If you get health insurance through your workplace, you'll probably have a chance this fall to make important decisions about your coverage and costs.
Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act. Some 55% of Americans have employer-based coverage, according to Mercer, a human-resources consultant.
"From the employee perspective, if there is any year to pay attention to the information, this is the year," says Brian Marcotte, president and chief executive of the National Business Group on Health, a nonprofit representing large employers.
Starting next year, one change could be an ACA provision requiring some large employers—generally those with 50 or more full-time or equivalent workers—to offer affordable, adequate coverage to employees working more than 30 hours a week.
Such companies could be liable for a "shared responsibility payment" if an employee opts for a health plan on a government insurance exchange and receives a tax credit to buy it, according to the Internal Revenue Service.
The change could be important to people whose employers offer them coverage for the first time, says Beth Umland, Mercer's research director for health and benefits. She says workers should expect their employers to tell them if they're eligible for coverage.
If you're unsatisfied with your employer's coverage, you may shop elsewhere, says Karen Pollitz, senior fellow at the Kaiser Family Foundation, a health-care policy nonprofit. But, she says, you probably won't be eligible for a premium tax credit unless your employer's plan fails to meet ACA standards for affordability or adequate coverage.
Research from both Mercer and the NBGH indicates that future benefit packages are likely to include more high-deductible health plans, those in which the consumer pays a relatively high amount for care out of pocket until reaching a dollar threshold, above which the insurer pays. Usage of these plans has been increasing for many years, and some employers have indicated in surveys that they are a way to control rising costs and respond to the ACA.
"Before the Affordable Care Act, consumers could face unlimited out-of-pocket expenses for plans with high deductibles," says Ben Wakana, a spokesman for the Department of Health and Human Services. "Now, most plans must cap out-of-pocket expenses and cannot place annual or lifetime limits on coverage."
If you're considering a high-deductible savings plan, it's important to do the math to see if it makes financial sense for you. "High deductible plans usually come with a lower paycheck deduction. What you save on the premium over the year could make up for the higher deductible—and if you don't spend much on health care you will come out ahead," says Mercer's Ms. Umland. "But if you don't have the resources to cover the expenses up to the deductible, it might not be the best choice."
Another way to save money is to participate in incentive programs your employer might offer. Experts say these are also growing in number. More companies are rewarding employees who participate in programs like talking to a health coach or getting a biometric screening, says Tracy Watts, senior partner in charge of health reform at Mercer. Knowing if your plan offers these programs can save you several hundred dollars a year, says Mercer.
One more thing to know, says Mr. Marcotte, is that about 30% of employers could levy surcharges for spouses who get coverage through another employer.
Also, check your plan's network, says Ms. Pollitz, and make sure any must-see doctors are in it. Narrow networks might have lower premiums, but "going out of network even a little can wipe out any savings," she says.
And your plan by now will likely include benefit expansions stipulated by the ACA—things like preventive care and the right to enroll dependent children in a parent's plan through age 26. Some plans might still have so-called grandfathered status, which exempts them from some changes, according to the Labor Department.