In 2010, American workers with employer paid health insurance can expect to pay a larger share of their health insurance costs. Over 60% of employers plan to deduct more from the salaries of workers to pay for health insurance. And health plans will cover less because of higher deductibles and copayments.

It's not like this hasn't been going on for a while. Employees' annual contributions to health insurance premiums have almost tripled, to $3,515 in 2009 from $1,543 in 1999. And workers also are getting less coverage. More than 40% of employers in a recent Watson Wyatt survey said they will raise deductibles, co-payments, and out-of-pocket maximums in 2010 due to the economic crisis.

Other ways workers will pay more.

• Some employers are reducing or even eliminating spousal and dependent coverage to control rising costs. Some are charging higher premiums for working spouses who have access to other health care coverage. More employers are also expected to audit their workers to eliminate dependents who are not eligible for coverage.


• More employers will offer consumer directed health plans (CDHP) next year as they are increasingly viewed as an effective way to control rising costs. Those employers adopting new plans are generally adding a high-deductible plan, often with a health savings account (HSA). Some employers are sweetening the deal by making contributions to the employees HSA that can be used for any medical or dental expense.


• Some workers will see changes to their prescription drug benefits in 2010. As part of an overall movement to CDHPs, a number of employers are introducing a CDHP prescription drug benefit option that typically offers workers 100 percent coverage on a list of preventive medications. Other companies are introducing value-based designs that include zero copays on certain prescription drug therapies that are known to help lower health costs and reduce hospitalizations.

These trends highlight the struggle companies are facing in offering affordable health insurance to their workers.