and more expensive. Unemployment is nearly 10 percent nationally, 8.9 percent on Long Island. And wages have been stagnant -- for those who have jobs.

Now another worry looms on the horizon. With open enrollment for 2010 work-sponsored health insurance benefits getting under way, workers should prepare to dig deeper into their wallets to cover increased costs.

Towers Perrin, a human resource consulting firm, said that employers' 2010 health care costs are rising an average of 7 percent nationwide.

But closer to home, Lou Basso, president of the Farmingdale-based Alcott Group, which serves as an outsourced human resources department for about 200 small and mid-size businesses in the area, said many of his clients are seeing 10 percent to 15 percent increases in premiums. All this at a time when national attention is focused on health care reform that aims to bring those costs down.

Even with "inflation being supposedly nonexistent, we're still getting double-digit health increases. It's mind-boggling," said Basso, who pointed out that as companies strive to stay profitable amid rising costs, some of the cost "burdens keep being shifted to the employee." That can come in the form of higher premiums, deductibles and co-pays, experts said.

Last year Lisa Marino, 49, of Farmingville, got hit with a higher premium and pharmacy co-pays. She said she is now paying more than $5,000 a year in out-of-pocket expenses.

"I don't know if there are any changes this year. I'm holding my breath," she said. "With everything else more expensive . . . from a personal budget perspective it becomes increasingly difficult to decide what kind of treatment you will go for."

Marino has decided against thrice-weekly recommended physical therapy sessions of $35 each related to a chronic condition. And she's not the only one minding the bottom line.

Patty O'Connell, vice president of human resources at People's Alliance Federal Credit Union in Hauppauge, said the organization tries to keep costs down, but she's aware that employee raises can be eaten up by health care contributions. People's Alliance held open enrollment in July, avoiding heavy cost increases in September, she said.

Still, in a tough labor market like this one, many employees "are just happy to have their jobs" and appreciate the coverage even if their outlay is going up, said O'Connell, who is also co-chair of the human resources committee of the Hauppauge Industrial Association.

Despite rising costs, there are opportunities for workers to save. Look for employers to offer more incentives -- such as gift cards, cash, a break on premiums -- if you participate in healthy-living programs. Employers in the Towers Perrin report indicated that at least through 2012, they expect to continue to increase health risk assessments, weight control and stop-smoking programs, and biometric screenings, exams that determine a person's risk level for certain medical conditions.

Last year at Mailmen Inc., a direct-mail company in Islandia that employs about 250, employees were invited to take such screening tests, comprising questionnaires and comprehensive blood tests. Those who chose to do so got a monthly break on their health insurance premiums -- $10 a week for individuals and $15 a week for a family plan.

Of the 117 employees who took health insurance, "we had 100 percent participation for the screening," human resources manager Jackie Ramos-Gonzalez said. The company is planning to offer a similar program for the coming year, she said.

Test results were confidential, but the company received anonymous aggregated data used to develop support initiatives, she said, such as sessions by the American Diabetes Association and American Cancer Society, healthier cafeteria choices and an employee walking club.