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I just wanted to thank the MFO community....I reached a big milestone in my HSA, thanks to all of you and the T Rowe Price funds you have recommended over the years. It is greatly appreciated!
I just wanted to thank the MFO community....I reached a big milestone in my HSA, thanks to all of you and the T Rowe Price funds you have recommended over the years. It is greatly appreciated!
Hi l5b,
What's the milestone? Hopefully the Health Savings Account finds you healthy, wealthy and wise. Were you able to set an hsa with TRP funds at TRP or through an intermediary?
Just reached a certain $$ level. Yes, thankfully, I am healthy and using the HSA as a supercharged savings account for future healthcare expenses. I set up the HSA at Saturna Capital...no maintenance fees there. They have a limited selection of fund families available, so I went with TRP funds, based on MFO recommendations. The downside of Saturna is that you must hold the funds for 180 days, so I have been very careful in my selection and stagger my investments and redemptions accordingly. It is a comparatively small account, so it has been challenging at times.
As an additional funding source have you considered a rollover into your hsa?
If you haven't already done so and have a tax deferred IRA you can make a one time rollover from your IRA to you hsa. The amount cannot exceed your maximum allowable hsa contribution. For an individual that would be $4350 for 2015 and a but more if you have a family hsa plan.
Its a nice way to move what would be taxable IRA dollars into tax free hsa. This is not a distribution...its a one time rollover.
My entire IRA is a Roth, which I converted in '08 - '09 (I think). And I have continued with the "back-door" Roth contributions ever since. But an interesting idea, nevertheless...thanks!
I'm trying the HSA through my employer for a family this year. It's a little bit confusing to start with, especially if you have prescriptions through mail order, but I'm curious to see how it goes for the year.
Yes, I agree...it can be confusing. I had my HSA at another firm before I moved it to Saturna and it was run very differently. I also manage an HSA for my son at TD Ameritrade...also run differently. Like I said, I have not made any withdrawals, but Saturna said if I needed cash for medical expenses, to just let them know and they would send a check (?!?)...no documentation necessary. I guess they are using the honor system there...my prior firm had an actual debit card.
@little5bee: I hope PRHSX was one of the funds from Price. Regards, Ted YTD: +24.14% 2014: +31.94% 2013: +51.40% 2012: +31.93% 2011: +11.01% 2010: +16.33% 2009: +32.19%
Yes, I agree...it can be confusing. I had my HSA at another firm before I moved it to Saturna and it was run very differently. I also manage an HSA for my son at TD Ameritrade...also run differently. Like I said, I have not made any withdrawals, but Saturna said if I needed cash for medical expenses, to just let them know and they would send a check (?!?)...no documentation necessary. I guess they are using the honor system there...my prior firm had an actual debit card.
I have been given a debit card and a bank account has been set up through BNY Mellon. I am having bi-weekly payroll deductions to begin funding the HSA. You have to have a minimum amount in the account before you can branch off into investments for the funds.
Hi, Maurice -- I would definitely check again at Fidelity, since HSAs have become more popular. The issue I had was that the maintenance fees were quite steep, and with a small account, it really ate into my return. That's basically why I switched to Saturna...but sometimes I wish I were with my prior firm, because I could "trade" the Rydex funds daily. I really did well with that strategy in 2011.
As an additional funding source have you considered a rollover into your hsa?
If you haven't already done so and have a tax deferred IRA you can make a one time rollover from your IRA to you hsa. The amount cannot exceed your maximum allowable hsa contribution. For an individual that would be $4350 for 2015 and a but more if you have a family hsa plan.
Its a nice way to move what would be taxable IRA dollars into tax free hsa. This is not a distribution...its a one time rollover.
Generally, I don't see this as an advantage, assuming you have outside money with which to fund your HSA. It's basically a shell game. You're taking money out of an IRA and thus losing the deduction you could have had by making a regular HSA contribution. So effectively, you are paying taxes on that IRA rollover.
