As Open Enrollment Begins, Health Benefits May Not Change Much - The New York Times

Open enrollment season is here again for workers fortunate enough to have health insurance through their job.

Workers could pay 4 to 5 percent more for their health premiums next year, according to various estimates of cost increases.

That’s in line with increases in recent years, even as the pandemic continues to bring economic challenges and uncertainty for both workers and their employers. People may use more medical services in 2021 because they put off routine care this year during the pandemic shutdowns. And the costs of treating coronavirus cases continue, while the country awaits a vaccine.

Still, many employers have indicated that they are trying to avoid major changes in health benefits for next year, to avoid jarring workers already stressed by the pandemic. Some employers may absorb much of the cost increase so workers pay about the same in premiums as they do this year, said Steve Wojcik, vice president of policy with the Business Group on Health.

“Quite a number are recognizing the financial challenges employees face,” said Mr. Wojcik, whose organization represents employers on health care and benefit matters.

Of more than 1,100 employers responding to a survey by the benefits consultant Mercer since early July, more than half said they would make no changes of any kind that would reduce their costs in 2021. Just 18 percent said they would take steps to shift more costs to employees, like increasing co-payments and raising deductibles — the amount workers pay out of pocket for care before the plan starts paying.

“That’s very good news for employees,” said Tracy Watts, a senior consultant at Mercer.

This year, the average annual family health premium increased 4 percent to more than $21,000, according to the Kaiser Family Foundation. Workers, on average, contributed about $5,600 toward the cost, and employers paid the rest. (Kaiser surveyed 1,765 randomly selected employers with three or more workers. About half of the interviews were done before employers had felt the full impact of the pandemic.)

Most Americans have employer-provided health insurance. But during the pandemic, millions lost their jobs and related benefits. Estimates vary, but a study from the Commonwealth Fund published this month suggests that as many as 14.6 million people — 7.7 million workers and nearly seven million dependents — had lost employer-based coverage as of June because of the pandemic-induced recession.

It’s unclear how many of those people lost coverage permanently. Some job losses may have been temporary, and some workers may have continued paying the full cost of their group coverage through the federal COBRA program. Others may have found coverage through Medicaid, the government health plan for the poor, or under the Affordable Care Act, which both expanded Medicaid coverage in some states and authorized the sale of subsidized, private health plans through federal and state marketplaces.

(The future of the Affordable Care Act’s safety net is uncertain, as a court challenge to the law awaits a hearing before the Supreme Court, scheduled for the week after the Nov. 3 presidential election.)

Like many workplace meetings, benefits discussions are moving online during the pandemic. Many employers are shifting to virtual enrollment fairs, instead of holding traditional gatherings in the office cafeteria.

In some employer offerings, Mercer said, workers can earn points for “visiting” online information booths and earn the chance to win gifts, like an iPad.

Care itself is also increasingly moving online. About half of large employers will offer more virtual care options in 2021, according to the Business Group on Health. Many people became more comfortable with seeing doctors remotely during the pandemic, whether for an online visit with their own doctor or a session with an independent telehealth provider, said Ellen Kelsay, president and chief executive of the group. Employers also expect to expand virtual options for mental health treatments, via online sessions, videos and apps.

Many employers said they expected to add on-site health clinics next year, according to the Business Group on Health. Some types of businesses, including manufacturing and health care companies, have found that on-site clinics have been useful for coronavirus screening and testing as well as for telehealth services, Ms. Kelsay said.

Here are some questions and answers about open enrollment this year:

How should I choose a health plan?

Open enrollment periods vary by employer, but typically last several weeks. When evaluating options, employees should be careful to review a plan’s network of doctors and hospitals, said Cheryl Fish-Parcham, director of access initiatives with Families USA, a health care advocacy group. Some employers may offer “narrow” network plans at lower cost, but those plans typically include a limited number of doctors and a single hospital. Some plans are “open,” meaning you can go outside the network for a fee, but others pay nothing unless you are within the network, she said.

You may want to call to confirm that your regular doctor participates in the plan. “Make sure it includes the providers you want,” Ms. Fish-Parcham said.

If you take medication regularly for a chronic condition, she added, make sure the plan’s prescription benefit covers it.

If your employer offers multiple plan choices, Ms. Watts of Mercer said, you should take the time to compare the total cost of coverage for each option — don’t just look at the premiums. She advises taking the total premium and subtracting any contributions made by your employer, such as to a health savings account, to compare the cost of different plans.

“Do the math,” she said.

To see your total potential financial exposure, add the plan deductible. If you are generally healthy and don’t take regular medication, a plan with a higher deductible may save you money. If you can’t afford unexpected costs, a lower deductible — typically with a higher premium — may be the best option. The average deductible for an individual is $1,644, Kaiser found.

Theresa Adams, senior knowledge adviser at the Society for Human Resource Management, said many workers didn’t take enough time to evaluate benefits. She encouraged them to make use of online tools offered by their employers to help choose options and to reach out with questions.

How much can I contribute to a health savings account in 2021?

Contribution limits ticked up for next year, the Internal Revenue Service announced. The maximum contribution is $3,600 for an individual and $7,200 for family coverage. (People 55 and older can save an extra $1,000.) H.S.A.s, however, are available only with specific types of health plans with high deductibles — at least $1,400 for individual coverage and $2,800 for family coverage for 2021. Typically, your employer will specify if a plan is H.S.A. qualified.

Some plans have a different option, called a health care flexible spending account. You can contribute to it before taxes, via paycheck withdrawals, to pay for care and products that your health plan doesn’t cover. Contribution limits are lower than with an H.S.A., and if you change jobs, your flexible spending account doesn’t go with you, as an H.S.A. does.

When is open enrollment for the Affordable Care Act marketplace?

According to Healthcare.gov, open enrollment for coverage starting on Jan. 1 runs from Nov. 1 through Dec. 15. Open enrollment for state-run marketplaces may vary.

The legal challenge before the Supreme Court isn’t expected to affect this year’s open enrollment, as the court’s decision would probably come before next summer.

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