending, their generous healthcare costs have been seen as an extra financial burden.
Ford expects to spend $3.5bn on healthcare this year, 13% more than in 2004.
In October it reported a third quarter loss of $284m.