If I'm going to pay taxes when I move money from a traditional IRA to another tax-advantaged account, I'd rather pay the taxes (directly) and move it to a Roth, rather than pay the taxes indirectly (by losing a deduction) and move it to an HSA.
With the Roth, after five years, I can take the money out tax free, no questions asked. With the HSA, questions are asked - what were the medical expenses that this withdrawal is covering?
On the other hand, with the rollover to the HSA, there's no five year waiting period.
If you need to pull money out of a traditional IRA and you're under 59.5, then "laundering" it through the HSA gives you a way to do that (if you've got matching medical expenses). That's the only reason I can see for doing a rollover to an HSA.
@ msf said: If you need to pull money out of a traditional IRA and you're under 59.5, then "laundering" it through the HSA gives you a way to do that (if you've got matching medical expenses). That's the only reason I can see for doing a rollover to an HSA.
For those that may have retired early or are retired and under age 65 with little or no earned income this rollover feature provides a way to fully fund an hsa in the form of a rollover without impacting present income. This perfectly legal rollover might help the newly retired "coupon clipper" who also has to do their own "laundry" and may not have the resources to budget for hsa contributions.
At 59.5 I plan on taking IRA distributions equal to my hsa contributions there by offsetting the taxes on the IRA with an equal hsa tax deductible contribution. I will do this until I am 65. I mention age 65 because that is the age at which one can no longer add to their hsa (because medicare kicks in).
Bottom line, without earned income you can't make Roth contributions. Not true with hsa contributions. hsa contributions are tax deductible even without earned income. In my case these hsa contributions will reduce any other taxable income I have (pension, annuities, SS, interest and dividends) and IRA distributions.
Regarding complexities - each HSA administrator handles things differently - checks, debit cards, ACH transfers. Some will do the medical expense bookkeeping for you. (Similar to mutual fund companies keeping track of cost basis for you - pre-2012 - as a service, but not reporting it to the IRS.)
Whatever works best for you. Since I view HSAs as savings vehicles, I don't care about the withdrawal mechanism. I just keep track of all my eligible expenses since I opened the account. At some time in the future I'll withdraw a lump sum. I'll be able to justify the withdrawal with those medical expenses, so long as I keep good records.
Fidelity does offer an HSA account, but only to employer-sponsored plans. I've spoken with them for years about this. They tell me that they've gotten lots of requests, and they keep looking into it. My guess is that these are not especially profitable accounts, so they're not too interested. - Accounts tend not to be large (limited contributions, people take withdrawals for expenses) - Servicing costs are high (lots of small withdrawals) - Regulatory costs are high
Question about Saturna - they mention Archipelago, but don't provide detail. Last time I checked (a couple of years ago?), this was a smaller list of funds (but more "interesting" as I recall), and required a $10K min. Did Archipelago vanish from Saturna?
Hi, msf....I am also using my HSA for saving and investing. It's been a few years since I made the switch to Saturna, but I remember that originally I was in one "arm" of the firm, which didn't have a large list of funds, so I switched my HSA to the brokerage "arm". They still do not have the selection of funds that Schwab or TD have, but they offer TRP funds NTF, so that's what I focused on. Again, there are positives and negatives with them, just like with any brokerage. When I start withdrawing cash....who knows...I may decide to switch again.
Bee, I did not know about the roll over from IRA to HSA. Thank you for that great information. Unless I'm mistaken, this is nothing like a shell game. Money into an IRA is taxed when you take it out, but in an HSA, there is no tax in and no tax out. What could be better then that?
I have been maxing out my HSA contributions for the last few years and not using the money. I pay for medical expenses with taxed money. But, I have been very lucky that I have had good health, limited expenses. I plan to use the accumulating money in the HSA account as a bridge to pay health insurance when I retire - until medicare kicks in.
Thanks again. You are a gem to this discussion board.
