Is your health plan at work any good?

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Do you get your health insurance through work? Do you think it’s any good?

The Kaiser Family Foundation and Health Research & Educational Trust recently released its 2012 Employer Health Benefits survey. The study findings can help you judge whether your own health plan is better or worse than the average nationwide.

The survey found:

Average group health insurance premiums will rise about $700 or 4.5 percent for family coverage and about $190 or 3.4 percent for single coverage in 2013. That’s based on an average annual premium of $15,475 for family coverage and $5,615 for single coverage. The increase is modest compared to recent years.
On average, workers contribute about 18 percent of the premium for single coverage and 28 percent of the premium for family coverage.
Copays average $33 for in-network primary care doctors and $33 for visits with in-network specialists.
Emergency room visits on average cost $118. (The cost may be waived by some plans.)
Most workers on average pay $10 for generic drugs and $29 for brand-name medications. Workers also pay about $51 for non-preferred brands and $79 for specialty drugs. With most plans, the cost of your prescription drugs doesn’t count toward your annual deductible.
About a third of workers have an annual medical insurance deductible of at least $1,000. About 14 percent of workers face deductibles of at least $2,000 a year. The deductible is how much you must pay out-of-pocket before all or most of services are reimbursed by your health insurance plan.
Is your same-sex or unmarried partner eligible for benefits? The answer is yes at about a third of employers — a slight increase from recent years.
The average copayment for a hospital stay is $263.
The average copayment for an outpatient procedure is $127.

FSAs for medical expenses

If your employer offers a flexible spending account (FSA) you can use pre-tax dollars for your out-of-pocket medical expenses.

The survey found only about 17 percent of small firms that employ less than 199 workers offer FSAs, but more than three-quarters of larger firms do. That is about the same percentage as the last time the survey asked employers about FSAs.

The survey also found that more employers offer their employees the opportunity to complete health risk assessments. The results can be used to change behaviors, such as smoking or overeating, which can cause health problems. Nearly 40 percent of large firms ask employees to complete a health risk assessment. Among those that do, more than 60 percent offer financial incentives for doing so, the survey found. An assessment can result in a reduction in premiums.

More employers are nudging workers to become healthy by offering weight-loss programs, gym membership discounts, on-site exercise facilities, smoking cessation programs and classes in nutrition.

Comparing your health insurance plan

Before you compare your own plan to the survey results, consider that the numbers are national averages.

“And averages don’t tell the full story,” says Robert Zirkelbach, spokesperson for America’s Health Insurance Plans. “Costs are different in different parts of the country,” he says. “Costs also can vary within the same community.”

Sabrina Collette, a research professor at the Health Policy Institute at Georgetown University, says determining whether your health plan is a good one isn’t just about how it compares to the national averages. It’s about how it works for you.

Even if your plan requires you to pay more for doctor’s visits or prescription drugs or hospital stays, it could be the best health insurance for your needs, she says.

If you are healthy and don’t go to the doctor very often, you may not mind paying more when you do use those services, especially if your monthly premiums are lower.

Access to care

On the other hand, if you have a chronic condition, or if you need surgery or are hospitalized, your copays and deductibles are going to be more important to you than the amount you pay in premiums, Collette says.

“What’s important to you depends on your unique circumstances and the health needs of . . . your family members who are covered by the plan,” Collette says.

Zirkelbach says the best health insurance plans aren’t necessarily about cost but about access to care. Are the doctors you want to see in your plan’s network? A poor plan will limit your choices.

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