What are your chances of staying healthy for the next 12 months? Care to place a bet?

Those are the questions for many of the tens of millions of working Americans now engaged in the annual health-benefits enrollment process and who for the first time have the option of signing up for the relatively new kind of coverage known as a consumer-directed health plan.

But because the plans can pose risks and uncertainties, many employers are still not offering them. And even where the plans are available, most experts do not expect more than a small fraction of workers to choose the coverage.

Meant to save employers money — possibly workers, too, if their gambles pay off — the plans dangle the lure of lower monthly premiums than conventional coverage. The trade-off is a higher annual deductible, the money the member must pay to cover medical expenses before the insurance kicks in.

With the new plans, the deductible is at least $1,000 for an individual but can go much higher.

In some cases, these plans also feature a health savings account that lets the employee set tax-sheltered money aside to spend on medical bills, whether in the coming year or farther out in the future.

Some versions also help members figure out the best doctors to go to and are more generous than conventional coverage in paying for care meant to keep people healthy. In some cases, consumer-directed plans are the only type of coverage offered.

If all this sounds more complicated and risky that conventional health insurance, it is. Despite heavy promotion by insurance companies, corporate benefit consultants and even cheerleading by President Bush, employers have been slow to push consumer-directed health plans and workers have been even slower to choose them.

“It’s a risk thing that you take,” said Judy Rosenthal, a working mother in Independence, Mo., who has experimented with four plans in five years.

Several years ago, Ms. Rosenthal chose a $1,000 deductible with a relatively low $126 monthly premium for herself and her two young sons. Three months later, one son broke his leg. Right off the top, she had to pay $1,000 before the health plan picked up the remainder of her son’s bills.

“I got scared and went to a $250 deductible for the next year,” said Ms. Rosenthal, who works as a research coordinator at Discover Vision Centers, an eye care chain. The premium was $326 a month that year, 2003. But it kept going up — to $388 in 2004 and $440 for 2005, when she switched plans again.

“I couldn’t afford that,” she said. So to reduce her monthly outlay, she gambled on a plan with a $2,500 deductible with a $230 monthly premium.

“Last year, I came out ahead,” Ms. Rosenthal said. “With kids, you never know.”

During her employer’s enrollment period this year, for coverage beginning July 1, Ms. Rosenthal signed up for a $1,500 deductible plan with a $323.81 premium. Over the Fourth of July weekend, one son hurt his back playing baseball. Ms. Rosenthal quickly burned through her own $1,500 on a visit to an orthopedic surgeon and subsequent physical therapy.

Because consumer-directed health plans have been around for only a short time and adopted by relatively few workers, it is hard to know yet whether they are meeting the goal of making people better consumers of health care.

The evidence “shows that greater cost-sharing leads to reduction in health care use and expenditures,” said Melinda Beeuwkes Buntin, an economist who led a study of the plans that was released last month by the research center Rand. “But what we don’t know is how this will affect overall health quality and patients’ health.”

That is why, despite the prospect of saving money on their employees’ health benefits, many companies are also cautious, mindful that their workers could end up worse off.

“Large employers are not rushing pell-mell into these products,” said Peter V. Lee, the chief executive of the Pacific Business Group on Health, a San Francisco-based employer group.

During the enrollment season for 2006, only 7 percent of employers that offer health benefits made consumer-directed plans an option, according to a widely respected annual survey conducted jointly by the Kaiser Family Foundation and the Health Research and Educational Trust, which was released in late September.

The report estimated that fewer than three million workers and their dependents were enrolled in such plans. Many consultants and insurers say the numbers are actually much higher — at least twice Kaiser’s estimate — but that would still be only a small fraction of the 70 million or so American workers covered by employer health insurance.

Last year, the Kroger supermarket chain, one of the first large companies to offer a consumer-directed plan linked to an individual health savings account, managed to persuade only 5 percent — or 3,500 of its 70,000 eligible employees — to sign up. To attract more employees in the current sign-up period, Kroger is adding a $500 match to employee contributions to the health savings account.

In an individual health savings account the annual contribution cannot exceed the plan’s annual deductible. But it can grow tax-free until the money is withdrawn and can be added to year after year. And employees keep it, even if they change jobs. Nationally, employees have opened about 1.2 million accounts holding about $1.5 billion, according to a survey of 60 administrators of health savings plans by Steve Davis, managing editor of Inside Consumer-Directed Care, a trade newsletter.

“We think health savings accounts give our associates a long-term interest in the economics of health care that wasn’t there before,” said Mike Stoll, vice president for corporate benefits at Kroger.

So that employees do not skimp on the preventive medicine that can stave off much more expensive health conditions, many of the plans provide 100 percent coverage for such basics as yearly physicals or annual mammograms. The insurer UnitedHealth Group is the leading provider of consumer-directed plans, with 1.8 million members. By combining financial incentives with the help people need to make better health care decisions, UnitedHealth said, its patients with chronic diseases who are enrolled have 12 percent fewer emergency room visits than those in traditional plans.