Thanks for the info. It bothered me enough that I had no idea what "interesting" meant that I tried searching for Archipelago. Got one hit, on boggleheads:
If I do not want to invest in those 10 funds, looks like I can open a Saturna Brokerage account and buy mutual funds there. It has access to Vanguard funds via "Saturna Brokerage Archipelago", with some stiff conditions to avoid transaction fee:
I think NTF Vanguard funds qualifies as "interesting". Seems to be a thing of the past, though. (Health Savings Administrators does offer Vanguard funds NTF, but they tack on a 32 basis point ER, and like a 12b-1 in excess of 25 basis points, I regard that surcharge as a load.)
Regardless, Saturna seems to be one of the least expensive ways of owning an HSA without being restricted to a small list of funds provided by Devenir. (Devenir's HSA bank fund list, Devenir's Select Account HSA fund list, etc.)
I have a general question about the HSA (which is different than the Flexible Savings Accounts, which generally expire in that year). When I was previously employed, my employer switched the health insurance plan offerings to HSA eligible insurance plans that allowed for an HSA account, and that was how I funded the account.
The previous plans were not HSA eligible.
Now that I purchase under the Affordable Care Act (ACA) plans, it says which plans are eligible for an opening an HSA account as the contribution can be deducted against Income.
So two questions: 1. the health insurance plan has to be eligible to open an HSA account (as specified in the ACA plans - I was told the answer for this is Yes, ie, can only fund an HSA with specific IRS approved health insurance plans.
2. do you need Earned Income (employer or business income) to fund or add funds to an HSA account?
For those that have an HSA account, did all you have an HSA eligible health insurance plan when it was opened and funded?
1. Generally, you need to have an eligible HDHP (high deductible health plan) in order to open an HSA. However, if you have an existing HSA, you're allowed to open another one (even without having an eligible HDHP), and transfer/roll over the existing HSA to the new one.
- 18 years of age or older - Must be enrolled in a qualified High Deductible Health Plan (HDHP) to make contributions. - If not enrolled in a HDHP you are still qualified to roll over or transfer funds from your current HSA
2. As others have stated, you don't need compensation income in order to contribute to an HSA. AFAIK (this is speculation), you don't need income at all (though you'll waste the deduction that way).
In order to fund (not open) an HSA, you must have had an eligible HDHP. However, since funding can be retroactive (like an IRA, you can fund it early the next year), you can fund the HSA because you were in an HDHP, even if you aren't currently.
From my specific example, in 2014, I was in an employer HSA (HDHP) eligible plan and made the HSA contribution.
In 2015, I went to the ACA and chose a non-HSA eligible plan (I did not want the high deductible for my medical costs as no Earned Income, and because I have no Earned Income, the HSA contribution could be wasted as no real effect to reduce Adjusted Gross Income).
Edit - Therefore, in 2015 with no HDHP plan, I can not make an HSA contribution for the 2015 tax year, is that a correct statement?
And I have found that at least in the ACA versions, even with the high deductibles, the HSA plans were more expensive, higher deductible but offer the HSA contributions, which therefore are great for high income earners and business owners that can deduct all premiums and HSA contributions.
So long as you have income, whether it is considered compensation or not, you get to deduct your HSA contribution. It reduces your AGI.
You are correct that you can only make HSA contributions for the months in which you have an HDHP plan (and no other coverage).
As to whether HSA-eligible HDHP plans come out better, it depends on where you live.
Where I live, there are only three HSA-eligible plans offered. Comparing each with the "most popular" non-HSA plans from the same insurer, I would come out better with the HSA-eligible plan each time.
Insurer 1: Bronze vs. HSA-Bronze - HSA plan costs $48/year more - HSA plan has $400 higher deductible. (All services subject to deductible in both plans) Worst case, HSA plan costs $448 more, but allows deduction of $4350 in HSA contributions.
Insurer 2: Bronze vs. HSA-Bronze - HSA plan costs $276/year more - HSA plan has $3K lower deductible - All services on both plans are subject to deductible, except first two PCP visits ($45 co-pay) with non-HSA plan. Worst case, HSA plan costs about $600 more (assuming PCP visit negotiated charge is around $200), but allows $4350 deduction.
Insurer 2: Silver vs. HSA-Silver - HSA plan costs $120/year less - HSA deductible is $200 more - All services on both plans are subject to deductible, except for PCP visits with non-HSA plan.
