Whether you need to wade through the corporate-speak to grasp just how the exchanges work depends on where you work. Many small businesses will let their workers shop for insurance in the exchanges because they allow the boss to offload the headaches and time of administering health insurance onto the employee and the exchange. And those employees may be better off in the exchanges, where they will almost certainly get more choice and may pay less than they do now for coverage.
Large companies will tend to devise their own exchanges, as companies like Sears and Darden Restaurants have already done, that offer multiple affordable options. In most cases, if you're one of these larger firms that offer an affordable health plan, you won't be eligible for your state's exchange.
Still, it's worth examining each document, and triage according to how each applies to your situation. Anything that looks irrelevant should still be retained in a separate file; you never know what might become pertinent later.
Employers will continue a push this year toward account-based health plans, also known as consumer-driven health plans. These plans come with low premiums, but high deductibles—patients are typically asked to pay the first $3,000 to $5,000 of each year's medical expenses themselves. These plans often add a health-savings account where the employee save pre-tax dollars to pay for those expenses.
Though often the employer will add money to the account as well as part of the employee's benefits, the point of these consumer-driven plans, as their name indicates, is to introduce market forces to our inefficient, price-bloated medical system.
"It's a step toward giving people more control," says Paul Fronstin, head of health-benefits research at the Employee Benefit Research Institute. "They say, 'We'll give you this pot of money and give you some exposure to the health care market.'"
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The popularity of these plans is growing. Some 10 percent of the U.S. working population was enrolled in one of these plans in 2012, up from 7 percent the year before, according to a study by EBRI.
Critics of the account-based plans complain that the account-based plans reward healthier employees while putting those who are poorer and suffer from chronic diseases at risk. This is because the emphasis in these plans tends to be on preventative medicine. "Well visits tend to be covered but not pharmaceuticals, and those who can't afford to pay out of pocket stop taking their pills," says Elise Gould, director of health policy research at the Economic Policy Institute.
(EBRI's report does show that consumer driven plans are adopted most by healthier employees.)
There are other problems with the logic behind the market-incentive plans: while you may choose to go to the doctor less often if you are paying for each visit yourself, and thereby cut the overall cost of your health care, "you can't negotiate your price," notes Fronstin.
Don't dismiss the account-based plans out-of-hand, however. Do the math—or ask your H.R. officer to do it with you-- to determine how much the plan really costs, the tax savings involved, and how your family uses health care. Fronstin says the low premium, combined with a firm's contribution, may be cheaper for a family that uses a lot of health care money, despite the high deductible.
This year, look for health care to be delivered via phone or computer, or to your desk: "telemedicine," "e-visits," and onsite clinics will be increasingly replacing traditional doctor's appointments. And "doctor's orders" — recommendations about how to improve your health — will increasingly be replaced by company incentives to quit smoking, lower your cholesterol or blood sugar.
Health plans will also begin to reward workers who take care of their diabetes, asthma or hypertension by eliminating cost-sharing for doctor's appointments and medicines related to their condition. "Benefit design is going to become more sophisticated," says Fronstin. "It may get to point that cost sharing is different depending on the quality of the provider." A worker may have a lower co-pay, for instance, for having her baby at a hospital whose maternity department has a great track record.
Some workers may bridle at letting their health-insurance plan dictate where they get their health care, much less what they put in their mouths. But improving the health of the company's workforce not only saves your company money; it will likely keep your premiums lower in the long run, and by paying you to quit smoking or join a gym, return the savings to you right away.
Most of these innovations are aimed at slowing your company's health-care costs, not lowering them outright. The cost of providing health care will rise by five to seven percent this year, with some individual companies looking at percentage increases still in the double digits.
Given the skyrocketing costs of the past decade, that's good news. The bad news is that progress for the foreseeable future is going to come at employees' expense, not employers'.