Expect to pay more for health coverage next year — possibly a lot more — whether you get your health insurance from an employer or on a health care exchange.
As open enrollment season approaches, employers say they are facing the stiffest increase in health costs in more than a decade — almost 9 percent on average. But some project double-digit increases, even after they take steps to hold down costs, according to a large survey of employers conducted by Mercer, a benefits consultant. The reasons include higher labor costs for health care workers, higher charges from doctors and hospitals, and more demand for care and costly new drugs, like those for weight loss.
Experts say workers should expect to share some of the burden through higher premiums and out-of-pocket expenses for coverage next year. But the impact will vary depending on where you work.
“It’s not clear how much of that cost they will pass along to employees, rather than eat it,” said Cynthia Cox, a health insurance expert at KFF, a health care research group. Larger employers may be better able to shield workers from some costs, she said, while smaller firms may have less flexibility.
With costs rising, it’s important to compare plans offered during your employer’s open-enrollment period — typically, a period of a few weeks in the fall — to make sure you are on the best plan for you and your family.
“Inertia is a powerful force,” said Louise Norris, a health policy analyst at Healthinsurance.org, an information and referral site. “But it’s always a good idea to evaluate your coverage during open enrollment.”
Make sure, for instance, that your doctor and your preferred pharmacy are still on your plan and that medications you take are still on the plan’s approved list, or formulary. “Don’t assume anything will stay the same,” Ms. Norris said.
What if my employer’s coverage is too expensive?
Employers may offer plans that have lower monthly premiums — the amount deducted from your paycheck — in exchange for paying more when you need care. The plans typically have higher deductibles — the amount you pay before insurance covers your treatment — or co-payments, which you pay at the doctor’s office. High-deductible plans may come with employer contributions to a special health savings account, or H.S.A. — say, $1,000 — which you can use to help pay for out-of-pocket costs. If you don’t need the money right away, you can invest it and take the H.S.A. with you if you change jobs.
How much can I contribute to an H.S.A. in 2026?
If you have health coverage just for yourself in a plan that qualifies, you can make up to $4,400 in pretax contributions next year (including any employer contributions). If you have family coverage, you can contribute $8,750. People 55 and older can put away an extra $1,000.
Is a higher deductible risky?
It’s important to consider your family’s health needs before choosing a high-deductible plan, experts say. The minimum annual deductible for family coverage in an H.S.A.-eligible plan is $3,400 for 2026. That means you’ll need to cover the full cost of care, other than preventive services like cancer screenings and other tests, with your H.S.A. balance or other funds until you meet the limit.
“It can backfire,” Ms. Cox of KFF said. “If you pick a high-deductible plan, make sure you have enough savings in the bank.”
Ms. Norris said it would be wise to calculate what you’d pay in a “worst case” scenario, in which you have to meet not just your deductible, but also your plan’s out-of-pocket maximum cost. A lengthy hospitalization or a cancer diagnosis can mean staggering bills. Health plans may cover just 80 percent of costs after you meet your deductible. They’ll cover 100 percent only after you meet the plan maximum.
Are there other employer options for health services?
Ms. Cox suggested contacting your employer’s human resources department to ask about programs that might help lower your costs. “There may be other benefits you didn’t realize existed,” she said. Employers, for instance, increasingly offer free telemedicine options with round-the-clock virtual access to doctors. And employee assistance programs may provide up to 10 free or low-cost mental health visits.
Caitlin Donovan, senior director at the Patient Advocate Foundation, a nonprofit that provides help and financial aid to people with debilitating diseases, suggested checking to see if moving off a spouse’s employer plan and onto one from your own employer may save you money. Some employers may charge extra to cover a spouse, she said, if the spouse has insurance available through a job.
Can I save money with a ‘narrow network’ health plan?
Possibly. But Ms. Donovan said employees should carefully check the details if a plan offering a lower premium provides access to only a small provider network. “It may seem like there’s less sticker shock,” she said, making it more attractive. But people with complex illnesses may be better off paying a higher premium, she said, if it allows them to keep providers that are familiar with their care. If they seek care out of the network, it will be more expensive or not covered at all.
While shopping around for medical care based on price is usually impractical, Ms. Donovan said, it can make sense for some services. There may be variability in pricing, for instance, for imaging tests like X-rays and M.R.I.s., depending on whether the test is done at a hospital or a free-standing clinic.
Can A.I. help me choose health coverage?
Experts are generally cautious about patients using generative artificial intelligence tools, like ChatGPT, to select a plan and advise against providing personally identifiable details. “I don’t know if I’d personally trust it yet, knowing what A.I. can sometimes conjure,” said Anthony Wright, executive director of Families USA, a nonprofit group that promotes access to health care.
Ms. Norris said the tools could be helpful in narrowing options, depending on how skilled you are in crafting your questions. A.I. may also raise good questions that you may not have considered. But don’t assume that what the tool recommends is best, she said. Check with your benefits office to make sure it’s correct.
What’s happening with Affordable Care Act plans?
Plans available under the Affordable Care Act, also known as Obamacare, could see drastic premium increases because the expanded tax credits that have lowered costs for millions of Americans are scheduled to end. Unless the Republican-controlled Congress votes to extend them, the enhanced credits will expire at the end of the year. That could lead to out-of-pocket premiums paid by marketplace enrollees rising by an average of at least 75 percent, a KFF analysis estimated.
KFF has updated its tax credit calculator so that people enrolled in marketplace plans can see how their premium payments may change if the enhanced credits expire. Open enrollment on HealthCare.gov, the federal marketplace, begins Nov. 1.
KFF calculated some examples using a benchmark marketplace plan, showing that a 35-year-old couple making $30,000 a year would see their annual premium go from zero to $1,107, while a 49-year-old couple that earns $90,000 and has a 19-year-old child would see their annual premium rise to almost $9,000, from $6,246.
The more generous subsidies began in 2021 as part of the government’s pandemic relief program and were extended through 2025 under the Biden administration. The subsidies have driven marketplace enrollment to about 24 million people.
Democrats have sought to retain the more generous credits as part of their negotiations with Republicans to avoid a government shutdown. But whether the issue will be resolved remains unclear.
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