Oct. 14--Accepting the status quo could be costly for consumers re-enrolling in a workplace health insurance plan for 2013.
Private insurance offered by employers seems to get more expensive and complicated every year. For nearly a decade, painful premium increases have elicited groans and complaints at annual enrollment meetings, held in October at many Tampa workplaces.
In 2013, workers will see an increase, but it will be a smaller bump up front than usual for most: an average 4 percent annual increase versus 10 percent or more each year inthe past decade. The Employer Health Benefits Survey has been taken every year since 1999 by the Kaiser Family Foundation and Health Research & Educational Trust.
That milder sticker shock may mistakenly coax people into thinking nothing's really changed, experts say. But insurance companies have and will continue to tweak what they offer, much as they have for the past several years as the nation readies for health care reform.
"The important first step is saying that I am not going to automatically re-sign up for what I did last year. Look and ask questions," said Jay Wolfson, assistant vice president and health policy professor at the University of South Florida Health. "Think that this could affect my life, my children's life, and it will affect my pocketbook."
An estimated 149 million Americans who are 64 and younger are enrolled in private-insurance plans at employers large and small. On average, families paid $15,745 in annual premiums in 2012 for coverage. Individuals spent $5,615, according to the Employer Health Benefits Survey.
That cost to employees has risen significantly, even before insurance companies began implementing the Patient Protection and Affordable Care Act, or "Obamacare," which became law in 2010.
And while politicians continue to debate whether to keep or repeal the controversial law, employers and insurers keep making adjustments. The solution for many: controlling health care expenses by placing more of the burden on employees.
On the plus side, employers and insurers also have implemented some of the more popular components of the law, such as adding coverage for adult children to family plans and preventive screenings for women. And there will be new tweaks in plans for 2013.
"There will be changes -- good, bad or indifferent," said Alvaro Hernandez, who oversees public sector employer plans for Humana in Florida. "It will affect (consumers), carriers and employers."
It's been three years since the Hillsborough County School District, the Tampa-area's largest employer, introduced a plan to prepare for health reform changes, said Deborah Henry, general manager of employee benefits and insurance.
"People were concerned that when the law went into effect everything would go crazy," Henry said.
Now, more than 11,000 of the district's 24,212 insured employees, their spouses and children participate in what's called a "consumer-driven" or high-deductable plan. Employees pay a smaller monthly premium but a larger upfront cost, usually $1,000 or more. After that, insurance covers a percentage of the medical bills.
The premium difference in the district's Humana plans is significant, Henry said. School district employees who choose a traditional HMO pay $922.11 a month, while those in the "Coverage First" option pay $644.50 a month.
As a result, the school district saw a decrease in claims and costs last year. And, contrary to national trends, school employees have not experienced a monthly premium increase in two years.
"Whether it's tied to the (Affordable Care Act) or not, (the district's) costs are going down ... they have not impacted our plans in a negative way," Henry said.
The shift has been slower at BayCare Health System, where about 16 percent of the employees have opted for a high-deductable plan that is managed by Great Western/Cigna. The rest of the 29,000 employees, spouses and children with BayCare insurance participate in a more expensive PPO plan.
BayCare President and CEO Steve Mason said high-deductible and similar plans are signs of fundamental changes coming to the health care system. How and how much people pay is changing, regardless of the outcome of the Affordable Care Act -- or what employees or employers want.
"I think we all as individuals need to think about the future. How are we going to cover the cost of our health care expenditures?" he said.
The high-deductable plans are popular with employers because it reduces their significant investment in health insurance. The Kaiser 2012 benefits survey showed that firms contributed $10,409 for each employee's insurance in a high-deductable plan and $15,729 for a traditional HMO.
In 2012, 59 percent of the nation's large employers offered high-deductable plans, up from 17 percent just a year before, according to a RAND Corporation health care analysis.
What did that mean to their employees? The RAND study found that families switching from a traditional to a high-deductable option spent 21 percent less of their own money on health care in the first year. However, those same individuals also cut back on preventative care, such as cancer screenings, even though their insurance would have covered 100 percent of the cost.
Consumers need to seriously weigh the pros and cons of high-deductible plans, said Tim Jost, a health care law professor at Washington and Lee University in Virginia.
Jost worries that people with chronic disease might choose to avoid medically necessary procedures or costly prescriptions to keep their costs down. That's a short-term solution that could have long-term consequences. The plans are best for healthy individuals who need little medical care, he said.
Henry, who just wrapped up enrollment for Hillsborough schools employees, says it's inevitable insurance plans and costs will change for 2014, when most of the Affordable Care Act kicks in, or when a new administration puts the brakes on current reform.
Instead, she suggests doing your homework now, compare options and ask friends what they are doing. Try not to get caught up in the health care hype in negative political ads, she said.
Henry understands it all makes people apprehensive, but checking out on your health insurance decisions could hurt more in the long run.
"It's investing your emotions and your money. People don't want to deal with that," she said. "It's too much."
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