Talk:Health savings account

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This is the talk page for discussing improvements to the Health savings account article.
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Contents

[edit] HSAs and Health Policy

From the section about generic vs brand-name drugs, I am forced to wonder: are there any health-care plans anymore that really allow for this level of choice? Generally speaking most people working for a company that would choose an option like this would ready be on a health plan that forces the use of generics when available. It seems to me that the section is detailing a situation that is unlikely and excessively favorable toward the HSA providers. Johnashby 22:00, 26 February 2007 (UTC)

[edit] Drawbacks?

Why do so many people add information to this page that clearly have no experience in the health insurance industry? Referencing studies that were created to discredit the HSA program adds little value to this section. The Consumers Union study was one of the worst studies i have ever read and never discussed the real issues. When a study comes out from someone who isn't in a political "think tank" or actually has experience selling insurance to individuals and companies, i would not list them on this page. Lets stick to facts - not fiction. Just because a organization produces a study, doesn't make that study valuable - or even true. JAMES 7/18/07

I have been diligently googling(tm?) for information on HSAs, and I while I cannot find this spelled out anywhere, it seems to me that a drawback, or at least a possible 'gotcha' of an HSA is this: The IRS may allow many expenses from an HSA as being tax-deductible, that are not considered by the insurer as deductible. For example dental work (braces), optional laser eye surgery, accupuncture, chiropractic, etc. etc. Wouldn't this mean that your family could spend $5000 from your HSA, but have only met $2000 of your HDHP's deductible, so that there would now be a $3000 gap that would have to be covered out-of-pocket with after-tax dollars? I haven't seen anything on the web that points this out, the descriptions all cheerily talk about how "after you have spent your HSA money, your insurance plan takes over." It doesn't necessarily take over *right away*, does it? Spike0xFF 00:43, 24 August 2006 (UTC) ps Sonria & all others - Big thanks for your work from this wikipedia user! And can't we lock out those morons with the IP addresses??

Spike, it takes over right away if all of your expenses were deductible eligible, but you're quite right about the "gotcha" with respect to non-deductible but otherwise eligible expenses. The design idea, as explained to me, is that the money from the investments (the interest income) will increase the account balance to the point that it's greater than the deductible. But I'll make sure to include that in my work. Thanks for the note. Sonria 16:56, 22 October 2006 (UTC)

Some think of this feature as being one of "choice." With the HSA you have the choice about where and on what to spend your health care dollars. Maybe you don't need to visit the doctor this year and your idea of health care is buying new orthotics for your running shoes. It won't count towards your deductible, but you are not going to hit it anyway. Another time when this is useful is when your HSA account balance begins to exceed your annual deductible. You might then choose to use this surplus for a big ticket item not covered by your health plan such as laser eye surgery.Jobim69 22:48, 5 December 2006 (UTC)


Why did 68.71.98.20 change my section on drawbacks on 14 November 2006? I attributed it to testimony by the Commonwealth Fund to the Senate, and to Consumers Union and the American Public Health Association. The new section has no source at all. Also, "get hit by a bus" doesn't sound encyclopedic. If no one has any objection, I'm going to revert it. Nbauman 23:40, 10 December 2006 (UTC)

Nbauman, have you ever read those studies or have you spoken with the authors? If you did you would have never listed any study by the Commonwealth Fund. Please read the GAO study - how can you base a study on interviewing 47 people? or by using experience from only three different companies? There are drawbacks to HSA plans, but the almost all of the studies quoted on this page are so biased and never actually discuss the true drawbacks. Why is it that every one of the studies against HSA plans are from organizations supporting Universal healthcare? Don't you think there is a bit of bias there? The GAO study clearly states not to base any conclusions from their study because their sample size was so small.

