For those of us lucky enough to have health insurance through our jobs, it’s time for our annual head scratch. Open enrollment is upon us, and we have to choose our coverage options.

If your boss offers a good plan and pays the bulk of the cost, give him or her a kiss. This stuff is expensive.

The average cost of family coverage is $13,375 this year, with employees paying on average $3,515 of that, according to a new survey by the Kaiser Family Foundation.

Costs went up 5 percent in 2009, and we’re in for another boost next year. The New York Times last month reported that small businesses are getting hit with 15 percent price hikes from health insurance companies. Large firms, which pay medical claims with their own cash, are seeing smaller increases.

This year, about one in five employers shoved their higher costs on to employees, either by cutting coverage or boosting the worker’s share of the premiums. If the boss does that to you, give him a dirty look.

Don’t ignore open enrollment. At some employers, workers who fail to pick an insurance plan get no coverage at all, notes Larry Poger of Poger and O’Connor, a benefits consulting and brokerage form in Clayton.

Given the dollars involved, it pays to take a close look at the choices, says Sam Gibbs, vice president at eHealthinsurance.com, “It’s not unheard of for an employee to be paying $600 or $700 a month toward the premium,” he notes.

Workers at big companies usually have several health insurance options — some with low premiums and big deductible and co-pays, and others with high premiums and low deductible and co-pays.

The deductible is what you have to pay out of pocket for care before insurance kicks in. Co-pays and co-insurance are the portion of the health care bill that you have to pay even after you’ve paid the deductible. .
So, the first question is: Could you afford to pay a big deductible if you had to? If not, choose a low-deductible plan. Still, Poger finds that only one out of four workers actually runs through the deductible in a given year.

Check the plan’s maximum annual out-of-pocket expense. Many people who think they have good insurance find out otherwise when they see the portion of a hospital bill that they’re expected to pay. It’s important to have a reasonable maximum on what you can be charged.

Generally speaking, young healthy people without children will probably do better with high-deductible plans, says Dennis Nilges, benefit consultant with Wolfe Nilges & Nohorski in Des Peres. If they become sick, they’ll be stuck with bigger bills, but only for a year. They can switch to lower deductible plans when the next open enrollment period comes around, and their pre-existing condition will still be covered.

On the other hand, people with chronic illnesses, sniffly kids, or contemplating pregnancy, should probably grab low-deductible plans.

More employers these days are offering very-high deductible plans — at least $1,150 per person and $2,300 for a family — coupled with health savings accounts. A big benefit of health savings accounts is that money going in isn’t taxed, and you can withdraw money for health expenses without paying taxes. Take it out for any other reason and you’ll pay taxes plus a 10 percent penalty, unless you’re 65 years old or disabled.

You can take the account with you when you leave the company. Eventually, it becomes the equivalent of a retirement account.

Generally speaking, such plans are best for people both healthy and wealthy, who will have no problem paying a big deductible if they have to.

Most plans will charge you less to use a doctor and hospital in their network, and more if you stray outside. So, you’ll want a plan that covers your doctor, and the hospitals you prefer. Better check the list. If you do a lot of traveling, or have a kid away at college, look for a plan with a national network of doctors and hospitals.

Plans come with varying restrictions. HMOs are generally less expensive than other plans, often having no deductible. But they are more restrictive, trying to limit your care to network doctors and hospitals except in emergencies