Rees T. Bowen, P.C.  

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  • Working with New Health Savings Accounts in Choosing a Health Plan

    There are a number of options available in today's marketplace aimed at defraying some of the cost of health and medical related expenses.  Such choices include health reimbursement accounts (HRAs), Archer medical savings accounts (MSAs), flexible spending accounts (FSAs) and newly created Health Savings Accounts (HSAs).  Below are brief descriptions of the attributes and benefits of each type of plan to assist in determining which plan is most beneficial for your particular needs.

    Health Reimbursement Accounts

    HRAs are employer funded plans that allows employees to pay for medical expenses, health insurance premiums and long-term care, though the employer may establish additional limitations.  The employer determines the amount of the annual contribution, but as a general rule, contributions are set below the annual deductible of the accompanying health plan.  Any size employer may offer this type of plan.

    Reimbursements from an HRA are excluded from the employee's gross income.  The unused portion of the account rolls over from year to year, though an employer may restrict the amount of the carryover.  However, HRA funds are generally not portable unless the employer permits (subject to COBRA provisions).  Since these plans are relatively new, there are few current participants.  However, qualified HRAs cannot be linked to a deferred compensation arrangement or salary reduction plan.  Thus, an HRA cannot be used in conjunction with a cafeteria plan in such a way that the HRA is funded through salary reductions.

    Reimbursements from HRAs must be substantiated.  The IRS has authorized the use of debit and credit cards for reimbursement purposes.  The employee will use the card at authorized service providers for eligible expenses.  Presumably, this mechanism will aid in meeting the substantiation requirements.

    Flexible Spending Accounts

    In stark contrast to HRAs are FSAs, which also are used to reimburse medical expenses, but not health insurance premiums or long-term care.  Reimbursements are also excludable from an employee’s gross income.  Unlike HRAs, FSAs may be offered as part of a cafeteria plan option allowing for contributions to be made on a salary reduction basis, which is the usual route.  Employees may also make contributions to an FSA if it is a stand-alone plan.

    Under these arrangements, the employee, not the employer, will determine the amount to be contributed to the plan, though employers will often impose a limit.  The employee can alter this amount on an annual basis.  However, any unused contribution cannot be rolled over but instead will be lost if not used by the end of the year.  As with HRAs, contributions are not subject to either income or employment taxes such as FICA, Social Security and Medicare.

    Like HRAs, any size employer can establish FSAs and participants may include former employees.  Generally, FSAs are not portable, although COBRA extensions may apply in certain situations.  In addition, FSAs and HRAs do not have a qualifying health insurance requirement.  According to a 1999 Department of Labor Survey, 23 million private-sector workers had access to an FSA account for that year.

    Health Savings Accounts

    Recently enacted legislation will largely replace Archer MSA with HSAs.  HSAs, approved as part of the Medicare Act of 2003, which was passed in December, are allowed starting in 2004.  Both Archer MSAs and HSAs plans are aimed at providing tax benefits for individuals with high-deductible health plans.  And, both plans would allow a contribution limit of up to $2,600 for individuals and $5,150 for families for 2004.

    However, the definition of a high-deductible health plan is less restrictive for HSAs than for MSAs. These accounts present an opportunity to benefit more workers.  For HSAs, a high-deductible plan is one in which the deductible for individuals is $1,000 or $2,000 for a family.  MSAs require $1,700 and $2,600, respectively.  Further, MSAs may only be offered to employees of firms with 50 or fewer employees or to the self-employed.  HSAs have no such restriction.  After December 31, 2003, new MSAs cannot be established unless Congress grants an extension and so HSAs appear to be a clear replacement alternative.

    HSAs offer a number of significant tax benefits.  Contributions by employees are deductible in determining adjusted gross income, in other words, they are "above-the-line" deductions that may be taken by all taxpayers.  Alternately, a contribution by an employer is made on a pre-tax salary reduction basis on behalf of the employee and will also generate a deduction for the employer. Thus, the contribution is tax-free to the employee and tax-deductible to the employer.  Employers may offer HSAs either as a stand-alone benefit or through a cafeteria plan.

    Distributions from HSAs are also made on a tax-free basis, provided the distribution relates to a qualified medical expense.  Expenses generally include costs incurred to diagnose, cure, treat or prevent disease, as well as premiums for long-term care, COBRA and health insurance for those 65 or older or unemployed.  Expenses that are not qualified will be treated as taxable income to the recipient and may result in the imposition of a 10 percent excise tax.

    Finally, and most significantly, contributions to HSAs grow tax-free and roll over from year to year, allowing a significant build-up as employees’ age.  In addition, HSAs are portable.  Thus, younger employees may build-up large amounts in HSAs and carry those funds with them as they move across jobs throughout their careers.  With the rising costs of health care, HSAs likely will be a valuable recruiting tool.  For older workers, namely those in the 55 and older category, the contribution limit is raised by $500 in 2004 and will increase $100 annually thereafter to $1,000 in 2009.  Catch-up contributions will allow increased saving in crucial pre-retirement years.

    More choices

    These plans are in addition to any number of current retirement plan options available, including IRAs, Roth IRAs, 401(k) plans, among others.  Also, the Bush Administration recently proposed creating three new types of retirement plans last spring.  While those plans were not embraced in Congress, the administration has since indicated that it will likely again propose the plans in 2004.

 

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