Jayne O’Donnell, USA TODAY | article

A report out today puts numbers behind what hit many workers when they signed up for health insurance during open enrollment last year: deductible shock.

Premiums for employer-paid insurance are up 3% this year, but deductibles are up nearly 50% since 2009, the report by the Kaiser Family Foundation shows.

The average deductible this year is $1,217, up from $826 five years ago. Nearly 20% of workers overall have to pay at least $2,000 before their insurance kicks in, while workers at firms with 199 or fewer employees are feeling the pain of out-of-pocket costs even more: A third of these employees at small companies pay at least $2,000 deductibles.

“Skin-in-the-game insurance” is becoming the norm, says Kaiser Family Foundation CEO Drew Altman, referring to the higher percentage of health care costs employees have to share.

Deductibles will keep going up as companies try to keep their own health care costs down by raising the amount of cost-sharing workers have to bear, says Gary Claxton, a Kaiser Family Foundation vice president who co-authored the annual study.

At Noblehurst Farms, a dairy farm in Linwood, N.Y., the premiums went up, but deductibles held steady this year because the 40-member plan was already a high-deductible one started four years ago. Everyone, from the owners to the calf managers, pays a $1,500 deductible for a single person’s plan and $3,000 for a family plan, says Sarah Noble-Moag, a director of the company, which participated in the Kaiser survey. Though some employees were skeptical at first, they’ve come to accept the plans and appreciate the $1,000 the company contributes to their health savings accounts to help offset the deductibles, she says.

“As an employer, you see employees take a big hit when they have any kind of medical expense,” says Noble-Moag, whose grandfather formed the farm’s corporation in the 1960s. “It can bankrupt a person.”