Nanci Hellmich

USA TODAY

More employees are getting hit with higher health insurance premiums and co-payments, and many don't have the money to cover unexpected medical expenses, a new report finds.

More than half of companies (56%) increased employees' share of health care premiums or co-payments for doctors' visits in 2013, and 59% of employers say they intend to do the same in 2014, according to the annual Aflac WorkForces Report. It's based on a survey of 1,856 employers and 5,209 employees at small, medium and large-size companies.

In 2013, 19% of companies implemented a major medical plan with a high deductible (more than $1,000) and Health Savings Accounts as an alternative to a traditional medical plan, the study finds.

Employees are worried about covering their medical costs: 49% have less than $1,000 to pay for unexpected out-of-pocket medical expenses; 53% would borrow from their 401(k)s or credit cards to cover unexpected medical costs; 66% say they wouldn't be able to adjust to the large financial costs associated with a serious injury or illness.

The survey also showed 69% of workers at least somewhat agree that they regularly underestimate the total costs of an injury or illness, including medical, household and out-of-pocket expenses.

Many employees are in a "fragile financial situation" and couldn't afford the out-of-pocket expenses of many medical situations, says Matthew Owenby, vice president of human resources for Aflac, a provider of supplemental insurance, such as accident, cancer, critical illness, dental and vision.

Some companies are already offering high-deductible plans and, "I think we'll see more of this in the future," he says.

The need to control costs is driving many companies' decisions on benefits, Owenby says. The report shows that almost half of employers (49%) agree that controlling costs is the primary objective, and took steps to contain costs, including:

• 39% hired independent contractors or consultants.

• 32% eliminated or delayed raises.

• 22% eliminated or cut back on benefits.

• 21% changed some full-time workers to part-time workers.

The report notes that the Kaiser Family Foundation finds that health care premiums have increased 80% since 2003, nearly three times as fast as wages (31%) and inflation (27%).