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BENEFITS
Time to Prep for Your Health Care Debate
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by Kimberly Lankford

This move makes employees more aware of the cost of services -- and potentially more careful with how much they choose to use -- and automatically adjusts their expenses with health-care inflation, says Maureen Cotter, an independent health care consultant in Dearborn, Mich.

And keep a close eye on your share of the costs for prescription drugs. Some employees will see an increase while others may be offered incentives to use generics and mail order programs.

Again, some employer plans are switching from a fixed co-pay of $10 for generic drugs, $20 for a preferred brand and $40 for a nonpreferred brand, to a 10% to 15% coinsurance for generics, 20% for a preferred brand and 30% for a nonpreferred brand, says Strukoff.

"Everybody needs to be prepared to pay more," says Cotter. "People need to budget at least a 10% increase in what's coming out of their paycheck."

Weigh your options

Because of these changes, you can't just compare your options based on premiums alone; you need to calculate your potential out-of-pocket expenses under each of your plan choices. "People need to reconsider their options maybe for the first time in a long time," says Cotter.

Also consider any options available to your spouse, even if you've always been covered under your own plan. If you switch yourself to coverage through your spouse's job, don't forget to add in any incentives your employer offers for not signing up for their plan. The Kaiser Family Foundation study found that 17% of the employers provide additional compensation or benefits to employees who decline the offer of health coverage.

If your medical expenses are generally low, the policy with the lowest premium may still work out best for you. But be sure to consider any unique health care needs you expect to have in the coming year, such as if you're having a baby or special medical treatments. In that case, this may be the year to sign up for the more comprehensive plan.

"If you're going to have a child, you'll have all of those extra office visits and immunizations," says Graybill. "It may very well be of value to have a richer benefit plan."

Doing this cost-benefit analysis can be time consuming, but your decision can make a huge difference in your health care expenses throughout the year. Take advantage of any calculators your employer offers to help with the math.

And if your premiums have risen and your coverage has shrunk significantly, it doesn't hurt to compare the costs to buying a policy on your own instead of opting for your employer's coverage (especially if you're offered incentives not to sign up). This is only a viable option if everyone in your family is in good health and you live in a state with a competitive health insurance marketplace (not New York or New Jersey, for example), but it could still be worthwhile to go to eHealthInsurance.com and get some quick price quotes to see what's available.

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