Page 22 - Kiplinger's Personal Finance - November 2018

employers offer matching contribu- Compare coverage for any drugs says Katherine Hempstead, senior
tions, but most give a fixed amount you take. Make sure your drugs are on policy adviser with the Robert Wood
to everyone who signs up for the the plan’s formulary (the list of drugs Johnson Foundation, which studies
high-deductible health plan. Those the plan covers), and find out what the health insurance market. “But the
lump-sum contributions tend to your co-payments will be. Most plans carriers who stayed in the market have
happen early in the year because have four or five tiers of drug co-pay- figured out how to make money and
“employers are looking to help people ments—with co-pays as little as $0 to develop different provider networks,
overcome the fear that they won’t $5 for preferred generics and as much and they understand the customer
have money in the account if some- as 40% to 50% of the cost for non- better.” For example, many counties
thing happens,” says Eric Dowley, preferred brand-name drugs. in Ohio and Pennsylvania had only
senior vice president of HSAs for Take advantage of any resources one insurer in 2018, but more areas
Fidelity Investments. your employer offers to help you man- will have two or three insurers selling
age your health care costs, such as individual coverage in 2019, she says.
Check the policy limits. Also compare decision-making tools, second-opinion (See the box on page 34 for a snapshot
the most you could pay out of pocket programs and concierge services. of what states are doing to keep costs
under each type of plan if you have “They’re offering more resources to down.)
major medical expenses. The maxi- help consumers maximize their health Paul and Nancy Melquist of Shore-
mum out-of-pocket spending limit care benefits,” says Brian Marcotte, view, Minn., started buying their own
(which includes co-payments and president and CEO of the NBGH. coverage in 2017, after Paul retired
deductibles but not premiums) aver- “They help people understand their at age 58 from a career in the defense
aged $3,500 for employee-only PPOs treatment options and where they industry. Because the Melquists don’t
($7,000 for family plans) and $3,600 can go for care.” have many regular medical expenses,
for employee-only high-deductible If both spouses have access to em- they chose the plan that had the low-
plans ($7,200 for family plans), accord- ployer health insurance, compare the est premium but also a $6,600 deduct-
ing to the NBGH study. Find out what costs and coverage for all of the op- ible for each person. Even so, the
is included in this calculation for your tions. Each of you could stay on your Melquists paid $1,250 per month in
plan choices. For example, those limits own plan and add the kids to the plan premiums. Their only medical ex-
usually only cover in-network care; with the lowest costs, or it might make pense for the year ended up being
they may be double those levels if you sense to put the whole family on one their annual physicals. “We paid
use out-of-network providers. plan. However, about one-third of em- $15,000 for two physicals, which was
Are the doctors and hospitals you’d ployers in the NBGH survey assess a not a satisfying financial transaction,”
like to use included in the plan’s net- surcharge if your spouse could get Paul says. They did contribute money
work? What happens if you go out of coverage from his or her workplace to an HSA. Their premiums went
network? (Some plans charge higher but chooses to be covered by your plan down slightly in 2018, to about $1,165
co-payments and deductibles for out- instead; the average surcharge was per month, and they’re hoping they’ll
of-network providers, but others don’t $1,200 in 2019, according to the NBGH. have some lower-cost options for 2019.
cover out-of-network care at all except The average rise in premiums for
for emergencies.) INDIVIDUAL individual policies is expected to slow
Also check whether the plan has in 2019, to about 5%—and average pre-
“centers of excellence,” where you can COVERAGE miums are even going down in a few
pay in-network rates at major out-of- states, such as Tennessee, says Hemp-
state hospitals that specialize in cer- The options are very different if you stead. You may have more insurers
tain treatments. Your plan may even are buying insurance on your own. to choose from and more low-cost
pay your travel expenses to use one of After a tumultuous few years—when options during open enrollment this
these nationally recognized hospitals, many insurers stopped selling individ- year, which runs from November 1 to
such as the Cleveland Clinic or Mayo ual health insurance or repeatedly December 15 (although a few states
Clinic. Nearly 80% of the plans in the boosted premiums by double digits— have extended the deadline).
NBGH study cover a center of excel- the market is turning around. More
lence for transplants and 46% cover insurers are selling individual policies Strategies for people with higher incomes .
one for orthopedics (for knees, hips again or expanding into new counties People who earn too much to qualify
and spine). Many plans also offer and states, and now fewer areas are for a subsidy to purchase a policy on
centers of excellence for cancer treat- left with only one insurance option. a state exchange may face sticker
ments, fertility treatments, cardio- “It hit bottom last year, when we shock—especially if they’re in their
vascular care and bariatric surgery. had a lot of exits from big insurers,” fifties or early sixties and have to

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