Comments on: What is a High Deductible Health Plan with HSA and Is it for You? http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/ We're here, We're queer, and We're not going Shopping without Coupons Wed, 10 Mar 2010 04:23:21 -0700 http://wordpress.org/?v=2.9.1 hourly 1 By: GoHealth http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-139934 GoHealth Mon, 30 Jun 2008 19:06:41 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-139934 Also, there are a couple ways to get the tax benefits of a Health Savings Account. The easiest way is to have the savings for your HSA come straight out of your paycheck; before taxes are taken out of your income. It looks like many of you who commented here do it this way. But if you can't take money directly out of your paycheck for some reason, you can still get an HSA's tax advantages with an "above-the-line" deduction. All you have to do is subtract what you saved in your HSA from your taxable income on your next tax return. For example, if you save $2,000 in an HSA, you can take off $2,000 from your taxable income. A little more hassle, true, but it's good to know you can still get the tax benefits.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-139934">0</span> <small>(to vote for this comment, please visit the site)</small></p> Also, there are a couple ways to get the tax benefits of a Health Savings Account.

The easiest way is to have the savings for your HSA come straight out of your paycheck; before taxes are taken out of your income. It looks like many of you who commented here do it this way.

But if you can’t take money directly out of your paycheck for some reason, you can still get an HSA’s tax advantages with an “above-the-line” deduction. All you have to do is subtract what you saved in your HSA from your taxable income on your next tax return. For example, if you save $2,000 in an HSA, you can take off $2,000 from your taxable income.

A little more hassle, true, but it’s good to know you can still get the tax benefits.

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]]> By: What’s Your Financial IQ? Here’s A Test | Moolanomy http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-131603 What’s Your Financial IQ? Here’s A Test | Moolanomy Wed, 28 May 2008 12:03:17 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-131603 [...] understand how the Health Saving Account [...]<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-131603">0</span> <small>(to vote for this comment, please visit the site)</small></p> [...] understand how the Health Saving Account [...]

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]]> By: CBL http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-111475 CBL Fri, 07 Mar 2008 15:48:05 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-111475 This year I investigated a high deductible plan offered by my husband's employer. In order to project expenses and compare plans, I created a hypothetical medical situation and called the customer service number to get a ballpark idea of what physician, lab, rehab, etc. charges would be if I chose the high deductible plan. I was told that I could determine these charges with the providers I chose only at the time of service. The customer service representative also told me that in the three years she had been answering questions about the plan that I was the only person who had ever inquired about what my out-of-pocket costs might be. It was clear that if I chose the high deductible policy and required more than a couple of physician visits, I would be paying more in the long run than for the PPO and HMO plans offered. It was also clear that this plan not only represented cost shifting to the patient but also increased reimbursement to the providers. This was SWEET--the insurer won, the providers won, and the patient lost. Consumer driven health care is all about maximizing fees for providers without penalizing insurers. True consumer-driven health care can arise only when insurance is completely eliminated and providers (hospitals, physicians, nursing homes, outpatient surgery and diagnostic centers, etc.) cannot lien your assets or garnish your wages for their "reasonable and customary fees" that are 60-80 percent higher than the reimbursement they receive from insurance companies. The three biggest problems in health care today are fragmentation of services, hospital monopolies that restrict competition and innovation and the fact that charges are not market driven. The insurer reimburses the provider as little as possible in order to earn a huge profit on premiums. The provider's reasonable and customary charges are paid only by the hapless uninsured patient--those patients with insurance are charged much, much less. So what are the provider's services actually worth? What will the market bear? No one knows because neither what insurer's pay nor what providers want in terms of reimbursement reflect what consumers are willing and able to pay in a free market.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-111475">0</span> <small>(to vote for this comment, please visit the site)</small></p> This year I investigated a high deductible plan offered by my husband’s employer. In order to project expenses and compare plans, I created a hypothetical medical situation and called the customer service number to get a ballpark idea of what physician, lab, rehab, etc. charges would be if I chose the high deductible plan. I was told that I could determine these charges with the providers I chose only at the time of service. The customer service representative also told me that in the three years she had been answering questions about the plan that I was the only person who had ever inquired about what my out-of-pocket costs might be. It was clear that if I chose the high deductible policy and required more than a couple of physician visits, I would be paying more in the long run than for the PPO and HMO plans offered. It was also clear that this plan not only represented cost shifting to the patient but also increased reimbursement to the providers. This was SWEET–the insurer won, the providers won, and the patient lost. Consumer driven health care is all about maximizing fees for providers without penalizing insurers. True consumer-driven health care can arise only when insurance is completely eliminated and providers (hospitals, physicians, nursing homes, outpatient surgery and diagnostic centers, etc.) cannot lien your assets or garnish your wages for their “reasonable and customary fees” that are 60-80 percent higher than the reimbursement they receive from insurance companies. The three biggest problems in health care today are fragmentation of services, hospital monopolies that restrict competition and innovation and the fact that charges are not market driven. The insurer reimburses the provider as little as possible in order to earn a huge profit on premiums. The provider’s reasonable and customary charges are paid only by the hapless uninsured patient–those patients with insurance are charged much, much less. So what are the provider’s services actually worth? What will the market bear? No one knows because neither what insurer’s pay nor what providers want in terms of reimbursement reflect what consumers are willing and able to pay in a free market.

