insurance

How Employees Can Save Money on Health Care Costs

Use these strategies to save money on medical expenses and make smart decisions during open enrollment.

What changes in premiums and coverage for employee health insurance can I expect in 2014, and how can I reduce my costs?

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. Premiums for employer-based health insurance rose by 4% from 2012 to 2013. Total annual premiums now average $16,351 for family coverage, with workers paying an average of $4,565 for their share of the cost. Premiums for individual coverage are averaging $5,884 annually, with employees paying $999 of the cost. Workers in small firms contribute a smaller share of the cost for single coverage than workers in larger firms do (16% versus 19%), but small-firm employees contribute a much higher percentage for family coverage (36% versus 26%).

The 4% 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.

Cost-cutting strategy: 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% of the costs of primary and specialty care, as well as an average of 18% for hospital admissions and outpatient surgery (see below).

More plans are offering several pricing tiers for prescription drugs -- 81% 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.

Cost-cutting strategy: 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.) See FAQs About Health Savings Accounts for more information.

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 is 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. See 30 Ways to Cut Health Care Costs for advice on saving money on medical and drug expenses.

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% of larger employers offer biometric screenings to measure workers’ health risks (such as cholesterol, blood pressure, stress and nutrition), and 11% 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.

Future changes. 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. See The Health Law’s Impact on Employer Coverage for more information about how the health care law affects employer plans.

Most Popular

Where's My Stimulus Check? Use the IRS's "Get My Payment" Portal to Get an Answer
Coronavirus and Your Money

Where's My Stimulus Check? Use the IRS's "Get My Payment" Portal to Get an Answer

The IRS has an online tool that lets you track the status of your second stimulus check.
January 18, 2021
When Could We Get a Third Stimulus Check?
Coronavirus and Your Money

When Could We Get a Third Stimulus Check?

President Biden and others in Congress are pushing for a third-round of stimulus checks, but it might be a while before we get them.
January 20, 2021
Don’t Have a Pension? The SECURE Act Could Help
retirement planning

Don’t Have a Pension? The SECURE Act Could Help

If you’re worried about retirement, the SECURE Act has a lot to offer. It has several provisions to allow people to save more, for more years — and it…
January 22, 2021

Recommended

12 Ways the Biden Stimulus Package Could Put (or Keep) Money in Your Pocket
Coronavirus and Your Money

12 Ways the Biden Stimulus Package Could Put (or Keep) Money in Your Pocket

President Biden's "American Rescue Plan" includes several proposals to assist people financially harmed by the pandemic.
January 20, 2021
What You'll Pay for Medicare in 2021
Healthy Living on a Budget

What You'll Pay for Medicare in 2021

For Medicare premiums 2021, look for modest increases in premiums and out-of-pocket costs.
December 16, 2020
Making Wise Choices During Open Enrollment
health insurance

Making Wise Choices During Open Enrollment

Contributing Editor Lisa Gerstner runs through the new variables of the 2020 open enrollment season. Also, hosts Sandy Block and David Muhlbaum talk a…
November 17, 2020
What the New President Means for Your Money
Politics

What the New President Means for Your Money

President-Elect Biden wants more consumer protections and perks for the middle class and seniors.
November 17, 2020