Feb 22nd, 2008
Health Savings Account Vs Health Reimbursement Account Vs Flex Savings Account (and keeping my hair for cheaper)
Ok so there seems to be a lot of confusion around the Health Savings Account that the government is now allowing. So I figured it would be good to go over the kinds of medical savings accounts currently available and point out the differences. First of all some definitions:
Health Savings Account:
Its a tax-advantaged medical savings account available to taxpayers who are enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account are not subject to federal income tax at the time of deposit. The funds in the account can be used to pay for qualified medical expenses at any time without having to pay taxes on them. Withdrawals for non-medical expenses are treated very similarly to those in a retirement account in that they provide tax advantages if taken after retirement age, and they incur penalties if taken earlier. These accounts are a huge part of consumer driven health care.
Health Reimbursement Account:
These are accounts that allow an employer, as agreed to in the HRA plan document, to reimburse for medical expenses paid by participating employees. HRAs reimburse only those items (copays, coinsurance, deductibles and services) agreed to by the employer which are not covered by the company’s selected standard insurance plan (any health insurance plan, not only high-deductible plans).
Flex Savings Account:
This is actually similar to the other two but it is offered with more traditional (such as the 80/20) plans as well.
These are all (FSA being the slight exception to the rule) consumer driven health care plans.
What is a consumer driven health care plan?
It is a plan that allows members to use personal income to pay routine health care expenses directly, while having a high deductible health insurance plan that protects them from huge (catastrphic) medical expenses. Its called “consumer driven” because it gives patients greater control over their own health. It also makes consumers more health care cost conscious…though in more of a good way. For example a study showed that people with chronic problems were 20% more likely to follow their treatment regime carefully if they were part of a consumer driven plan.
What is the main advantage?
There are many advantages and some disadvantages but the main advantage is that it is before-tax money. So if you do not use health care much, you will save a good deal of money in the long run.
All of that being said here is an overview of the differences:
|
|
HSA |
HRA |
FSA |
|
Overview |
A tax exempt trust/accound created to pay for medican expenses of the account holder and his or her dependents |
An employer funded account that reimburses employees for qualified medical expenses |
A cafeteria plan established by the IRS. Three components: Health Insurance Premiums, Qualified med expenses, and dependent care expenses |
|
Who can establish an account? |
Employer or a person on their own |
Employer |
Employer |
|
Who holds the funds? |
You can basically invest it how you would like as long as it follows guidelines |
Employer or VEBA |
Employer |
|
What qualifies as a medical expense? |
Whatever you decide, but you have to be able to defend it if you get audited |
Ditto |
Ditto (the actual guidelines were originally setup for FSA) |
|
Who funds the account? |
Employer, employee or family |
Employer |
Employee |
|
Is there a contribution limit? |
Yes, up to max of 100% of the deductible |
65% of deductible (or 75% for family) |
No limits |
|
Who owns the money? |
Employee |
Employee |
Employee ONLY until the end of the claim period |
|
Can it be rolled over? |
Yes, one allowed per 12 month period |
No. |
No. Use it or lose it. |
|
Can it be used for retirement income? |
Yes, but you have to wait till 65 or you will pay extra tax |
No. |
No. Use it or lose it. |
|
Requirements? |
Deductible must at least be $1,000.00 for single $2,000.00 for family |
No |
No |
|
Dollar Limits? |
Yes, up to max of deductible |
No (fed income tax law limits) |
No limits. |
There seems to be a lack of information around on these types of accounts so I hope this helps clear things up a bit. I personally am going to open a health savings account for next year. My employer pays for everything for a high deductible plan, and I am currently on an 80/20 plan but I just don’t go to the doctor very often despite a very serious injury from a few years ago. I especially like that it can be rolled over into retirement and that it can sit and collect interest.
Because I don’t go to the doctor, I have one fixed monthly medical cost: $69/month for propecia. Now, I have all my hair. My dad has no hair (not that he looks bad, I’d like to just wait until I can pull off the “Im old and bald but I am a BA” ala Patrick Steward/Bruce Willis). I decided Id like to keep mine for a while, so propecia it is. Thing is, health insurance doesn’t cover it, so its all out of pocket. If I used a health savings account this WOULD cover it, so by using that to pay for it every month I would effectively be giving myself a $30+/month raise.
Of course this banks on no huge medical bills, but I figure this is the only time in my life that I could get away with that. Maybe you can too.

8] Toilet Paper
7) Mouse
2) Engagement Ring
There is an episode of the TV show South Park where there are a group of “underpants gnomes.” The “Underpants Gnomes” are a community of underground gnomes who steal underpants, notably from Tweek (one of the characters).
The Worse Career Plan:
Next up on our list of “plans people don’t seem to think they need, but they are so wrong I want to give them the business end of a cattle prod” is retirement planning. Most peoples retirement model looks like the picture on the right. This one is both simple and extremely complex at the same time. The simple part: download my 401k/Roth IRA calculator and go to town assuming 8% rate of return (conservative). The complex part: deciding how to setup your portfolio, deciding what age you want to retire at. If you want to retire early, deciding how you are going to get by before you can withdraw from your retirement accounts (and don’t tell me you WANT to pay those huge tax penalties unless your retirement portfolio contains the united states treasury). Next make a plan (just like the career plan….how’d you guess I was heading that way). Ask yourself the following questions:
Recently a lot of employers have started to offer the roth 401k as an option. My employer started offering it last month. The roth 401k, quite frankly, is a dream come true in my opinion. Ok so thats a little exaggeration but it truely is the best of both worlds - 401k and Roth IRA.
I’ve had quite a few friends ranting and raving about Apple stock, that its just going to keep going up, mac sales are up, iPhones are hot, and Jesus himself might come back to earth early so that he can get his hands on a new iPod nano. They are all going hog wild buying their stock….BUT while Apple is doing well, there are some less obvious things going on that could (potentially) cause a DROP sometime in the not too distant future. Its just one more reason you should diversify, don’t bank on any one stock.

Notice it is stuffed full of junk. So I went about cleaning it up. I have to say I have a TON of cards and stuff. A rather intimate look at my life. Sorry though, no credit card numbers, as much as I would love to have one of the spambots come by and pick that up. So just going through got health insurance card, pre-paid mastercard I wont at the company Christmas party LAST year that has $1.11 left on it that I cant see to use but won’t let myself throw away. Next a noodles frequent diner card that I have had for probably 5 years now (and never use). King Soopers card, vital. Platinum credit card from my credit union, beer tour card from old C’s, an old card insurance card, big city burrito card (these are probably the best burritos in the world, I could eat one a day if it wouldn’t make me fatter than Rosie Odonnell after thanksgiving), check card and drivers license.
You could definitely argue that I don’t need both credit cards, and you would probably be right but Ive had both forever. My most proud piece is the irony of my old chicago world beer tour card right next to my GNC card. Anyway, from a personal finance perspective, its a good idea to go through make sure your wallet is organized. If you have extra credit cards in there, REMOVE them because should one happen to fall out, you might not notice until someone has already charged up who knows how much. So, whats in YOUR wallet?
My girlfriend and I walked into king soopers today and there were (see right, we took a picture) literally swarms of guys looking for a last second present for their girlfriends/wives. As we walked by they had prices listed. Roses were $10/piece! ouch! There was the “super deal” of a dozen for $70. Thats right, for a dozen roses. Wow. So we came up with some better ideas that don’t involve you spending $70 for a bunch of wilty overpriced flowers.