Unless most of your services are PCP, the HSA is going to cost at worst a few hundred dollars more. Again, the HSA tax deduction will more than compensate for that.
A real problem with ACA plans is that even if they're not HSA-eligible, they still tend to be high deductible (albeit not HSA-eligible, because of the way they're structured). So if you're seeing ACA plans with much lower deductibles, consider yourself fortunate.
@msf - thank you for your insight on the questions, but also the real time examples.
I used the ACA as I needed to purchase health insurance. You are correct in that ACA plans tend to be high deductible plans and the total out-of-pocket costs are at very high points (in my case, for a family).
What I saw with the non-HSA plan was that PCP visits were $40. With the HSA plans, the deductibles were high, then the co-insurance allocation begins until you reach the maximum out-of-pocket expense limit for the calendar year.
Knowing that my child could see the doctor for $40 versus having to pay for each visit in full (even at the negotiated insurance cost) until I reached the deductible was an important aspect for me to manage my personal cash flow situation. Whether non-HSA or HSA, once you reach the deductible, you then start the co-insurance process until you reach the maximum out-of-pocket costs for the plan. In the ACA plans, the deductibles and maximum out-of-pocket costs are very high to anything I have experienced when I was employed.
Individual plans have traditionally had higher deductibles/co-pays, but nothing like what we're seeing under ACA. That, and narrow networks, are some of the main ways that ACA premiums are being kept lower.
Trying to figure out the best plan becomes intractable, especially when more than one person is involved. You've identified a key difference between HSA plans and some non-HSA plans - the latter often allow doctor visits for co-pays, without requiring that you meet the deductible. The more people you're insuring the more important that becomes, as it becomes more likely that someone will be going to the doctor.
One other difference between HSA and non-HSA plans - with the HSA plans, the deductible is a single family deductible (e.g. $12,000). For a non-HSA plan, the deductible is an individual deductible (e.g. $6,000 per person and $12,000 for the family).
So in an HSA plan, no one escapes the deductible until the family pays the combined deductible. In a non-HSA plan, once someone reaches the individual cap (e.g. $6K), that person doesn't have to pay more deductibles. But the other family members do.
That can work out better if one person is incurring most of the expenses. Then, instead of meeting a family $12K deductible, that person starts getting real coverage after $6K.
If I understand insurance plans deductibles correctly they reset each year. This also seem like something that needs to be managed over the course of a single health event. When does the deductible coverage begin? When does it end?
If a patient is being treated for a single condition that bridges multiple years, which I'm sure many do, keeping track of these recurring deductibles seems like the kinda math you might be able to handle, but maybe not the average sick guy.
I wonder if doctors are able to offer services that provide a "package of care" that has a cost, but not a time frame thus avoiding having to meet a second deductible for at least that "illness". An illness doesn't know when the year's deductible resets and so long as you remain in contract with the insurance provider (don't change carriers) it seems continuation of care should be covered under the original deductible... not multiple deductibles due to calendar reset.
In my imperfect world, a deductible for a health event should be treated much like a deductible for a car crash. If it takes the mechanic longer to "fix" my car I'm not required to meet a second deductible. A patient should not be required to meet multiple deductibles over the treating/healing process (maybe multiple years).
Then again, I don't want my doctor to tell me I just "totaled myself".
Just some thoughts and thanks for all your information here. Great thread l5b!
What I find interesting is the discussion regarding rolling over an existing IRA to an HSA.
The rollover provision is a one time event and the amount can only be as much as you are allowed to contribute in a given year. For instance an individual ( age 55 or older) could rollover $4350 from their IRA into their hsa for TY 2015. More if its a family plan. The rollover would be in lieu of any other contribution.
@Maurice - you're right, I missed your question about an inherited IRA. I would have sworn the rollover could not be done (as, e.g. you cannot roll over an inherited IRA into your own, unless you inherited as a spouse). But a little searching turned up IRS Notice 2008-51, which seems to say this is okay:
The distributions must be from an IRA or Roth IRA to an HSA owned by the individual who owns the IRA or Roth IRA or, in the case of an inherited IRA, for whom the IRA or Roth IRA is maintained (i.e., a qualified HSA funding distribution cannot be made to an HSA owned by any other person, including the individual’s spouse).