Even Kaiser Permanente, the health plan best known for its classic H.M.O.’s, plans to offer consumer-directed products in California next year. And Medicare, the federal insurance program, is experimenting with some form of health savings accounts in 39 states.

“We’re getting there,” ” said Tracy L. Bahl, a UnitedHealth Group executive who manages health benefits for large employers. While adoption may be slower than anticipated, he said, “the trajectory still remains positive.”

The real attraction of the plans for employers is the potential savings. UnitedHealth points to its own study of 50,000 workers in these plans, which found that the average cost of care for members decreased 3 to 5 percent, compared with an increase of 8 to 10 percent in UnitedHealth’s traditional plans.

Some employees are enthusiastic about consumer-directed coverage. About half the 5,000 eligible workers at the Visant Corporation, a printing and marketing company in Armonk, N.Y., are enrolled in a plan with a deductible of $1,000 for an individual and $2,000 for a family.

For Brian Hartman, a 36-year-old Visant finance executive, the company this year contributed $600 to a health reimbursement account — a savings vehicle similar to a health savings account except that the employer keeps its contributed money if the employee leaves the company. For doctors in the network, the plan covers 90 percent of fees, and those fees are discounted for plan members.

Mr. Hartman said that his former health plan, a traditional preferred provider — P.P.O. — plan, with a $500 deductible for each member, had covered only 80 percent of doctor fees. That coverage “was not so great,” Mr. Hartman said.

Now, “I’m really impressed with the level of discounts at the different doctors we go to in the new plan,” he said. “We don’t have a co-pay. There is no paperwork.”

Other people in consumer-directed plans have been disappointed, though. Don Cohon of Muir Beach, Calif., tried the new approach and went back to more traditional coverage.

He switched back after an expensive bicycle accident in February 2005 that sent him to an emergency room. Even before he was examined Mr. Cohon incurred a $12,000 “trauma activation fee.” Although he spent less than three hours in the hospital, after X-rays, a CT scan and treatment for some bruises, his total bill came to $25,000.

Mr. Cohon, whose plan had a $2,500 deductible, was responsible for $6,200 of the charges.

He eventually managed to persuade the hospital to forgive the bulk of that amount. But he is now enrolled in a traditional plan offered by his employer, the Edgewood Center for Children and Families, a non-profit social services group.

“It’s much better coverage,” he said. “It’s not a high-deductible.”

Even for consumers who try to make careful use of the health care system because they are now paying a larger share of cost, high medical bills can be inevitable. “It sounds good to say you need skin in the game,” said Dr. Greg M. Silver, a family physician in Clearwater, Fla.

In his case, the “skin” was a plan with a $5,000 deductible. And he was careful to choose family doctors and a hospital that were in the plan’s network — the hospital where Dr. Silver was a department chairman. But when his son had to have an appendectomy at that hospital, he discovered that none of the specialists there were in the network.

Dr. Silver ended up depleting his health savings account to pay the $8,000 in medical bills he was responsible for. “I learned the hard way,” he said.

Work Safe,

Brother Tom Moore

tmlocalone@aol.com

Ramiro Jara was lured by the same promise that drew his brothers and cousins to New York from the highlands of Ecuador six years ago. Opportunity. A new life. Wages he could never have earned back home.

And he found a steady job, as a construction worker, learning how to nimbly navigate platforms and scaffolding that wrapped Manhattan’s soaring buildings. But early yesterday, as the morning traffic roared by below, Mr. Jara, 25, took a fatal misstep about 15 stories above the ground while working on an ornate office building at 114 Fifth Avenue near Union Square.

Mr. Jara’s harness was not attached to a safety line, a rarity, his brothers said yesterday in hushed tones. He was moving between two hanging scaffolds on the side of the building when he fell, hitting a platform one story above the ground and dying almost instantly, the police said.

Mr. Jara’s fall was labeled an accident by the authorities. A spokeswoman for the Department of Buildings, Jennifer Givner, said Mr. Jara’s employer, Town Restoration Services in Brooklyn, did not have a permit for the beams that the scaffolds were hanging from, nor did it have a licensed rigger or designated foreman on-site to monitor the work. Certificates of fitness, showing that workers had been trained for the rigs, were also missing.

The buildings department had not issued any violations yesterday as it continued its investigation. Reached by phone, an employee of Town Restoration Services did not comment.

Work at 114 Fifth Avenue was stopped, and Mr. Jara’s relatives — two brothers and three cousins — struggled to absorb their loss. They and Mr. Jara shared a cramped railroad-style apartment in the Bushwick neighborhood of Brooklyn.

Mr. Jara regularly sent money to his mother in Cuenca, Ecuador, said Luis Jara, a cousin.

Ramiro Jara’s brothers and cousins said they hoped Town Restoration Services would help pay to send his body to Ecuador.