For starters, it shouldn't shock anyone who's had health coverage for the past 10 years that prices continue to climb, driven by medical inflation, and now there are added costs tied to health reform. That doesn't mean it won't hurt, especially as many workers are still reeling from pay cuts, furloughs or other reduced benefits.

Employees' cost of family coverage rose 14 percent this year to $3,997, according to an annual survey by the Kaiser Family Foundation. That's about 30 percent of the $13,770 total cost, up from 27 percent last year.

Some big employers are seeing total costs rise as much as 10 percent for 2011. But many midsized and small companies are seeing increases "north of 20 percent," said John McDonnell, a principal with Progress Benefits Solutions in Raleigh. "In this economy, another $50,000 in annual premiums means a position the employer can't afford to fill."

While some employers continue to share the burden of higher costs, they also know that workers don't have many opportunities to jump ship when they're hit with higher premiums, deductibles and co-pays.

Most employers provide a choice of health plans with different levels of benefits and a range of prices. While it's tempting to simply pick based on monthly premiums, it's important to know how much health care your family consumes, what types of coverage you need and more.

"The HMO days of $10 covers everything areover," said Steve Crist, a director of sales with Blue Cross and Blue Shield of North Carolina, the state's largest health insurer. "It's going to take us a while to get us out of that mindset."

Increasingly, employers are offering high-deductible plans of $1,000 or more, coupled with health savings accounts that allow consumers to set aside pre-tax money. While that concept scares some consumers, if you can get a handle on what you spend and what things cost, it can be a cost-effective option.

Most employers hold meetings where insurer representatives explain plans and answer questions. Never be afraid to ask questions. Most employers and insurers also provide information online.

"Every year, employees freak out about the costs," McDonnell said. "Now there aren't as many complainers in the audience. It's more people trying to understand what's new and what they need to do."

You should sign up for a flexible savings account, which also allows pre-tax money to be set aside to cover co-pays, prescriptions, glasses and more. That money must be spent each year or it's lost, so keep track of it.

Starting next year, you need a doctor's prescription for over-the-counter drugs to be reimbursed. There are some exclusions to that rule, including insulin and first-aid supplies. Some FSA administrators are now using debit cards, which cuts costs but can create another hassle. For example, the cards can only be used for qualifying purchases, and you'll need to save receipts in case the expense is challenged.

If you're not sure how much you spent on health-related purchases last year, consider contributing a small amount this year to see how far it goes toward the expenses. The website www.SaveSmart SpendHealthy.com has basic information on FSAs, a savings calculator and a list of eligible expenses.