Regarding HSAs that are worth opening, my brief look at Saturna suggests to me that it has improved a bit, and is very good if you want to invest entirely in mutual funds. They offer several NTF funds (not a huge number, but enough) from a modest set of families. The main downside IMHO is that you must make one transaction each year to avoid a $12.50 fee, and you have to hold an NTF fund at least 180 days. (So you have to remember to do a transaction between July and December every year if you're not buying/selling for other reasons.)
if you're just looking for a higher yielding "bank" account, you can get 1% (or more, for higher balances) at a few credit unions. (Link is to a listing of top paying HSA accounts; you'll need to configure for your state and balance amount.)
@bee - the resets on deductibles are annoying. Your question about when they start is especially relevant for people who switch jobs in mid-year. They lose credit for whatever they did pay, and have to restart the deductible with a new insurer or policy.
The HSA rules try in a small way to address this problem (by allowing you to make a full year's contribution even if you begin the HDHP in December, so long as you remain in an eligible HDHP plan for all of the following year).
But that's a small patch. IMHO we need a better integrated health coverage system, or at least a more portable one that doesn't depend on the whims of employers. (Disclosure: I've helped select plans at a couple of small companies where I've worked, so I'm comfortable saying the selection process isn't capricious, but that doesn't help when you move from one employer to another.)
What your question brought to mind was concierge services. Higher priced, and generally limited to doctor services (not hospitals, etc.), but perhaps some of those address the question of multiple deductibles. On the other hand, these services are not ones designed to save you money, just grief.
Comments
What's the milestone? Hopefully the Health Savings Account finds you healthy, wealthy and wise. Were you able to set an hsa with TRP funds at TRP or through an intermediary?
If you haven't already done so and have a tax deferred IRA you can make a one time rollover from your IRA to you hsa. The amount cannot exceed your maximum allowable hsa contribution. For an individual that would be $4350 for 2015 and a but more if you have a family hsa plan.
Its a nice way to move what would be taxable IRA dollars into tax free hsa. This is not a distribution...its a one time rollover.
Article on topic:
rules-for-ira-to-hsa-rollovers
IRA to hsa worksheet:
IRA_to_HSA_Worksheet.pdf
Regards,
Ted
YTD: +24.14%
2014: +31.94%
2013: +51.40%
2012: +31.93%
2011: +11.01%
2010: +16.33%
2009: +32.19%
If I'm going to pay taxes when I move money from a traditional IRA to another tax-advantaged account, I'd rather pay the taxes (directly) and move it to a Roth, rather than pay the taxes indirectly (by losing a deduction) and move it to an HSA.
With the Roth, after five years, I can take the money out tax free, no questions asked. With the HSA, questions are asked - what were the medical expenses that this withdrawal is covering?
On the other hand, with the rollover to the HSA, there's no five year waiting period.
If you need to pull money out of a traditional IRA and you're under 59.5, then "laundering" it through the HSA gives you a way to do that (if you've got matching medical expenses). That's the only reason I can see for doing a rollover to an HSA.
At 59.5 I plan on taking IRA distributions equal to my hsa contributions there by offsetting the taxes on the IRA with an equal hsa tax deductible contribution. I will do this until I am 65. I mention age 65 because that is the age at which one can no longer add to their hsa (because medicare kicks in).
Bottom line, without earned income you can't make Roth contributions. Not true with hsa contributions. hsa contributions are tax deductible even without earned income. In my case these hsa contributions will reduce any other taxable income I have (pension, annuities, SS, interest and dividends) and IRA distributions.
Whatever works best for you. Since I view HSAs as savings vehicles, I don't care about the withdrawal mechanism. I just keep track of all my eligible expenses since I opened the account. At some time in the future I'll withdraw a lump sum. I'll be able to justify the withdrawal with those medical expenses, so long as I keep good records.
