Making the most of that shiny new HSA

NEW YORK Thu Apr 19, 2012 12:34pm EDT

Discovery Communications Wellness Center Medical Director Liz Sequeira arrives to examine patient Bonnary Lek (L) during a medical appointment at the clinic in the Discovery headquarters in Silver Spring, Maryland December 3, 2009. REUTERS/Jim Bourg

Discovery Communications Wellness Center Medical Director Liz Sequeira arrives to examine patient Bonnary Lek (L) during a medical appointment at the clinic in the Discovery headquarters in Silver Spring, Maryland December 3, 2009.

Credit: Reuters/Jim Bourg

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NEW YORK (Reuters) - Health savings accounts have been around for almost a decade, but lately people have been snapping them up like they are milk and rock salt, and a big snow storm is brewing.

Enrollment in these specialized tax-deductible, tax-free accounts has exploded: In March 2005 there were slightly more than 1 million accounts; a year ago there were 11.4 million, according to America's Health Insurance Plans, a trade group. Since then, the growth has been exponential, with Fidelity Investments saying its HSA business grew 61 percent in a year.

The idea behind these accounts is this: Consumers set aside pre-tax dollars in a special account that they can use for the out-of-pocket medical expenses that arise when they are in high-deductible plans.

Some of that new popularity stems from the growth of lower cost high deductible health insurance plans that are showing up in employer's benefit packages.

But the big tax advantages that these accounts confer on their owners is also significant.

"I don't know of anything else that has a triple tax advantage like an HSA," says Paul Ashley, a financial adviser with First Person Benefit Advisors in Indianapolis. "You pay into the account pre-tax; then it sits in the account, tax free, whether you acquire gains through interest or investments. And then when you spend money for a qualified purpose, you're not taxed there either. That's a powerful incentive."

Furthermore, account holders keep their accounts even when they change jobs, points out Jennifer L. Zegel, an associate with the Philadelphia-based law firm Reger Rizzo & Darnall. "I think HSAs have grown rapidly in recent years because they are portable."

Whatever the reasons, there's a decent chance that an HSA may be in your future. You may already have one.


At first blush, HSAs sound like Flexible Spending Accounts - the tax-sheltered accounts that allow employees to set aside some of their pay to fund medical or dependent care expenses. But there's one major difference: While FSAs expire at the end of each year, HSA funds roll over year to year. HSAs also are sometimes confused with employer-funded health reimbursement accounts (HRAs). These accounts are set up by employers to reimburse employee medical expenses. HRAs offer similar tax benefits to HSAs and funds can be kept year to year, but HRAs are not transferable when an employee leaves his/her employer.

"The ‘use it or lose it' rule with FSAs scares the bejesus out of people," says John Hauserman, CFP and president of Retirement Quest Wealth Management in Baltimore. "But HSAs are different. I think of these plans as a health retirement account, something you can hold onto for a long time and use as you need it." Some account holders take advantage of this, saving and investing their HSAs from one year to the next so they can use them in retirement, when medical expenses may be high.

But before racing to sign up, consumers should consider some of the downsides and complexities of HSAs.

First, not all employers offer them. The 2011 Kaiser Employer Health Benefits annual survey found that only 23 percent of firms offering health benefits offer a high deductible health plan or an HSA-qualified plan.

And users should be able to shell out some money for their own health care. The high-deductible healthcare plans that allow individuals to use an HSA are required to have deductibles of at least $1,200 for individuals and $2,400 for families. Maximum deductibles are $6,050 for individuals and $12,100 for families.

Aside from preventative services such as an annual checkup with a doctor, there is no reimbursement for medical services until the deductible is reached. And after reaching the deductible, "people typically have to pay additional copayments and coinsurance on the care they receive, making out-of-pocket spending potentially quite a bit higher than the deductible," says Adam C. Powell, a healthcare economist and president of health insurance consulting firm Payer+Provider.


Ideal HSA candidates are young and likely not to see their doctor regularly, says D. Wes Rommerskirchen, a business development supervisor with Benefit Plans Plus in St. Louis. "If they're young and healthy - or, if they have a family, their family is healthy - they can use it to really build their funds," Rommerskirchen says. "And, when those health expenses hit, they'll have the funds available."