(A bit of housekeeping here -- the Wikipedia convention is you're not supposed to add your comments in the middle of somebody else's comments, like an email message. You're supposed to add your comments at the end of the last person's comment, which makes it easier to follow the discussion.)
Have I read those studies or spoken to the authors? Yes, I have. I've followed the health care debate for 30 years in JAMA, NEJM, AJPH and Health Affairs, I've been to press conferences and seminars by the insurance industry, pharmaceutical industry, and professional medical societies, where I talked to their executive directors and experts, and asked questions, and I've interviewed them and written articles about it for medical magazines.
But my credentials don't matter. Sometimes an intelligent recent college graduate can see through the BS better than I can. And I can often see through the BS better than the experts.
I accept the Commonwealth Fund and GAO as WP:RS for Wikipedia purposes. You may not agree with them, and I may not agree with them, but that's irrelevant -- they're a WP:NPOV part of the debate, and they must be included. You can't delete a viewpoint merely because, in your personal opinion, they're wrong.
As to the merits of the GAO study and the number necessary to interview -- they've gone through a review and published their results. Have you done the same? The senior author of that study was John E. Dicken, Director, Health Care, and his CV is here. Do you think he has any experience in the health care industry? Can you match his credentials?
I don't know what your credentials are, but even if you do know more than the experts at the GAO, Commonwealth Fund, Consumer Reports, American College of Physicians, etc., you still wouldn't have a right to delete their viewpoints under Wikipedia WP:NPOV, WP:CENSOR, and several other no-compromise Wikipedia rules. You're free to add your corrections to their supposed errors, provided you link to a reliable source WP:RS rather than merely giving your own opinions and analysis WP:NOR.
Since you bring up bias -- what's your own bias? Do you have any financial benefit from HSAs, by selling them, for example? There's nothing wrong with that, but you should disclose it. Nbauman 22:48, 18 July 2007 (UTC)

Since there were no objections, I have reverted it.Nbauman 23:45, 31 December 2006 (UTC)

Congress has just addressed a major drawback in December of 2006 by passing a revision that would remove the contribution limit of the HDHP deductible and change the limit to the statutory maximum of $2700 single/$5450 family for 2007. [its 2850 and 5600] It doesn't completely remove the gap of uninsured items, but does go a long way toward being fully funded. The President is expected to sign the bill shortly and it should be effective for 2007. There are several other ammendments as well, such as allowing rollovers of FSA and IRA accounts to HSA, Allowing full year contribution if entering mid-year, and change to discrimination rules and FSA grace periods. Source: http://www.americanbenefitscouncil.org/documents/hr_6111_chart.pdf Utilitysupplies 15:18, 13 December 2006 (UTC)

Bush just signed this act, so that now, anyone who has a HDHP may contribute $2850 (single) or $5650 (family). http://www.ustreas.gov/offices/public-affairs/hsa/07IndexedAmounts.shtml I wouldn't call it a drawback of HDHP that certain things like laser eye surgery or braces are not covered; it is, rather, a drawback of health insurance in general. HDHPs do not tend to have narrower coverage than regular plans, only higher deductibles. If someone uses up all of their HSA buying braces, they will have nothing with which to pay their deductible. Under traditional insurance, they would have had very little or no deductible, but they would have paid for the braces out of pocket. There is very little difference really, except it becomes easy to borrow from yourself, so to speak, by buying the braces with the HSA, only to have to cover the deductible out of pocket later should your expenses exceed the amount in your HSA. --Jrodgers32 03:20, 23 December 2006 (UTC)

Hey guys! I would agree with Mr. Rodgers. The fact that these other qualified medical expenses don't go toward the deductible isn't really a drawback, it's actually a great benefit! Traditionally, health plans don't cover expenses like laser eye surgery, or acupuncture, but with HSAs, you can use tax-free dollars to pay for them. So you're actually saving lots of money. Just think, if you didn't have an HSA, you'd be paying with after-tax dollars, which would be much more expensive. Also, the list of qualified medical expenses is extremely long. Did you know that it includes things like band aids, gauze, and Tylenol? How about widening a door for a handicapped family member? Yup, all qualified medical expenses.  :o) I hope this is helpful. Rwking2 21:11, 21 February 2007 (UTC)

[edit] Co-payments?

