Small Changes By Employers Can Raise Workers' Health Costs

During the open enrollment period for health insurance this fall, workers who get health coverage on the job may not see huge premium increases, significant hikes to deductibles or other out-of-pocket expenses. But there may be other less obvious changes that could make a real difference in coverage or costs, benefits consultants say.

Employers are focusing more sharply on employee wellness. And some employers are raising the bar for workers to qualify for incentives, says Tracy Watts, senior partner at human resources consultant Mercer.

Some employers have offered cash incentives, made deposits into health savings accounts or given workers breaks on premiums if they filled out an assessment of their health risks. But it's becoming more common, Watts said, for employers to tie the incentives to requirements that workers participate in biometric screening, such as measuring workers' blood pressure, cholesterol or blood sugar levels to ensure they're within recommended ranges.

Likewise, some employers that had already moved to require biometric screening to earn financial rewards are now moving to limit those perks to people who've achieved target levels or who are working with a health coach to get there.

Premium increases for dependents, especially spouses who have health insurance available through their own jobs, are likely to be higher next year than for employee-only coverage.

"If employee-only coverage is going up 5 percent, coverage for the spouse and maybe the family is going up 10 percent," says Randall Abbott, a senior consultant at Towers Watson.

As workers evaluate their plan offerings, one key area to check is coverage of specialty prescriptions, pricey drugs that often require special handling or administration and are typically used to treat complex conditions such as cancer, hepatitis C or multiple sclerosis. Biologic drugs derived from living cells are often considered specialty drugs. Specialty drugs currently account for about one-third of total drug spending in the U.S., and that figure could increase to half by 2018, according to a report published in August by the Congressional Research Service.

Health plans' strategies to contain specialty drug spending may make it tougher for consumers to access them. "We're seeing acute attention to prescription drugs, especially specialty drugs," says Abbott.

In addition, some employers have been ratcheting back generous health benefits and shifting more costs to workers in anticipation of the so-called Cadillac tax on health plans with generous benefits.

Under the law, employee health benefits that exceed $10,200 for single-coverage and $27,500 for family coverage in 2018 will trigger a health plan excise tax of 40 percent on the amounts over those thresholds.

Delving into coverage details may not be the formidable task it once was because employers and insurers increasingly are making tools available that help workers evaluate and compare plans.

And the effort can be worthwhile. "Even if you're planning on staying with the same plan, that plan may be changing," says Craig Rosenberg, who leads the health and welfare benefits administration practice at Aon Hewitt. What's more, he says, "your health may be changing, and maybe the best health plan for you has changed."