That's another reason why young and healthy people are best suited for HSAs; the accounts have an annual contribution limit of $3,100 for individuals and $6,250 for families.(Someone over the age of 55 can contribute an additional $1,000 each year under catch up provisions.) So it's possible that, in the event of a major medial incident during the first or second year of an HSA plan, individuals might not have enough cash set aside to cover the entire cost.

"It is important to try to keep at least the deductible saved in an HSA so that those expenditures can be made with pre-tax money, says Powell.

But there are limits on what those expenditures can entail. Health club dues, hair transplants and cosmetic surgery - as well as the other expenditures deemed "not includible" by the Internal Revenue Service (see IRS's Publication 502 for a list here) - are off limits. So are over-the-counter drugs such as Advil or Tylenol, unless they're prescribed by a doctor.

And individuals who pull money out of their HSAs for non-medical purposes will pay dearly for that: the withdrawal will be taxed as ordinary income and subject to an additional 20 percent penalty.


Though non-medical withdrawals are always taxed as ordinary income, that 20 percent penalty is dropped at age 65, and that allows for some creative strategies.

Retirees, who presumably will face higher healthcare costs as they age, can use HSA balances built up over the years to supplant their retirement income. Even if they end up drawing down the money for non medical purposes in retirement, the end result is no worse than a traditional tax-deferred account.

Some advisers, like Zegel, suggest stashing the maximum contribution in an HSA, not using it until you retire, and then pulling money out to repay yourself for medical expenses you had when you were building the HSA. Of course that requires keeping all of your medical receipts for years and years.

HSAs can be a great option for many. But it's not right for everyone.

"If someone has chronic medical condition, it would not be a viable option," she says. "They would be paying too much out of pocket. But it's great for people who want to save for future medical expenses."

(Editing by Linda Stern)

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Comments (5)
ArtAsInquiry wrote:
HSAs should be sold by financial consultants to the very very healthy who wish to leverage their good health for tax advantages. They also must willing to take their chances that no catastrophes will befall them until the HSA is fully funded.

HSAa are about as useful to the general population as snake oil. And they were designed by insurance companies as a way for employers, squeezed by rising premiums, to shift healthcare costs to their employees.

Was this so-called article written by AHIP, the lobbying arm of the insurance industry? The friendly, informative tone legitimizes HSAs. HSAs are a nightmare for all but the smallest minority.

Apr 19, 2012 5:51pm EDT  --  Report as abuse
Psychologist wrote:
Health savings accounts are an excellent idea. They promote preventive
care, which minimizes the cost of long-term medical care. The use of walk-in clinics is also increasing because these clinics reduce the demands made on hospital emergency rooms and provide an alternative to the shortage of physicians in the United States.

Apr 19, 2012 9:15pm EDT  --  Report as abuse
ArtAsInquiry wrote:
“Walk-in clinics”, “Medicaid” and “charity care” are buzz words for doing nothing about the inaccessibility of healthcare for hard-working, employed individuals not covered by employer-based group plans. If these employed people were able to fund an HSA, they might as well get insurance on the individual market. It’s affordable if you are in great health and have NO pre-existing conditions. So the HSA is superfluous.

HSAs don’t solve the problem of accessing healthcare for working,low-middle income people who don’t get insurance through their employers.To offer this insurance product as a panacea to our healthcare crisis is at best uninformed, and often disingenuous.

For example, a 60 year old woman paid $700/month for her HSA (because of her age) and on top of that she could FUND the HSA to the tune of $5000/year. She paid the premium for the HSA. She could not fund the savings account. She said, “I am essentially uninsured because I don’t have the money for the HSA. I don’t seek out any preventive services because if the drs. found something how would I come up with the first $5,000 to pay medical bills? I keep the insurance just in case I get cancer or suffer a stroke.I’m too scared to be without anything.”

Her plan was to hope nothing happened until she turned 65 When she would qualify for Medicare.

There may be some viability in the group market if the employers fund a good portion of the HSA. But employers are turning to HSAs to lower their premiums. So it would defeat the purpose to pay lower premiums and ALSO substantially fund an employee’s HSA.

HSAs — horrible ruse on the working public.

Apr 20, 2012 10:15am EDT  --  Report as abuse
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