What to Expect From Your Health Insurance in 2015

I get health insurance through my employer. What changes should I expect in my coverage for next year?

The National Business Group on Health’s survey of large employers usually provides the first glimpse of changes employers will be making to their health insurance plans for the coming year. The survey focuses on large employers, who tend to pay a bigger portion of the costs than small employers, but the same trends apply no matter where you get your insurance.

Higher costs and cost-sharing. The employers surveyed expect their health insurance costs to rise by 5%, on average, in 2015 (about the same as the 2014 increase). They’ll cover some of that increase themselves, but they’ll continue to pass along some of the extra cost to employees through higher premiums and deductibles and increased cost-sharing. The median deductible for 2015 will be $1,000 for employee-only coverage and $2,325 for family coverage, and employees will pay a median of 20% of the premiums for themselves and 23% for their families. Most of the employers still cover family members, but 29% of the employers surveyed plan to apply a premium surcharge for spouses who are offered health coverage through their own employers. They don’t want to drop coverage for dependents, but they don’t want to pay a lot to subsidize coverage for working spouses who can get coverage through their own employers (only 1% of the employers surveyed don’t plan to offer any coverage to spouses).

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What you can do. When comparing plans during open enrollment, don’t look just at premiums; also compare deductibles and co-payments for the medications and type of care you tend to use. If both you and your spouse can get coverage through work, look at all of your options. For example, compare the cost of each of you staying on your own employer’s plan and choosing one of the plans for the kids versus the entire family being on one employer’s plan. The best option for 2015 may be different than it has been in the past.

More high-deductible plans and cash incentives. Employers are hoping to control costs by giving employees more incentives to save money themselves. Many more are offering high-deductible plans – an increase from 72% in 2014 to 81% in 2015. The biggest surprise is the increase in employers who will offer high-deductible plans with no lower-deductible options – from 22% in 2014 to 32% in 2015 -- says Karen Marlo, vice-president of the National Business Group on Health. Employers are also encouraging employees to pick the high-deductible plan by pairing it with a tax-advantaged health savings account and contributing cash to the HSA, with the maximum employer contribution averaging $600.

What you can do. If your employer offers several policies, see whether you could save money with a high-deductible plan. If the policy has a deductible of at least $1,250 for individual coverage or $2,500 for families, you can generally contribute pretax money to a health savings account – up to $3,300 in 2014 for individual coverage or up to $6,550 for family coverage (plus $1,000 if you are 55 or older anytime during the year). You can then use that money tax-free for medical expenses in any year. Find out how to get the maximum contribution from your employer – 42% of employers will contribute a fixed amount per participant, no matter how much they contribute; 13% will make a matching contribution; and 30% will make contributions based on the employee completing a wellness or education program.

Better health care shopping tools. Until recently, it could be difficult to shop for the best price for care, especially because each insurer negotiates a different rate with health care providers. Employers are improving their tools to help you understand the cost of your health care choices. They’re also offering more support when researching your care options. For example, 85% plan to offer nurse coaching, and 71% plan to offer self-service decision support tools to help you choose the type of care you need.

What you can do. Make the most of these resources before choosing where to schedule procedures, especially x-rays and other tests. The tools may show that a standalone radiology facility in your area charges a lot less than a hospital for the same tests. Many of the tools also show quality ratings. And if you’re not sure what type of care you need – whether you can go to an urgent-care center or need to go to a hospital emergency room, for example – the insurer’s nurse line may point you in the right direction.

New rules for drug coverage. Employers are also searching for ways to manage the rising costs of specialty drugs. They’re continuing to add hurdles before covering some expensive drugs. For example, 80% plan to require prior authorization for certain drugs (the insurer asks your doctor a detailed list of questions about your condition and your treatment before covering the drug), and 77% plan to require step therapy (you must use other medications first, if possible). Many will also require you to pay the difference between the cost of a brand-name drug and the generic version of it (rather than just a higher co-payment for the brand-name drug); some will require you to use mail order for maintenance medications. About one-third plan to require you to use a specialty pharmacy for certain high-cost drugs; such pharmacies specialize in helping patients manage medications for diseases such as Hepatitis C. “In many cases, these expensive drugs are breakthrough therapies for chronic, complex diseases,” says Marlo. “Insurers don’t want to deny access, but they want to manage it in a way to make sure the appropriate person receives the drug.” These pharmacies often have nurses that provide support, monitor your care and answer questions about your medications.

What you can do. If you have a choice of plans, estimate your out-of-pocket costs for your drugs and dosages. And be sure you follow all the rules to get the best coverage and minimize costs, whether that involves choosing a generic drug, working with a certain pharmacy or getting your medications through mail order.