How healthy is your health insurance?
First off, you may want to count yourself as lucky if you can still get health insurance through work. Two-thirds of Minnesota employers still offer health insurance. But that number is on the decline.
Julie Brunner, executive director of the Minnesota Council of Health Plans, says many workers are grateful to have any coverage at all.
"You have a good plan if you have coverage and you didn't have coverage before," she says. "You have a good plan if you've maintained coverage when your peers around you have lost coverage."
Whether you have health insurance at work depends largely on the size of your employer. Virtually all firms with 200 or more employees still provide health insurance. But the majority of firms with fewer than ten employees have given that perk the heave-ho.
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You have a good plan if you've maintained coverage when your peers around you have lost coverage.
Workers who still have health insurance through employers are paying a lot more for it.
Richard Kleinbaum of St. Paul has medical coverage though his wife, who works at a big bank. Kleinbaum believes his coverage is as good, if not better, than most people's these days. But the 63-year-old semi-retired consultant says his co-pays and other out-of-pocket medical expenses have soared.
He once paid $5 to visit a doctor. Now, an office visit typically costs him $80.
"I don't go to the doctor when I have problems," he says. "I try to self-diagnose. I try to figure out what kind of pharmaceuticals I can get over the counter. And I'm fairly sophisticated. People who aren't sophisticated really [have] a problem."
People who still do have health insurance through work will likely get ringing reminders of rising costs as they consider their options during the fall open enrollment season.
Employers still generally pay 70 to 80 percent of the cost of employee health insurance. But premiums have been rising, of course, as employers pass on more of the spiraling cost of medical care.
For nearly two decades, an employee's cost to insure a family of four has regularly outstripped wage increases.
Workers are also facing higher co-pays for office visits, prescriptions and hospitalizations. All told, some health plans can cost employees $5,000 or more out-of-pocket every year.
But few folks actually come close to their maximum out -of-pocket limits. In Minnesota, out-of-pocket expenses average about $500 per person.
So, how's your plan?
University of Minnesota business professor Steve Parente offers some guidance.
"You know you've got it pretty good when your total out-of-pocket is basically not that much more than two to three to five percent of your total income," says Parenta, who closely monitors the health care industry.
For a household earning $50,000 a year, Parente's benchmark boils down to spending between $1,000 and $2,500 --total-- on health care.
Is that possible? Well, the University of Minnesota provides coverage within that price range, as do some other employers.
But Parente says there's more to the value of a health plan than what it costs you. A low premium doesn't assure you're getting a good deal. And a high premium doesn't guarantee you will have strong coverage. "You really have to see what the benefits are," he says. "The sticker price could be extremely low, and you take a look inside it and realize it doesn't cover just about anything you would use it for. And it may have no value to you whatsoever."
If your premiums are high, there can be several explanations.
"If you had a few very sick people in the group that could drive the cost up," says Julie Sonier, an economist with the Minnesota health department.
She says a few high-cost illnesses can lead to a double whammy: pricey premiums combined with high-out-of-pocket costs.
"You could have a high deductible, high co-insurance and you could still have a high premium cost if the overall health of the group is not very good," Sonier says. "Premium alone is not a good way to judge the quality of the benefits of a health insurance plan."
HealthPartners, Blue Cross and Blue Shield of Minnesota and other insurers are trying to help consumers better understand their options. The insurers are providing online tools that let consumers explore how they could fare under different plans. The big problem for anyone picking a plan, though, is guessing if the new year will bring good --or bad-- health.