The article says: "...the elimination of co-payments and the higher deductibles...lowers premiums because insurance underwriters are betting that Americans will consume less medical care and supplies, be more vigilant against excess and fraud in the healthcare industry, and shop for bargains if they see a relationship between medical cost and their bank accounts." I understand the argument for higher deductibles leading to more vigilance etc., and thus lower costs/risks to the underwriters. But the part about co-payments makes no sense to me. Isn't the entire logic behind co-payments to increase the connection between medical services rendered and out-of-pocket cost, and hopefully cause consumers to be more "vigilant", etc.? The argument here seems backwards to me; eliminating co-payments should, if anything, have the opposite effect as is being attributed to them here. Please consider this a request for correction or clarification, whichever is appropriate. - 66.159.194.130 06:05, 27 June 2006 (UTC)

  • The phrase "eliminating copayments" is correct, if a tad misleading. While you have not met your HDHP Deductible, there is no copayment because the health plan is not paying any part of the bill; it is all one big payment you make. Ideally, this comes out of the pre-tax money you have saved in your HSA, but it can come straight out of your own pocket. This is the part where they are hoping you are being a good consumer and comparison shopping, since the actual bill is up frontand in your face, and you are covering the cost at this point. Once you have met the deductible on the HDHP, though, there is still no copayment (at least, with the ones I have had experience with - not all that many, admittedly), as they are covering 100% of the bill.
    So yes, it is a tad misleading - when pulling from the HSA< there is no copayment, but instead you are paying out more. Normally, a phrase like "eliminate the copayment" would imply that the patient is paying less, when they are actually paying all of the bill. Caveat: I'm in no means an expert in insurance matters. However, my own employer is moving to an HSA, so I've been inundated with this sort of info lately. --Reverend Loki 15:33, 5 July 2006 (UTC)
I believe you're confusing copayments and coinsurance. Copayments are usually flat dollar amounts ($25/$45) and coinsurance is usually a percentage (as in 80%/20% type plans). Copayments generally don't count toward deductibles or coinsurance. The purpose of copayments was to make care accessible under the theory that people would be *more* likely to go to the doctor for preventive care and to catch conditions at an early stage (when they're easier and cheaper to treat). Coinsurance, on the other hand, is simple cost sharing. Sonria 17:00, 22 October 2006 (UTC)

[edit] Starting a Cleanup

Someone sent me this article this afternoon asking for cleanup -- I'm an employee benefits specialist. Cleanup will take some time but I went in today and added in several headings to ease readability. I also think that it's best to eventually create a separate page for high-deductible health plans (HDHPs) as those are legally independent of HSAs. Please be nice -- this is my first Wikipedia edit and I'm sure I've got style violations all over the place. Thanks. Sonria 01:42, 17 May 2006 (UTC)

[edit] Wegerje

What is the purpose the Ownership Society section. It seems out of place. I am wont to delete it. Wegerje 23:28, 10 Jan 2005 (UTC)

[edit] Clarification

"Most people who use HSAs would already have health insurance". What does this mean? That they also have insurance? Or that they used the old medical savings accounts? - Jerryseinfeld 20:34, 18 Dec 2004 (UTC)

(Deleted the advertising link that got posted in response to this.) HSAs work in tandem with health insurance. Sonria 17:01, 22 October 2006 (UTC)

[edit] Confusing, un-encyclopedic article

This article doesn't really explain what in the world a health savings account is. It tells how they differ from "medical savings accounts", and then says why they're good, in a very POV manner. This is not useful for someone who doesn't really know what a health savings account is in the first place. I'm going to try to do some research and rewrite this article, but may not get to it. --jacobolus (t) 16:05, 30 Mar 2005 (UTC)

Ok good point. I wrote it that way because I am familiar with both and the quickest way to know what it is is to refer to what it used to be. Simple failure of assumming prior knowledge. I'll rearange the beginning to be a proper intro as best I can. I guess I'm missing the POV unless your referring to assuming paying less taxes is good. That is a large part of why someone would use this type of plan, in addition to the lower premiums. - Taxman 16:45, Mar 30, 2005 (UTC)

[edit] November 3 2005 Article edit

Someone wrote me a message asking for refernces and to make an account. My account name is Mozaki... it doesnt seem to show up. I am not doing it right I guess.

