But that coverage won’t come cheap, as premiums, deductibles and cost sharing continue to rise, sometimes even more steeply than in previous years. More employers are also moving to high-deductible plans that shift more expenses onto their employees, requiring them to pay more before benefits kick in. And companies are making it pricier to insure spouses and children.
There is a bright spot, however: Employees who participate in the increasing number of company wellness programs can often reduce premium and other cost increases.
“It makes sense for the employer,” says Ron Fontanetta, a director at benefits consultant Towers Watson. “They’re trying to encourage healthy behavior. If people participate, [employers expect they] will see a reduction in overall costs, while employees will see an opportunity to mitigate their out-of-pocket costs.”
Employees are going to need that helping hand. According to the Kaiser survey, premiums for family coverage rose 9 percent this year, to an average of $15,073 a year. The employee share of that was $4,129. For employer-provided individual coverage, premiums rose 8 percent, with workers typically picking up $921 of the average $5,429 annual tab.
Mary and Jon Berg have coverage through the Las Vegas landscape company where Jon works. Last year, the company asked employees which they would prefer for the company’s two health plans: higher premiums or higher out-of-pocket expenses. Rather than raise premiums, the employees, many of whom don’t have high health-care costs, voted for higher out-of-pocket expenses through deductibles.
The change has been hard on the Bergs.
Mary is being treated for a gastrointestinal stromal tumor, a type of soft-tissue cancer. The couple pays $70 weekly for coverage through the company’s HMO plan. Under the new cost structure, they now have a $250 deductible, and they have been paying $150 every time Mary visits the emergency room, an increase from $50. The changes came on top of the co-payments the Bergs already make of $110 monthly for Mary’s daily Gleevec cancer pill and $750 for annual PET scans, among other out-of-pocket expenses.
They’d like to join the company’s other health plan, a PPO that would give them access to a wider network of doctors. But that plan costs an additional $40 a week in premiums and has a $1,500 deductible. That’s more than they can afford. Mary says they’re anxiously waiting to hear now about the cost of coverage for 2012. “They’ve indicated possible premium increases,” she says.
While most people are still enrolled in traditional plans such as HMOs and PPOs, employers continue to shift toward “consumer-driven health plans” or high-deductible health savings plans.