QWhat should I expect to happen to costs and coverage for my employer’s health insurance plan for 2019?
AYou can expect the cost of medical and drug benefits to rise by 5% in 2019, according to the annual health care survey by the National Business Group on Health.
This would be the sixth consecutive year with a 5% increase, with premiums and out-of-pocket costs for employees and their dependents averaging $14,800 next year. Fortunately, employers continue to cover 70% of that tab, on average, with workers picking up the rest.
Employers said that high-cost claimants, specialty pharmacy and the treatment of specific diseases or conditions (such as cancer or musculoskeletal conditions) were key drivers of the cost increases for 2019.
Most employers will continue to offer high-deductible plans paired with a health savings account in 2019, although fewer plan to offer it as their only option (30% in 2019, down from 38% in 2018). Such high-deductible plans have become the most popular insurance option. For 2018, 53% of employers said their high-deductible plan had the highest enrollment; 41% said that most employees opted for a lower-deductible preferred-provider organization (PPO) plan. Only 3% said that a health maintenance organization (HMO) plan was the most popular.
The average deductible for a high-deductible plan in 2018 was $1,600 for employee-only coverage and $3,200 for family coverage. That compares with an average PPO deductible of $500 for employee-only coverage and $1,250 for family coverage. Despite the plans’ difference in deductibles, the maximum out-of-pocket spending limits for the year were similar: an average of $3,500 for in-network care for employee-only PPOs ($7,000 for family plans) and $3,600 for employee-only high-deductible plans ($7,200 for family plans). Out-of-network care can have higher out-of-pocket spending limits.
Employers plan to continue to encourage enrollment in high-deductible plans by contributing to workers’ health savings accounts. (To qualify for a tax-friendly health savings account in 2019, your plan must have a deductible of at least $1,350 for single coverage or $2,700 for family coverage.) The typical employer HSA contribution next year will be $500 for workers with single coverage and $1,250 for those with family coverage.
Employers also haven’t given up on incentives to nudge workers toward healthy habits. About one-third of employers say they will contribute to workers’ HSAs as long as their employees participate in or complete a program to improve their health.
Besides carrots, some employers wield sticks. One-third say they will continue to assess a surcharge — averaging $1,200 in 2019 — for adding a spouse to the plan who can otherwise get coverage from his or her workplace.
The top health care initiative for about half of employers in 2019 will be increasing their virtual care solutions. Almost all of the large employers surveyed already offer telehealth services (where you can have a virtual doctor’s visit for minor services, such as sinus and upper respiratory infections, allergies and the flu). They plan to add more virtual care for mental and behavioral health services, health and lifestyle coaching, weight management and diabetes care management.