I used the already linked http://www.treas.gov website to double check my figures when I was writing and I left some stuff that was already there.

Otherwise the article was from memory of things I have picked up over the last 2 years. MMOH is probably my greatest single source.

That's the best I can do, sorry!

Ok, that's good. It's just that in general, Wikipedia needs to do a much better job of doing good research and citing sources. Try to cite reliable sources for any content you add. Specific facts and figures cited to specific sources is even better. As for your account name, it seems to be working now, as the edits are showing up under it. You have to be logged in and have cookies enables for wikipedia.org for it to work. Then sign by typing four tildes ~~~~. - Taxman Talk 18:11, 10 November 2005 (UTC)

[edit] No mention of Preventive Care

The article states: "This plan cannot allow copayment (which is entirely different from coinsurance) of any kind, including prescription drug copayments", but in fact there is an exception for preventive care - see http://www.ustreas.gov/press/releases/js1278.htm

Yes, good point, and thanks for the link, that was very valuable. But you could edit the page too, that's how Wikipedia works. - Taxman Talk 22:05, 21 December 2005 (UTC)

[edit] HSA's similarity to IRAs versus 401(k)'s

401(k) investments are limited to the investment program options that an employer sets up. There's much more flexibility in choosing investment options with an IRA. The HSAs have this same flexibility as an IRA, so I've made some edits for the article to focus more on that comparison than 401(k). Beyazid 04:58, 3 September 2006 (UTC)

You're quite correct, but I've added the 401(k) language back because most audiences will be able to relate to that a little better. In addition some 401(k) plans are structured with IRA-like flexibility. Sonria 01:04, 27 October 2006 (UTC)

[edit] they are not savings accounts

they are called Health Savings Accounts, but they are actually structured as checking accounts with debit cards and checks. Keltik31 21:43, 10 November 2006 (UTC)

The accounts earn interest, they can be invested in stocks and bond etc... they are an account where you save money for health related expenditures. This is why they are called "Health Savings Accounts" Mgunn 04:09, 25 November 2006 (UTC)

In addition, unlike Flexibile Spending Accounts (FSA's) that are normally use-it-or-lose-it in a cafeteria plan year, an HSA balance can be saved for future years medical expense or until retirement. Utilitysupplies 14:27, 28 November 2006 (UTC)

Specially my own HSA plan earns interest at checking accout rate (actually doesn't come close to covering the $3 low balance monthly fee at the moment since the HSA just started in January), but once your account gets high enough you can invest the rest in specific list of funds. Jon 17:46, 11 June 2007 (UTC)

[edit] Expert tag

I removed the expert tag because everything in the article checks out pretty well to the sources that I have read and the sources cited in the text. I'll try to cite more sources as I have a chance. - Taxman Talk 06:31, 7 January 2007 (UTC)

[edit] adding cleanup tag

I'm adding a cleanup tag. The introduction uses terms that may offend certain people who are dissatisfied with the current state of health care in the US. The statement that HDHPs are inexpensive is a relative statement (it depends entirely on a person's level of income) and by no means should be represented as absolute. The introduction of this article reads like it was written by an insurance salesperson. Headings such as "How do I get a HSA" are irrelevant since Wikipedia is not accessed merely by US citizens. The article also repeats itself (the reader is twice told the date that Bush signed the legislation). I think that the article itself should just represent the facts (the five Ws, as it were: Who, What, When, Where, and Why), and maybe perhaps have a section or two regarding the public's reception of HSAs (the current benefits/drawbacks sections are great). I think that by sticking to this strategy we can alleviate any further discontent. What do you think? --Kooky (talk) 23:02, 11 January 2007 (UTC)

[edit] Cleanup tag

Kooky, I must respectfully disagree with you.

