Just two years ago, Sandy Arroyo, 64, of Kennesaw, a retired Cobb County high school teacher, was paying $340 a month for health insurance for him and his wife. Today, the couple are bracing themselves for Jan. 1 — when their coverage will cost them $620 each month.

"It doesn't make sense," Arroyo said of his 82 percent cost increase. "They're driving people away from insurance, instead of towards it. Our insurance has increased dramatically every year, and no one seems to have any answers."

Arroyo said he was shocked and confused when he received a flier a few weeks ago indicating his wife will soon be charged an additional $50 per month as a "spousal surcharge" because his wife, a nurse in the WellStar Health System, elected not to take the insurance package her company offered and instead joined her husband's United Healthcare plan.

He called United for more information, and sure enough, they told him the fee would start in January because his wife had declined her own employer's insurance, he said.

David Bottoms, vice president of the Bottoms Group, a benefits consulting firm in Marietta, said more health insurers will be charging spousal fees in the future, as it often costs companies more to take on an added dependent than it would for the spouse to enroll in group health insurance offered by his or her own employer. Bottoms said the surcharge only applies when a spouse declines other insurance for which they are eligible.

Tobacco surcharges, and even obesity surcharges are also growing in popularity among large companies trying to hold down their insurance costs, he said.

Bottoms said that the average health insurance plan will cost 12 to 15 percent more next year - and that some initiatives in the federal healthcare reform act will add another two percent cost increase.

"The federal healthcare reform didn't really accomplish the goal of lowering healthcare costs, because they'll actually go up. But there will be expanded eligibility and expansion of coverage, and it's just going to cost more because there are more benefits," Bottoms said. "There will be a lot of government subsidies to lower the costs to individuals who qualify at a certain income level. And right now it just results in a two percent increase - the bulk of the increases are coming from the insurance companies. But once it gets to 2014 and all of the healthcare reform initiatives are implemented, all bets are off."

Some changes took effect in September, six months after President Barack Obama signed the healthcare bill into law. Those changes include allowing individuals to stay on a parent's insurance through age 26 and regardless of student status; prohibiting exclusions of preexisting conditions for children; and removal of caps on lifetime benefits.

Prohibiting preexisting-condition exclusions on children's insurance puts greater risk on health insurers, Bottoms said, and most carriers simply stopped writing individual health policies for children last spring.

Bottoms attributed the rising health insurance costs to medical advances - and litigation.

For one, doctors order multiple tests, in part to avoid liability lawsuits if a disease is not caught. Prescriptions are also expensive, adding to an insurer's cost.

Bottoms also said that although residents can choose to keep their insurance plans, they lose that grandfathered status if they change insurance carriers or if an employer makes many changes to the plan.

"It's going to be hard to keep that same plan long-term, because some of the things like benefit extensions or benefit caps are going to happen regardless," Bottoms said.

Bottom line, Bottoms said, costs will go up, even though most are not a result of federal healthcare reform - yet.

"Sometimes you'd think they'd just let you keep what you have and not charge you more, but they don't give you that option," Arroyo said. "Eventually, I'm afraid it's going to get to the point where no one can afford health insurance."