If you’re among the 149 million Americans who get health insurance at work, now may be the time to select your health insurance coverage options for 2015.
History shows that many employees are inclined to stick with the plan they had last year — if that’s still an option. But as the price of health care continues to rise, employers are making changes that can impact both your costs and access to care.
“I would say in particular this is a year to pay attention to annual enrollment,” says Brian Marcotte, president and CEO of the National Business Group on Health, a nonprofit association that represents large companies.
Here are six health benefit changes to watch for in your work-based health insurance benefits for 2015.
1. Higher out-of-pocket costs. Insurance premiums — the cost of your health plan that’s typically deducted from your paycheck — will go up in 2015, though at a lower rate than in years past.
According to an annual survey by the NBGH, large employers are projecting an average increase in costs of 6.5 percent in 2015. However, by making changes to health benefits, costs are expected to rise by just 5 percent.
Next year, many companies are shifting costs to workers in the form of higher deductibles, copays and co-insurance. And, according to Marcotte, more employees can expect to see “consumer-directed health plans”, among their options for coverage. These policies generally have lower monthly premiums but higher deductibles — cash you’ll have to pay for care before getting any help from insurance.
In fact, according to NBGH’s annual report, 57 percent of large employers are offering high-deductible plans for 2015; nearly one-third of companies (32 percent) are making these plans the only option. That’s an increase of nearly 50 percent as compared with this year.
If you don’t go to the doctor much, you may be able to save with a high-deductible plan, which reduces the amount of money that comes out of your paycheck, says Michael Thompson, a health care consultant with PricewaterhouseCoopers LLP. If you go for care frequently, however, you may do better with a plan that pays for more costs up-front.
Most important, Thompson says, is to understand what the worst case financial scenario is with any plan you choose. “Look at the maximum out-of-pocket expenses, and ask can I afford that. That’s a very important consideration for anybody. If you’re uncomfortable with the level of risk, go with a plan with a higher premium,” and lower out-of-pocket costs, he says.
2. Changing networks. Changes to provider networks are common from year to year, so you should always check to make sure your doctors participate in the plans you’re selecting.
About one-fourth of employers include a plan with narrow provider networks — those with fewer doctors that participate with the plan. About half of those firms offer employees incentives to join plans with narrow provider networks, according to the NBGH survey.
“The most important thing is to know who is in the network because health plans will always pay much more generously toward in-network services,” Thompson says.
Another growing trend among employers is to encourage the use of telemedicine and retail health clinics located in grocery stores or pharmacies. These alternatives to the doctor’s office allow you to get quick, convenient care for minor ailments, often at a lower cost.
3. Pharmacy networks also change. Pharmacy networks and pricing for prescription drugs also change from year to year. As has been the case for years, generic drugs will be promoted over expensive brand-name medications.
To help control rising costs, some employers are placing tighter controls over specialty medications used to treat rare and complex diseases. You may need to get approval more frequently and/or be required to have your specialty medication administered at lower-cost locations.
4. Paying more for your spouse. If you plan to cover your spouse with insurance offered through your job, you may see a higher price tag next year.
“We are seeing a trend in employers charging surcharges for a spouse if the spouse has coverage through their own employer,” Marcotte says.
According to the NBGH annual survey, most large employers offer spousal coverage, and nearly 3 in 10 apply a premium surcharge for spouses.
5. A push toward wellness. Employers continue to look for ways to keep workers healthy, so be prepared for incentives to get involved in wellness programs. According to the Kaiser Family Foundation’s annual Employer Health Benefits Survey, nearly all large employers and most small firms offer at least one wellness program.
If you participate in health improvement programs such as anti-smoking and weight-loss plans, you may have a chance to earn back some of your increased cost-sharing. Employers often reward participation with lower insurance premiums and contributions into health savings accounts, says Michael Dermer, chief incentive officer for Welltok, a health engagement company. In fact, about $600 per employee is typical among large companies, Dermer says.
Many employers require you take action, and in some instances complete biometric screenings, health risk assessments or some type of health coaching before paying up.
What you’ll find now is rewards are being extended to participating in and completing programs the employer sponsors, and in some cases showing demonstrated improvement in their health status,” Thompson says.
6. New decision support tools. As you shoulder more responsibility for your health care costs, employers are offering tools to help you make informed decisions about your benefits and medical care.
Nearly 3 in 4 companies (73 percent) surveyed by the NBGH said they’re adding or expanding tools to encourage employees to be better health care consumers.
“Employers are helping employees, at a minimum, with calculators to help them choose between various levels of plans and understand what they’ll pay out of pocket,” Thompson says. “Those calculators are intended to help consumers make an educated choice.”
Price transparency tools, access to physician quality information and information about how to avoid unnecessary treatments may also be available.
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6 Changes in Work-Based Health Insurance Benefits originally appeared on usnews.com
