If you're paying more out of pocket for health insurance from your employer, 2019 isn't likely to be any better. 

That’s because job-based health insurance costs are continuing to rise along with medical costs. To shield themselves from the impact of that increase, employers are pushing more of the cost onto their employees in the form of higher deductibles, which is the amount paid on top of monthly premiums before insurance starts kicking in.

The average deductible for an individual now stands at $1,573, up 53 percent from 2013, according to the Kaiser Family Foundation's 2018 Employer Benefits Survey, an annual report that is the most definitive study of the cost of employee benefits.

One-quarter of workers with insurance are in plans with a deductible of at least $2,000, up from 15 percent five years ago.

“If you get sick, bills can pile up quickly,” says the study's lead author, Gary Claxton, a Kaiser Family Foundation vice president and director of the Health Care Marketplace Project.

The amount workers are asked to pay toward their monthly premiums was about the same this year, according to the survey. But premiums have been steadily increasing for years. The average worker contributes $5,547 a year for family coverage—up 22 percent from five years ago. Individuals paid an average of $1,186 a year for insurance in 2018, up 19 percent since 2013.

The financial pain for workers is especially acute because wages haven’t kept up with the increase in health insurance costs, says Drew Altman, president and CEO of the Kaiser Family Foundation.

Still, the survey found some bright spots. Even as their costs have gone up, about 60 percent of all employers still offer insurance to workers, and about 90 percent of companies with more than 50 workers offer health benefits. And companies still cover the bulk of the cost—on average, 82 percent of the cost for a single person and 71 percent for those on family plans.

Also, increasing competition for workers in this strong economy is putting pressure on employers to make benefits packages more attractive. Fewer companies are making high-deductible health plans (HDHPs), which have the steepest out-of-pocket costs, the only option. Those plans have a minimum annual deductible of $1,350 for a single person and $2,700 for a family.

This year, 39 percent of large employers offer high-deductible health plans as the only choice for workers, according to a survey by the National Business Group on Health. For next year, only 30 percent of big employers say they will make it the only option.

“Given that the economy is good, employers don’t have a strong incentive to push people into plans that they may not be comfortable with," says Claxton. “Employers have to offer workers benefits that are attractive, or they may go somewhere else.”

Open enrollment—the time when you must choose your health insurance plan for next year—is coming up in November for most workers. Here are six ways to save money without sacrificing the quality of care you get.  

Most workers stick with the same options year after yea, but you can often save money by switching to a new plan. Plan benefits change frequently. Participating doctors are added and deleted, and drug formularies—the lists of prescription medications a plan covers—are revised.

Take the time to compare plans. Insurance companies provide much of that information online and in the multi-page packets your benefits department hands out. Those can be hard to get though, so take advantage of online plan comparison tools your employer offers or talk to your company's benefits representative about your options. Many companies offer one-on-one counseling to discuss plan choices on the phone.

You can’t choose the most cost-effective coverage without knowing how much you’re likely to spend on healthcare in the coming year. With that number in mind you will be able to make an informed decision between, say, a plan with a high deductible and one with a low one. Of course, no one has a crystal ball to see into the future, but the amount you and other family members spent on healthcare this year is a good indicator of about how much you’ll spend next year.

You can find your claims (including what you spent out of pocket) on your insurer’s website. Your pay stub will show how much you paid in monthly premiums and your pharmacy will have a record of how much you spent on medication.

If you’re in a low-premium/high deductible plan and didn’t come close to meeting your deductible last year, you might do fine sticking with it. But if you quickly hit your deductible (perhaps because of a chronic health condition that requires frequent doctor's visits), choosing a plan with a higher premium and a lower deductible could save you money overall.

Think about what could be different next year. Was someone in your family diagnosed with a health condition that requires new medication? Are you planning to start a family and make more visits to an OB-GYN? Are you finally going to get that surgery for your creaky knees? Talk with doctors about the cost, then see how much will be covered by the plans you’re offered.

It’s tempting to try to save money by choosing a plan with the lowest monthly premium, but that's only one part of what you pay for health insurance. In addition to premiums, consider the amount of the deductible so that you know how much you have to spend before the insurance company begins covering expenses.

Also look at co-pays (the flat charge you pay every time you go to a doctor, hospital, or other healthcare provider) and co-insurance (the percentage of the bill you have to pay for treatment). You’re responsible for co-pays and co-insurance for doctor's visits and procedures even after you’ve met your deductible.

Thanks to provisions put in place by the Affordable Care Act, you're entitled to a number of preventive services at no charge as long as you stay in your insurance network.

The range of no-cost services may surprise you, from colonoscopies and vaccinations to depression screening and nutrition counseling. Check out the full list of eligible services here. Taking care of yourself now could prevent needing expensive care later.

About 62 percent of large employers and 37 percent of small firms give workers rewards for participating in programs that help them identify health concerns and manage chronic diseases, according to the KFF survey. Those are typically questionnaires about medical history, health status, and lifestyle, or biometric screenings, which are health examinations conducted by a medical professional, or both.

Incentives take various forms, such as lower premiums or less cost-sharing, cash payments of $500 or more, gift cards, merchandise, or contributions to health-related savings accounts. Some employers also reward people for not enrolling in an insurance plan at work: 13 percent of employers give workers who enroll in a spouse’s plan additional compensation.

Fourteen percent also provide financial incentives in the form of lower cost sharing for workers who use retail clinics in pharmacies, supermarkets, and other stores to get care instead of going to a doctor.

Another way to ease the pain of high out-of-pocket costs is to use a flexible spending account (FSA) or a health savings account (HSA) if your employer offers one.

HSAs and FSAs allow you to set aside tax-free dollars to cover qualified out-of-pocket medical costs in the coming year. You decide whether to fund these during open enrollment. 

One-third of small firms and 76 percent of large companies offer employees the option of contributing to an FSA. 

You can get an HSA only if you have a high-deductible health plan. About 27 percent percent of small firms and 57 percent of large firms offer workers with a HDHP an HSA with a savings option. And three-quarters of companies that offer HSAs also contribute money to fund them, on average about $1,000.