I am having trouble understanding how the, "introduction uses terms that may offend certain people who are dissatisfied with the current state of health care in the US." I could not find where the article states the HDHPs are inexpensive (your evidence for offense). My best guess is that you were refering to the statement, "An HDHP generally costs less than what traditional health care coverage costs..." This statement is true. The monthly premiums for HDHPs are lower than traditional plans with the same deductible. The term inexpensive could even be used if it were qualified: HDHPs are inexpensive relative to traditional health care policies. This statement is absolute.

With regard to the "How do I get an HSA" heading, I would agree that it was irrelevant if Wikipedia were a static encyclopedia. However, many people interested in learning about health insurance or HSAs are not doing it for their own personal enjoyment, they are doing it because they are evaluating their health insurance options. Personally, when I am searching for some type of product online, I know that at Wikipedia I can get some information on that product and some information on how or where it can be purchased. Purchase information should not be excluded for the simple fact that foreigners may be interested in an article about health insurance in the USA. It's not as if the author posted a link to his/her website to purchase a HDHP.

[edit] Removal of copy-pasted material from article

I have deleted a large chunk of text that was in the introduction of the article which was a blatant copy and paste from the US Treasury document about these accounts. Whilst that material is probably public domain (and hence its presence was not a copyright violation) it constituted promotional material for these accounts, and its presence in the article made the article sound very much like a brochure promoting their use. If there is anything important in the material I have removed, it should be paraphrased in the article, not directly pasted. - Mark 04:59, 16 January 2007 (UTC)

[edit] Introduction

A lot of the information here is expert level - jumping right into exclusions and exceptions. That information should be included, but in a more organized fashion. Most people (as was mentioned before) are probably just researching "What is an HSA and should I get one?", so the intro should be something like this:

WHAT IS A HEALTH SAVINGS ACCOUNT?

A Health Savings Account, or HSA, allows employees to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis, similar to a 401(k). HSAs are available only to those enrolled in high-deductible health plans.

HSAs offer several advantages. Unused balances in a given calendar year can accumulate and carry over into the following year. The accounts are entirely portable, which means employees retain their balance even if they change jobs or health plans.

Copied from http://www.hap.org/info/products/hdhp.php

I tried to make a little more clear, but I don't think I did a great job. Gorona 19:46, 27 January 2007 (UTC)

You can't link to that site. It's a commercial site, which is prohibited by Wikipedia policies, as I described below. There are government, nonprofit, and trade association sites that will give you as good or better an explanation of HSAs. Nbauman 19:12, 5 April 2007 (UTC)

[edit] Advertising links

Here's Wikipedia policy on those advertising links I've been deleting Wikipedia:External_links#Links_normally_to_be_avoided particularly "4. #

  1. Links to sites that primarily exist to sell products or services." Nbauman 03:33, 27 March 2007 (UTC)

[edit] Could use a comparison with FSAs

I don't have an online sources on hand, but HSAs carry over year to year while FSAs are use it or lose it. Also you don't need pre approval to spend the money on an HSA unlike FSAs. (You do however need to keep records of deposits and expenses of an HSA for tax purposes; so any budget program would be highly useful.) In addition, the amount being contributed into an HSA can be changed in the middle of the year. Jon 14:13, 11 June 2007 (UTC)

[edit] "transportation expenses related to medical care"

That clause seems highly dubious to me on the qualified list without restrictions since it would seem to allow you to include airfare if you bought Asprin in the city you traveled to. It definately needs clarified. Jon 14:23, 11 June 2007 (UTC)

[edit] Needs list of exclusion items

From the IRS publications. The major ones I can think of is purely comestic when no health benifits such as breast argumentation and teeth whitening are not qualified. (By contrast, braces & lasik are specificly covered when recomended by the dentist or doctor.) Jon 14:22, 11 June 2007 (UTC)

[edit] HSA Experts

Anonymous user 76.189.12.1 deleted the first section of Talk, and added his own comment at the top of Talk, rather than at the bottom, where it belongs. I'm adding his comment to the bottom, where it belongs. Please read WP:T before posting. Nbauman 12:27, 2 August 2007 (UTC)

