The Kaiser Family Foundation just announced the results of its 2013 annual health benefits survey, which provides a great snapshot of the trends in costs and coverage for employer-based insurance. You can use the foundation's findings to save money on medical expenses now and to help you make smart decisions during open enrollment this fall, when you choose coverage for next year.
MODERATELY HIGHER PREMIUMS
Workers in small firms contribute a smaller share of the cost for single coverage than workers in larger firms do (16 percent vs. 19 percent), but small-firm employees contribute a much higher percentage for family coverage (36 percent vs. 26 percent).
The 4 percent increase is moderate by historical standards, but it comes on top of steady increases every year for the past 14 years. In 1999, the total cost for family coverage (both the employer's and the employee's share) was $5,791, and it was $2,196 for single coverage.
If both you and your spouse are employed and are offered health insurance coverage at work, figure first how much it would cost for each of you to stay on your own employer's plan and include the kids on the less expensive plan. Then calculate how much it would cost to cover all of you on your employer's plan or your spouse's plan, if it's an option (some employers are no longer providing coverage to spouses who can get insurance through their own employer).
One employer may provide a good deal for individual coverage, but the other may be better for family coverage. And don't look just at premiums; consider out-of-pocket costs and the extent of coverage, too.
RISING OUT-OF-POCKET COSTS
Premiums account for just a portion of health-coverage costs. Employers have also been boosting employee expenses over the past several years by raising deductibles and increasing employees' share of the cost of care.
The average deductible is $1,135 in 2013, which is only slightly higher than in 2012 but a significant jump over the past several years (the average deductible was just $735 in 2008). The average co-payment for a primary care, in-network office visit runs $23, and the average co-pay for a specialty visit is $35. But many people now pay coinsurance, or a percentage of the cost of the visit rather than a fixed amount.
Employees who pay coinsurance are expected to pick up an average of 18 percent of the costs of primary and specialty care, as well as an average of 18 percent for hospital admissions and outpatient surgery.
More plans are offering several pricing tiers for prescription drugs; 81 percent of workers are in plans that have three or more tiers of cost-sharing. The average co-pay for first-tier drugs (usually generics) is $10; for second-tier drugs, $29; for third-tier drugs, $52; and for fourth-tier drugs, $80.
The average co-pay for a hospital admission is $278; the co-pay for outpatient surgery averages $140. But nearly two-thirds of plans have imposed coinsurance for outpatient procedures rather than a fixed co-payment.
Some plans offer lower cost-sharing for certain kinds of care if you go to a retail clinic instead of the doctor's office, and some pick up more of the bill if you use a doctor from a high-performance provider network rather than a standard in-network doctor.
Choosing a higher deductible will generally reduce your premiums -- and if your deductible is higher than $1,250 for individual coverage or $2,500 for family coverage, you may contribute pretax money to a health savings account that you can use tax-free in any year for medical expenses.
Some employers even contribute extra money to their employees' accounts. (As long as your policy has a high enough deductible to be HSA-eligible, you may contribute pretax or tax-deductible money to an account even if your employer doesn't offer one.)
Now that more employers are switching over from fixed-dollar co-pays to coinsurance, you have more of an incentive to become a smart health care shopper. The lower the total cost for a procedure, doctor's visit or medication, the less you'll pay yourself. And with several payment tiers for drugs becoming the norm, it can be worthwhile to ask your doctor whether there's a generic substitute for your medication.
Many insurer Web sites and employer intranet sites include tools to help you find lower-cost alternatives to your medications.
CASH IN ON REWARDS FOR WELLNESS
Employers continue to offer incentives to improve employee health, such as weight-loss programs, biometric screenings, gym membership discounts or on-site exercise facilities, smoking-cessation programs, lifestyle or behavioral coaching, classes in nutrition or healthy living, Web-based resources for healthy living, flu shots or vaccinations, employee assistance programs, and wellness newsletters.
Some of these programs are more helpful than others, but a growing number of employers are offering financial incentives to participate, such as lower premiums, lower deductibles, a contribution to your health savings account, or gift cards or cash.
For example, more than 55 percent of larger employers offer biometric screenings to measure workers' health risks (such as cholesterol, blood pressure, stress and nutrition), and 11 percent of them reward or penalize workers financially based on specific outcomes.
Cost-cutting strategy: Find out whether your employer is offering financial incentives to participate in its wellness programs. You may discover that a program that was a hassle in the past is now worth your time -- and the money can add up if you participate in several programs.
The Kaiser Foundation survey shows the structure and costs of employer plans for 2013. Most employer plans aren't expected to make major changes in 2014 because of the new health care law but are likely to continue with current trends.
(c) 2013, KIPLINGER. ALL RIGHTS RESERVED. DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.
Open enrollment 101: How employees can save money on health care costs
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