Private health insurance exchanges? Are they right for you?

Enrollment in private health care exchanges is expected to double to 12 million in 2016, eventually exploding to 40 million by 2018, according to the global management consulting, technology services and outsourcing company Accenture.

After a year of huge changes in the health care world, now is your opportunity to step back and figure out whether you made the right choices. If you had any nasty surprises when using your policy — say, you discovered that your doctors weren’t covered, your drugs cost more than expected or your deductibles were too high to handle — this is your once-a-year opportunity for a do-over.

You may have more options this time; 77 insurers will be selling policies on the health insurance exchanges for the first time in 2015, a 25% increase from last year. Some big insurers that only dipped their toe in the exchanges in 2014 will bump up their presence significantly. UnitedHealthcare, for example, sold policies on four exchanges but plans to sell on as many as 24 for 2015; Cigna is entering three more states.

Average premium increases vary a lot by state because competition and insurers’ claims costs vary. A study of nine state exchanges by Avalere Health found average premiums for silver plans increasing by as much as 16% in Indiana but just 2.5% in Rhode Island. Premiums in Oregon will average 1.4% lower.

But premiums are just part of the picture. Many plans continue to shrink their provider networks, boost deductibles and other out-of-pocket costs, and add more hurdles before covering expensive drugs and procedures. The policy with the lowest premiums may cost you more when you start to use the coverage.

If you have insurance at work, don’t let inertia take over during open enrollment. Employers have been struggling to find creative ways to rein in rising costs. Some are giving their health coverage a major overhaul; others are introducing stealth changes that can boost your costs significantly.

Whether you get your health insurance through your employer or on your own, compare your options and make sure you’re getting the most out of your coverage.

Choosing a policy at work

Even though the Obama­care exchanges don’t directly affect people who get coverage through their employer, companies are still struggling with rising costs. Premiums for employer health insurance averaged $16,834 for family coverage in 2014, which is a 69% increase over the past 10 years, according to the Kaiser Family Foundation.

Large employers (those with at least 1,000 employees) surveyed by the National Business Group on Health expect their health insurance costs to rise by 5%, on average, in 2015, about the same as the 2014 increase. These employers plan to pass along some of the extra cost to employees through higher premiums and deductibles and increased cost sharing. The average deductible for the most popular plan offered by large employers continues to grow, reaching $1,000 for employee-only coverage and $2,325 for family coverage. Smaller employers tend to have even higher deductibles.

The biggest surprise is the number of large employers who are offering only high-deductible plans in 2015. The percentage jumps from 22% in 2014 to 32% in 2015 says National Business Group on Health.

Even if your company has low-deductible as well as high-deductible options, it may offer big incentives to pick the high-deductible plan by reducing premiums and contributing extra cash to your health savings account.

Employers are hoping that employees will become better health care shoppers if they have more skin in the game, which ends up saving the employers money, too. They’re also beefing up tools to help you compare prices — for example, showing the rates you’ll pay in your area that insurers negotiated with health care providers.

When comparing your options, consider not only premiums but also deductibles and coinsurance for medications and other health care. Check whether your doctors and other providers are included in the network, and add in the value of any incentives, such as contributions to an HSA.

It has always been a good idea to check out all of your choices during open enrollment, especially if both you and your spouse have coverage at work. You may do better if the two of you keep your own policies and cover the kids with your plan or your spouse’s.

Employers pay an average of 82% of the premiums for single coverage. But they tend to cover less of the cost for your dependents, paying an average of 71% of the premiums for family coverage, according to the Kaiser Family Foundation. Some charge spouses extra if they could have gotten coverage from their own employer, and 9% of employers don’t cover those spouses at all. Employers may even give their own employees a bonus for choosing to get their coverage elsewhere.

Buying insurance on your own

After the tumultuous launch of Healthcare.gov and the state exchanges, new enrollees started 2014 relieved that they could finally sign up. But many of them had big surprises when they started to use their policies — especially those who discovered that their doctors weren’t included or who had a tough time paying a high deductible.

Do nothing and your policy will renew automatically. But that could be a big mistake. Your plan may no longer be the lowest-cost plan available to you. You need to be particularly careful if your income is below 400% of the federal poverty level and you qualify for a subsidy to buy coverage on the exchanges.

If you don’t qualify for the subsidy, check out policies both on and off the exchanges. You may have more insurers to choose from off-exchange, and those policies must meet most of the same requirements for bronze, silver, gold and platinum policies as the policies on the exchanges, with the coverage (and premiums) increasing as you move up to the next level. You can get off-exchange policies through agents, insurers or Web sites such as www.healthquotestexas.com.