There are many new people that hae recently found this page and feel some sort of need to

1. Publish information that is both confusing to the reader and information that is false 2. Delete valuable links and other information that is valuable to the reader

I think we all understand the rules of this site, but please, if you dont have expertise or a background in the topic, please go else where. This is a very important topic and related to tax laws and facts. We started this page before most of these recent authors even knew what a HSA was. If you make a correction, can you please list your experience and or what qualifies you to make the change. 76.189.12.1

Actually, you don't understand the rules of this site. Please read WP:T.
  • You don't have to be an "expert" to post information on WP.
  • Some people here are self-declared "experts". Just because you think you're an expert, that doesn't mean you are one.
  • Even if you are an expert, that doesn't give you any special authority or privilege on WP.
  • Even if you are an expert, there may be other experts who disagree with you. WP has to present all significant viewponts. WP:NPOV
  • Even if you are an expert, you can only add material if you can give a reliable source. If you add your own opinion on your own authority, that violates WP:OR, and people will delete it.
  • If you delete other peoples' work that is supported by reliable sources, your deletions will be reverted. If you continue to delete them, somebody will get an administrator who will block your account.
  • If you follow the rules, your contributions will be welcome. Nbauman 12:41, 2 August 2007 (UTC)

[edit] Minor question for the experts

I've just done an edit on the initial paragraph of the benefits section (just fixing syntax), but I'm wondering about the final sentence.

"This greatly limits the maximum out of pocket costs."

Is "greatly limits" categorically true? Or would some other construction be better, such as "For most plans, this significantly limits..."?

Mhagerman 13:30, 9 August 2007 (UTC)

[edit] What happens if you use HSA for nonhealth related items?

What happens if you use your health savings account for items that are non health related items such as food, clothing, gas, etc.? Can you be punished? I mean, the money you put into this savings account is your money to begin with! —Preceding unsigned comment added by 65.117.122.6 (talk) 20:06, 17 September 2007 (UTC)

  • It becomes subject to income tax and penalties. If willful, it could be a criminal offense for tax fraud. No different than cheating on your tax return. Someone might want to research the law or actual cases for the article, or insert this information. Utilitysupplies 12:20, 18 September 2007 (UTC)
  • There is nothing illegal about using a HSA to pay for non-qualified expenses as long as you pay the taxes and penalties on the distribution. BradMajors 15:58, 22 October 2007 (UTC)

[edit] "Bush Administration"

The article says proponents "including the Bush Administration". Would not a more accurate statement be proponents "include the Republican party", since, the Republican party is generally in favour and opposition is generally within the Democratic party.

[edit] Non-prescription Drugs

From what I read, OTC drugs are eligible expense you can spend HSA money on without tax penalty. IRS Pub 502 says OTC drugs are only ineligible as a "tax deduction", not HSA withdrawal. If I'm right, the article needs to be corrected (ref #5). HkCaGu 00:46, 10 November 2007 (UTC)

I assume this is the clause you are referring to "Note. This rule applies only to the deduction for medical expenses. It does not limit reimbursements of medical expenses by employer-sponsored health plans that reimburse the cost of both prescription and nonprescription medicines." BradMajors 01:05, 10 November 2007 (UTC)

Correct, and 969 says "prescription and non-prescription" are both eligible. HkCaGu 01:10, 10 November 2007 (UTC)

[edit] Deductibles, Out of Pocket Expense Limits and Contribution Limits

The minimum deductible for 2007 is $1,100 for individual coverage and $2,200 for families. There is a maximum annual out-of-pocket expense limit of $5,500 for individuals and $11,000 for families.

While HSA's were designed to be coupled with a high-deductible plan, this out-of-pocket expense limitation bars individuals and families from choosing a more affordable plan with an even higher deductible (e.g. $10,000).

Limits for HSA contributions (for 2007) are $2,850 for individuals and $5,650 for families. Barley55 (talk) 02:29, 11 December 2007 (UTC)