Who said having health insurance was easy?

As health-care costs continue to rise and the recession leaves employers under pressure to tighten their belts, many companies are transferring more health-care costs to their employees. For workers, that could mean higher premiums, co-pays or deductibles next year.

These changes can make the open enrollment season – the period during which workers can make changes to their coverage – a confusing time for employees because they must quickly pinpoint which constellation of price increases are least painful to their wallets.

In some cases, there may be no escape. Employees are projected to pay $4,023 on average in premiums and out-of-pocket costs in 2010, up 10% from 2009, according to Hewitt Associates, a benefits consulting firm. And, according to a Kaiser Family Foundation (KFF) survey of 2,000 companies, 42% say they will likely increase the amount workers contribute to their premiums in 2010, 36% say they will likely increase deductibles, 39% say they will probably increase office-visit cost sharing, and 37% say they will probably increase the amount employees must pay for their prescriptions.

In most cases, open enrollment is the only time employees can review and change their health insurance. (Should some form of health-care legislation become law, most employees will have another opportunity to make changes to their health plan.)

Here are four tips that can help employees cut next year’s health-care costs during open enrollment:

Today, most insurance plans don’t cover all costs. Employees who have health-related expenses like dental visits, vision correction or co-pays not covered by their plan can contribute pretax dollars to a flexible spending account (FSA). Depending on the tax bracket, workers could save as much as 26% to 30% on their bill because the money going to pay for it won’t be subject to tax, says Sara Taylor, the health and welfare strategy leader at Hewitt Associates.

Individuals should consider the FSA as a one-year program. The money they contribute to an FSA during open enrollment must be used within a 12-month period that typically corresponds to the calendar year. That means contributors will have to visit the doctor or purchase prescription eye glasses by the end of the year. (They’ll have until March 31, 2011, to submit expenses for reimbursement.) Any money remaining in the FSA at that point won’t be returned.

In some cases, employees might find that they don’t need as much health insurance as they’re paying for. One option would be to eliminate vision and dental coverage and use an FSA for such expenses (This option works best for those who don’t need such services on a recurring basis).