• HooPayz

Honey, Our Coverage is Shrinking


As healthcare costs continue to escalate, employers are facing tough choices. Does the company absorb the increases or do they push additional costs to their employees? The frequent answer is startling…employees with $5,000 and $10,000 deductibles WITH family out-of-pocket costs up to $20,000 per year. Employees pay a portion of insurance premiums on top of those amounts. The bottom line – employee health benefits are shrinking!

Health Coverage Shrinking

That’s why this is the time to be proactive. Protect your family’s financial well-being by understanding your benefits and how to use them to minimize your out-of-pocket costs.

Market Trends in Benefit Coverage

The new normal is a family benefit plan with a $5,000 deductible, $20,000 out-of-pocket maximum and low premiums. We are seeing more employers offer plans with very low premiums and $10,000 deductibles – what used to be called catastrophic coverage. If you are not engaged in your health and your health benefits, your finances could take a beating. Becoming a good health consumer provides you with some protection and less expense.

Here’s what to look for:

  1. Fewer health plan options: During your company’s open enrollment period (when you pick and then register for your health plan), you might notice fewer options than in years past. That’s because many companies are narrowing the choices to reduce the administrative expense of managing multiple plans. For example, some employers are only offering high-deductible plans known as consumer driven health plans.

Tip: You still have a choice to make and it’s an important one! Know your family’s needs and take the time to match these to a health plan as closely as possible. The smaller details of a plan can make a big difference. Remember, a deductible is the amount you pay before your health insurance kicks in. If you have a high deductible, look into an FSA, HRA, or HSA to help pay for your deductible using tax advantaged dollars or employer funding

  1. Networks are getting smaller: If your company is utilizing the healthcare exchanges to provide healthcare insurance, there may be considerably fewer hospitals that are in-network on your plan.

Tips: If you or a family member has a specialist or group of providers that are based in a specific hospital, look for a plan where that hospital is in-network if you don’t want to switch providers. On the other hand, switching hospitals and physicians can save you money. Don’t assume all providers charge the same. If you have coinsurance as part of your plan (a % you pay), the higher the charges, the more you’ll pay.

Also, know your plan and always double-check your network before receiving care. Hospitals are already pricey, but it you accidentally visit a facility that is out-of-network, you may end up footing the entire bill! Read more about networks.

  1. Copays aren’t always fixed: A copay is the amount you pay, upfront, for your medical care, office visit, prescriptions, etc. Traditionally, copays have been fixed, meaning that regardless of the cost of your visit or care, you always paid the same dollar amount. Now, more and more employees are paying percentage copays. This means that you pay a percentage of your total cost. For example, if you’re filling a prescription that costs a total of $188, the amount you’ll pay towards your copay is very different depending on whether it’s a flat-dollar copay or a percentage copay:


Tips: Budget for the type of copay specified in your health plan. Regardless of whether your copay is fixed or based on a percentage, you’ll be expected to pay your copay at the facility, before you receive care.

And remember to look for a fair-price. If you visit a MRI facility that is more expensive than your other in-network options, you can expect to pay a much larger amount towards your percentage copay. Use a fair-priced-provider to save on out-of-pocket costs.

  1. Your spouse may cost more: Some companies are charging an additional monthly or yearly fee for your spouse to be covered if they have the option to get healthcare through their own employer.

Tip: Figure out the best option for you. Take a look at your spouse’s health plan choices and determine which coverage best suits their needs. It will all depend on which offering best suits his/her medical needs. Oftentimes, two separate, single policies will be considerably more expensive than a family plan. Calculate the costs for yourself. That additional fee might still be worth it. Budget accordingly.

Have a Question? We Can Help!

Seeing changes in your benefit offerings and have a question? Leave a comment below. We’d love to hear from you!

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