Fidelity does offer an HSA account, but only to employer-sponsored plans. I've spoken with them for years about this. They tell me that they've gotten lots of requests, and they keep looking into it. My guess is that these are not especially profitable accounts, so they're not too interested.
- Accounts tend not to be large (limited contributions, people take withdrawals for expenses)
- Servicing costs are high (lots of small withdrawals)
- Regulatory costs are high
Question about Saturna - they mention Archipelago, but don't provide detail. Last time I checked (a couple of years ago?), this was a smaller list of funds (but more "interesting" as I recall), and required a $10K min. Did Archipelago vanish from Saturna?
I have been maxing out my HSA contributions for the last few years and not using the money. I pay for medical expenses with taxed money. But, I have been very lucky that I have had good health, limited expenses. I plan to use the accumulating money in the HSA account as a bridge to pay health insurance when I retire - until medicare kicks in.
Thanks again. You are a gem to this discussion board.
(Health Savings Administrators does offer Vanguard funds NTF, but they tack on a 32 basis point ER, and like a 12b-1 in excess of 25 basis points, I regard that surcharge as a load.)
Regardless, Saturna seems to be one of the least expensive ways of owning an HSA without being restricted to a small list of funds provided by Devenir.
(Devenir's HSA bank fund list, Devenir's Select Account HSA fund list, etc.)
The previous plans were not HSA eligible.
Now that I purchase under the Affordable Care Act (ACA) plans, it says which plans are eligible for an opening an HSA account as the contribution can be deducted against Income.
So two questions: 1. the health insurance plan has to be eligible to open an HSA account (as specified in the ACA plans - I was told the answer for this is Yes, ie, can only fund an HSA with specific IRS approved health insurance plans.
2. do you need Earned Income (employer or business income) to fund or add funds to an HSA account?
For those that have an HSA account, did all you have an HSA eligible health insurance plan when it was opened and funded?
For example, here's Alliant CU's page: 2. As others have stated, you don't need compensation income in order to contribute to an HSA. AFAIK (this is speculation), you don't need income at all (though you'll waste the deduction that way).
In order to fund (not open) an HSA, you must have had an eligible HDHP. However, since funding can be retroactive (like an IRA, you can fund it early the next year), you can fund the HSA because you were in an HDHP, even if you aren't currently.
In 2015, I went to the ACA and chose a non-HSA eligible plan (I did not want the high deductible for my medical costs as no Earned Income, and because I have no Earned Income, the HSA contribution could be wasted as no real effect to reduce Adjusted Gross Income).
Edit - Therefore, in 2015 with no HDHP plan, I can not make an HSA contribution for the 2015 tax year, is that a correct statement?
And I have found that at least in the ACA versions, even with the high deductibles, the HSA plans were more expensive, higher deductible but offer the HSA contributions, which therefore are great for high income earners and business owners that can deduct all premiums and HSA contributions.
You are correct that you can only make HSA contributions for the months in which you have an HDHP plan (and no other coverage).
As to whether HSA-eligible HDHP plans come out better, it depends on where you live.
Where I live, there are only three HSA-eligible plans offered. Comparing each with the "most popular" non-HSA plans from the same insurer, I would come out better with the HSA-eligible plan each time.
Insurer 1: Bronze vs. HSA-Bronze
- HSA plan costs $48/year more
- HSA plan has $400 higher deductible. (All services subject to deductible in both plans)
Worst case, HSA plan costs $448 more, but allows deduction of $4350 in HSA contributions.
Insurer 2: Bronze vs. HSA-Bronze
- HSA plan costs $276/year more
- HSA plan has $3K lower deductible
- All services on both plans are subject to deductible, except first two PCP visits ($45 co-pay) with non-HSA plan.
Worst case, HSA plan costs about $600 more (assuming PCP visit negotiated charge is around $200), but allows $4350 deduction.
Insurer 2: Silver vs. HSA-Silver
- HSA plan costs $120/year less
- HSA deductible is $200 more
- All services on both plans are subject to deductible, except for PCP visits with non-HSA plan.
