Open-enrollment time is nearing -- are you ready?
Fall is open-enrollment season for most employees -- the time of year between late September and late November when you can change or newly enroll in your company's benefits, including health insurance.
While Obamacare has gotten the lion's share of attention lately, the reality is the vast majority of Americans, about 155 million, receive health insurance through their employer. Only an estimated 20 million get covered through the health care exchanges.
Fortunately for workers, the employer-based market is far more stable than the exchanges, but you still need to know about some important trends and keep expert advice in mind as you begin to slog through those lengthy health insurance documents likely clogging your email box this time of year.
The good news? Family premiums for employer-sponsored group health insurance plans rose just an average of 3 percent in 2017, according to the Kaiser Family Foundation/Health Research and Education Trust 2017 Employer Health Benefits Survey. That's a big contrast to the 20 percent average premium hikes for the individual market. This the sixth year of modest premium increases for workers, according to the study.
Encouraging as that trend is, it may not last. Employers' health care costs are expected to increase 6.5 percent in 2018, reports the PwC Health Research Institute, the first increase in three years. Employers may pass that hike onto employees in coming years.
That's an all too familiar situation for workers. Employees have been shouldering a much higher percentage of their companies' premium costs for years now. The average worker paid 32 percent of premium costs in 2017, compared to 14 percent in 2012, according to the Kaiser/HRET survey. That amounts to an average of $5,714 for family premiums. Employees at firms with fewer than 200 workers contribute even more -- an average of $6,814.
In addition, workers are paying a much greater percentage of their overall medical bills out of their own pockets. Consider deductibles. Companies are expected to continue to push high-deductible health care plans in 2018 as a way of passing more costs onto employees. At the same time, co-pays and co-insurance fees have also increased over the past few years, especially for prescription drug coverage.
In addition, more employers have implemented large surcharges for spouse, domestic partner and dependent coverage, according to data from the PwC Health Research Institute.
Employees are wrestling with these higher costs in the midst of stalled wage increases, making health insurance increasingly unaffordable.
All this underscores why workers need to take the upcoming open-enrollment period seriously. "Most employees just stay in the same plan they were in last year," said Tracy Watts, senior partner at Mercer, a benefits consulting firm. "But things could have changed, and this year's plan may not be the best financial decision for you."
Here are three steps you can take this open-enrollment season to land your best health insurance option.
Sweat the details. If your company is offering you more than one choice (and most large employers do), be sure to read through each offering statement carefully so you can weigh each option, even if you've been happy with your coverage in the past.
Do the math to determine if higher premium costs for a preferred-provider plan, the most popular choice among workers, will still be lower than what you would pay in deductibles and other out-of-pocket costs for a high-deductible plan.
Take a look at what you spent on health care last year and each plan's out-of-pocket maximums as a guide. Check to see if the plans pay 100 percent of preventive care, including annual physicals and screenings such as mammograms, before the deductible is met.
Keep an eye out for changes in your existing plan that can affect your calculations. Premiums and co-pays may rise in the coming year. And importantly, the number and types of prescription drugs that are covered may have changed also, potentially leaving you with a big pharmacy bill if the medicines you need are no longer covered.
Ask yourself what has changed with your health? If you or a covered family member has been injured or recently diagnosed with a chronic illness, you may find you need a different plan.
Finally, be aware that your company may offer an online health care decision tool that can help you with the comparison process
Make the most of a high-deductible plan. You may find the high-deductible option is the most affordable one for you, or as often happens, is your only affordable option. If that's the case, a health savings account -- a special account designed to help consumers save for costs associated with high-deductible health plans -- may take some of the sting out of the decision. As an incentive to get employees to sign up for high-deductible plans, many companies will make a contribution to your HSA.
These accounts offer a rare triple tax break: Your contributions are made on a pretax basis, earnings accumulate in the account tax free and qualified withdrawals for medical expenses aren't taxed. These accounts are portable, so they go with you if you leave your job.
It's worth noting that amid all the confusion in Washington over health care reform, making HSAs accessible to more people seems to have wide support.
Check out the latest trends. The big buzzwords in employer-sponsored insurance these days are Accountable Care Organizations (ACO), Value Based Care Networks and Narrow Networks. You may encounter one of these special networks during open enrollment as companies begin to embrace these new concepts, explained Greg Mansur, principal at PwC.
Essentially, these are different names for integrated networks of doctors, hospitals and other providers who are expected to coordinate all of your care and are accountable for the results.The jury is still out about how effective these networks are, although ACOs have been part of Medicare for a while now.
Consumers may balk because these networks often have fewer providers than those available in other plans. But Mansur suggests you should still take a close look. The selected providers may do a better job of coordinating the care you need -- and save you money.
