c.2013 New York Times News Service

c.2013 New York Times News Service

A lot of attention has been given to the health insurance exchanges opening next month. But if you’re like most Americans, you’ll still get your insurance through an employer. And that means the annual open enrollment season, when you choose your benefits for the coming year, will soon be upon you.

(Almost anyone can shop on the new exchanges, or marketplaces. But if your job comes with affordable coverage, you’re ineligible for any subsidies and you probably won’t need to shop there).

A few companies have made headlines with big changes to their employee health plans for next year. Walgreen Co., for instance, is shifting workers to a private health care exchange — separate from the state-based marketplaces created by the Affordable Care Act — where they can shop for plans with a contribution from the company.

And United Parcel Service recently told white-collar workers it would eliminate coverage for spouses who are were eligible for insurance through their own jobs.

So far companies making such major changes remain in the minority. But benefits experts caution that with so much in flux, it’s wise to carefully review the options your employer is offering for next year.

“The overarching theme this year is that you have to pay attention,” said Jody Dietel, chief compliance officer at the benefits management firm WageWorks.

Some trends to watch for include:

— Higher costs for covering your spouse and children.

If you don’t already, you may pay a surcharge for covering your spouse if your spouse’s job offers coverage. Under the health reform law, companies that offer insurance to workers must also offer it to their children, but you may pay more for covering them, too.

— Higher deductibles are here to stay.

The trend toward “consumer-driven” plans with high deductibles is continuing, as employers shift costs to workers. Usually, high-deductible plans are offered along with a health savings account, which employees can use to help pay for out-of-pocket medical costs. The idea is that if you are responsible for more of your medical spending, you’ll pay more attention to the cost. Most companies will now offer at least one such high-deductible plan as an option, and more are offering them as the sole plan.

“Our best indication is that they’ll be fairly universally offered in the next few years, and in some cases, exclusively offered,” said Christopher Ryan, vice president of ADP’s Strategic Advisory Services, a benefits consultant.

— Carrots and sticks to influence employee health behavior.

Companies are actively encouraging workers to improve their health, either by offering some sort of payment as an incentive for losing weight or exercising, or higher insurance premiums as a punishment.

“Lots of companies are getting aggressive around wellness and health promotion,” said Tom Billet, a health care consultant at Towers Watson.

For instance, your employer may ask you to complete a personal health assessment, or undergo some sort of health screening, like a blood pressure or cholesterol test. As a reward, the company will deposit a bonus into your health savings account.

Here are some questions to consider this year:

Q: Why did my employer gave me information about the state health insurance exchanges if I don’t need to use them?

The law requires employers to inform workers about the marketplaces. But for the “vast majority” of employees with workplace coverage, no action is warranted, Billet said.

Q: Should I choose coverage under my employer’s plan, or the one offered by my spouse’s employer?

A: If you and your spouse have coverage available through your respective jobs, you’ll have to “do the math” both ways to see which option makes the most sense financially, said Helen Darling, president of the National Business Group on Health, which represents large employers.

You’ll also want to take into account any restrictions the plans impose. If your spouse’s plan is less expensive but your family’s doctor isn’t in the plan’s network, for instance, you might want to go with your employer’s plan, even if it costs more.

Q: Is there any upside to high-deductible plans?

A: The plans usually are paired with a health savings account, which can be financed with pretax dollars by either you, your employer or both of you. You can use the money to pay for medical costs that fall under your deductible (and keep in mind that most preventive care is covered outside of the deductible, meaning you shouldn’t have to tap the account to pay for it). If you don’t spend the money, it can be rolled over to the next year.