Unless most of your services are PCP, the HSA is going to cost at worst a few hundred dollars more. Again, the HSA tax deduction will more than compensate for that.
A real problem with ACA plans is that even if they're not HSA-eligible, they still tend to be high deductible (albeit not HSA-eligible, because of the way they're structured). So if you're seeing ACA plans with much lower deductibles, consider yourself fortunate.
I used the ACA as I needed to purchase health insurance. You are correct in that ACA plans tend to be high deductible plans and the total out-of-pocket costs are at very high points (in my case, for a family).
What I saw with the non-HSA plan was that PCP visits were $40. With the HSA plans, the deductibles were high, then the co-insurance allocation begins until you reach the maximum out-of-pocket expense limit for the calendar year.
Knowing that my child could see the doctor for $40 versus having to pay for each visit in full (even at the negotiated insurance cost) until I reached the deductible was an important aspect for me to manage my personal cash flow situation. Whether non-HSA or HSA, once you reach the deductible, you then start the co-insurance process until you reach the maximum out-of-pocket costs for the plan. In the ACA plans, the deductibles and maximum out-of-pocket costs are very high to anything I have experienced when I was employed.
Trying to figure out the best plan becomes intractable, especially when more than one person is involved. You've identified a key difference between HSA plans and some non-HSA plans - the latter often allow doctor visits for co-pays, without requiring that you meet the deductible. The more people you're insuring the more important that becomes, as it becomes more likely that someone will be going to the doctor.
One other difference between HSA and non-HSA plans - with the HSA plans, the deductible is a single family deductible (e.g. $12,000). For a non-HSA plan, the deductible is an individual deductible (e.g. $6,000 per person and $12,000 for the family).
So in an HSA plan, no one escapes the deductible until the family pays the combined deductible. In a non-HSA plan, once someone reaches the individual cap (e.g. $6K), that person doesn't have to pay more deductibles. But the other family members do.
That can work out better if one person is incurring most of the expenses. Then, instead of meeting a family $12K deductible, that person starts getting real coverage after $6K.
If I understand insurance plans deductibles correctly they reset each year. This also seem like something that needs to be managed over the course of a single health event. When does the deductible coverage begin? When does it end?
If a patient is being treated for a single condition that bridges multiple years, which I'm sure many do, keeping track of these recurring deductibles seems like the kinda math you might be able to handle
I wonder if doctors are able to offer services that provide a "package of care" that has a cost, but not a time frame thus avoiding having to meet a second deductible for at least that "illness". An illness doesn't know when the year's deductible resets and so long as you remain in contract with the insurance provider (don't change carriers) it seems continuation of care should be covered under the original deductible... not multiple deductibles due to calendar reset.
In my imperfect world, a deductible for a health event should be treated much like a deductible for a car crash. If it takes the mechanic longer to "fix" my car I'm not required to meet a second deductible. A patient should not be required to meet multiple deductibles over the treating/healing process (maybe multiple years).
Then again, I don't want my doctor to tell me I just "totaled myself".
Just some thoughts and thanks for all your information here. Great thread l5b!
I use BRUFX as my hsa at Bruce Funds.
if you're just looking for a higher yielding "bank" account, you can get 1% (or more, for higher balances) at a few credit unions. (Link is to a listing of top paying HSA accounts; you'll need to configure for your state and balance amount.)
The HSA rules try in a small way to address this problem (by allowing you to make a full year's contribution even if you begin the HDHP in December, so long as you remain in an eligible HDHP plan for all of the following year).
But that's a small patch. IMHO we need a better integrated health coverage system, or at least a more portable one that doesn't depend on the whims of employers. (Disclosure: I've helped select plans at a couple of small companies where I've worked, so I'm comfortable saying the selection process isn't capricious, but that doesn't help when you move from one employer to another.)
What your question brought to mind was concierge services. Higher priced, and generally limited to doctor services (not hospitals, etc.), but perhaps some of those address the question of multiple deductibles. On the other hand, these services are not ones designed to save you money, just grief.