Health Savings Accounts Explained

One thing is certain with healthcare: premiums continue to climb higher.

As a result, more employees may find that health-savings accounts (HSA) have been added to their benefits packets this year, in some cases replacing HMO and PPO offerings.

HSAs are tax-free accounts tied to an insurance policy with a high deductible of $1,250 for an individual and $2,500 for a family. After the deductible is reached, policy holders receive comprehensive coverage.

To ease the burden of those out-of-pocket costs, participants can contribute, pre-tax, up to $2,650 for an individual and $5,250 for a family into an HSA. Withdrawals from HSAs are tax-free as long as they are used for medical purposes.

Unspent HSA money automatically rolls year to year and those funds can either earn interest or be invested into participating mutual funds for greater returns – potentially building a tax-free nest egg for healthcare costs.

Consider it the 401(k) plan for healthcare

Victoria Craig Bunce, director of research and policy at the Council for Affordable Health Insurance, said employers can save between 25 percent and 30 percent on health premiums by switching to an HSA. Those savings usually translate into lower premiums for employees – savings that employees can use to maximize their health savings accounts.

A study by Mellon Human Resources and Investor Solutions in May indicated that 7 percent of the over 360 employers surveyed already offer HSA plans to employees and 32 percent plan to offer them in 2006.

While it sounds like a win-win for both employers and employees, it’s still a hard sell for some companies. With some current healthcare deductibles as low as $150, employees may get put off by HSA’s much higher ones. And there’s something disconcerting about paying the entire cost of a doctor’s visit up-front, rather than the standard $15 or $20 co-pay.

David Bauer, past chairman of the Independent Insurance Agents and Brokers of New York, said in New York, many carriers have filed HSA offerings but despite interest from employers, clients are still cautious about signing up for these products.

“With these high deductibles, employers are skeptical about HSA renewal the following year,” he said.

He added that the perception that HSAs are for the “healthy and wealthy,” rather than the average wage earner, is also proving to be a hurdle for early adoption.

Wave of the future

But advocates insist that HSAs, which only became available in January 2004, are the wave of the future.

“It’s common that people are afraid of change,” said Dr. Stephen Neeleman, chief executive of HSA provider HealthEquity, and co-author of The Complete HSA Guidebook. “In 1981, when people began opting for 401(k) plans from traditional pension plans, we saw slower adoption.”

Neeleman added that of the 800 businesses HealthEquity services, over 90 percent of employers also contribute a portion of their cost savings towards partially funding high deductibles – making HSAs an increasingly attractive option.

Consumers may also want to consider the extra control they have over the type of healthcare they receive through an HSA, said Tom Richards, senior vice president of products at CIGNA.

HSA participants are no longer bound by referrals to receive medical care and, in some cases, physicians are willing to negotiate lower prices for up-front payment because it saves them the trouble of dealing with insurance companies.

Richards added that HSAs are also appealing because of their portability – if an employee leaves his company, he can transfer the funds to his new company’s HSA. Considering the benefits, CIGNA expects overall consumer driven plans to account for 3 percent to 5 percent of its market next year, he said.

Not for everyone

HSAs, however, aren’t for everyone. It’s generally a good idea to sit with a financial planner to see if the savings really do add up. Keep in mind that while savings are accumulating in the first year, if there is a sudden expensive health emergency, you may not necessarily have the funds to cover it in your HSA. That mean you’re responsible for those out-of-pockets costs.

But analysts expect HSAs to become an increasingly common choice for employers.

Peter Delano, senior analyst at research and consulting firm Tower Group said that HSA assets will reach between $10 billion to $26 billion by the end of 2010. Just don’t expect traditional healthcare plans to fall by the wayside, he said.