5 Ways Your Health Insurance Plan May Change in 2016
Q. What changes can I expect from my employer's health insurance plan during open enrollment for 2016?
A. Employers are just starting to announce their health insurance options for 2016, and you may need to make your decisions during open enrollment in the next month or two. The National Business Group on Health recently came out with its annual survey of large employers, which offers the first glimpse of the changes employees are likely to see in their health plans for 2016.
1. Higher premiums. Large employers expect their health care costs to increase by about 5 percent for 2016 -- the same size increase they expected in 2014 and 2015. They plan to pass along some of the extra cost to employees but more of it to dependents, with employees contributing 20 percent of their own premiums and 24 percent of the premiums for dependents (higher-income employees may pay more). About one-third of the companies plan to add a surcharge for spouses who could get coverage elsewhere but don't. But very few (only 4 percent) plan to exclude spouses who have similar coverage available through their own employer.
2. More high-deductible health plans. Employers are continuing to try to contain rising costs by forcing employees to take more control of their health care: 83 percent of large employers plan to offer a consumer-directed health insurance plan in 2016 (primarily high-deductible health insurance paired with a health savings account). Half of the employers plan to offer the high-deductible plan as an option, and 33 percent plan to offer it as the only option. More than half contribute to employees' HSAs, giving them tax-free money for medical expenses; some add more if you participate in a wellness program or take a health risk assessment. For more information about HSAs, see FAQs About Health Savings Accounts.
3. Restrictions on expensive drugs. Employers identified the cost of specialty drugs as one of the major causes for health care cost increases, and they're imposing more restrictions on coverage. More than three-quarters of the employers surveyed plan to use prior authorization for some of these specialty medications -- requiring physicians to fill out forms explaining why you need the specific drug. Three-quarters plan to use step therapy, covering the drug only after you've tried a list of less-expensive medications first.
4. New telemedicine options. Nearly three-quarters of the employers will offer telemedicine, which provides virtual visits with a doctor, as an option. "It's still primarily phone-based, but the video component is starting to take off," says Karen Marlo, vice president of benchmarking and analysis for the National Business Group on Health. "You can take a picture of a rash with your phone and e-mail it to someone who can look at it, for example. It's a good way to provide good quality care at a lower cost, and it improves access in parts of the country where you have to travel a long distance to go to a physician." A telemedicine doctor's appointment may cost $40 or $50, while an actual office visit may cost $150.
5. Cash for wellness programs. Employers continue to focus on plans to improve your health, which they hope will ultimately help lower their medical expenses, and they're giving employees more incentives to participate. Thirty-nine percent plan to offer a break on health insurance premiums or cost sharing for employees who participate in a wellness program, health assessment or biometric exam. Thirteen percent plan to offer breaks for participating in a disease management program, which provides special care and resources for people with complex conditions, such as diabetes. You may also get more money in your HSA: Nearly one-third of employers plan to contribute to an HSA for employees who complete a wellness or health education program, and 8 percent plan to make HSA contributions if you achieve a health goal.
For more information about what to expect from your health plan in 2016 -- whether you get coverage through your employer or on your own -- see Tactics to Get the Most from Your Health Plan in 2016.