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]]> By: RFD http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-108202 RFD Fri, 22 Feb 2008 23:29:16 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-108202 I've had an HSA policy for quite a few years along with an account at HSA Bank. Recently transferred the account from HSA Bank to Exante and learned that HSA Bank has come up with new ways to screw their customers. First they charge you $25 to close the account, even if you've been there for years. Then, they close your account and sit on your money for 5 business days before sending it to the new trustee without paying you interest. Worse still, they don't pay you any interest for the month in which you close the account. So if you close it around the end of the month, you lose a full month's interest. When I called them and asked about all this stuff, they politely explained that it's all disclosed on page 6 of their fine print account policies! I'd stay away from HSA Bank - anyone who would screw their customers that bad should be out of business!<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-108202">0</span> <small>(to vote for this comment, please visit the site)</small></p> I’ve had an HSA policy for quite a few years along with an account at HSA Bank. Recently transferred the account from HSA Bank to Exante and learned that HSA Bank has come up with new ways to screw their customers. First they charge you $25 to close the account, even if you’ve been there for years. Then, they close your account and sit on your money for 5 business days before sending it to the new trustee without paying you interest. Worse still, they don’t pay you any interest for the month in which you close the account. So if you close it around the end of the month, you lose a full month’s interest. When I called them and asked about all this stuff, they politely explained that it’s all disclosed on page 6 of their fine print account policies! I’d stay away from HSA Bank – anyone who would screw their customers that bad should be out of business!

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]]> By: vh http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-107245 vh Mon, 18 Feb 2008 23:16:42 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-107245 The HSA I had covered some preventive care--various kinds of routine check-ups, for example, cost no more than a co-pay. At the time I had the HSA, I was very lucky with my health, which was (and still is) very good. If you're generally healthy AND luckier than Zeus, you'll do just fine with an HSA. Problem is, most of us do not dwell on Mt. Olympus and few of us are immortal. Sooner or later, each of us WILL get sick, and most of us will get sick (expensively) unto death. My HSA covered all costs 100%, no deductible no questions asked any practitioner I chose, once I exceeded the high deductible. That, I thought, was potentially useful. But: what happens if you contract a disease or are seriously injured near the end of a year? Let's say you get sick in December. You have surgery that instantly exhausts a $2,500 deductible. Because you are not allowed to deposit $2,500/year and you're a relatively new customer, the bill consumes most or all of the savings in your HSA. January begins a new year. So, say, come February you have some more expensive procedures. These quickly exceed $2,500. You don't have that much left in your HSA, and so to keep from being carted off to debtor's prison, you pay it out of pocket. Meanwhile, you have to keep contributing monthly to the HSA, screw you very much. Does the HSA reimburse you (with YOUR OWN MONEY) to cover the February bills? Maybe so, but somehow it doesn't look like a smokin' deal. I abandoned my HSA after my employer finally started offering some decent health insurance options. And indeed, one Christmas I spent the holiday in the hospital enjoying an appendectomy, to the tune of $20,000. The new insurance plan covered ALL of it--I had to pay $75 for the emergency room co-pay. If I'd still been enrolled in the HSA, I would have had to pony up $2,500, and then come January I would have had to pay more for any further medical bills that arose. Another issue I had with the HSA is that you have very, very few choices of financial institutions to host your "savings." All of them have OUTRAGEOUS charges. And once the money is in one of those accounts, it's in there forever, or at least until you find ways to use it up on glasses and dental work and whatever other miscellany you can imagine to consume it. After you've quit the HSA plan, you're not allowed to move the money anywhere else. It took me almost two years to get my money out of the HSA account, and during all that time I was being nicked $10 or $15 a month in service fees. But: if my employer, a state government, came up with an HSA plan that did not rip me off and ensured that long-term costs of a single illness were covered from year year to year, as long as I was being treated for that illness, I would consider it. An HSA does allow you, IF YOUR HEALTH IS GOOD, to build savings that come back to you when you become Medicare-eligible. If you're lucky.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-107245">0</span> <small>(to vote for this comment, please visit the site)</small></p> The HSA I had covered some preventive care–various kinds of routine check-ups, for example, cost no more than a co-pay.

At the time I had the HSA, I was very lucky with my health, which was (and still is) very good. If you’re generally healthy AND luckier than Zeus, you’ll do just fine with an HSA. Problem is, most of us do not dwell on Mt. Olympus and few of us are immortal. Sooner or later, each of us WILL get sick, and most of us will get sick (expensively) unto death.

My HSA covered all costs 100%, no deductible no questions asked any practitioner I chose, once I exceeded the high deductible. That, I thought, was potentially useful.

But: what happens if you contract a disease or are seriously injured near the end of a year? Let’s say you get sick in December. You have surgery that instantly exhausts a $2,500 deductible. Because you are not allowed to deposit $2,500/year and you’re a relatively new customer, the bill consumes most or all of the savings in your HSA. January begins a new year. So, say, come February you have some more expensive procedures. These quickly exceed $2,500. You don’t have that much left in your HSA, and so to keep from being carted off to debtor’s prison, you pay it out of pocket. Meanwhile, you have to keep contributing monthly to the HSA, screw you very much. Does the HSA reimburse you (with YOUR OWN MONEY) to cover the February bills? Maybe so, but somehow it doesn’t look like a smokin’ deal.

I abandoned my HSA after my employer finally started offering some decent health insurance options. And indeed, one Christmas I spent the holiday in the hospital enjoying an appendectomy, to the tune of $20,000. The new insurance plan covered ALL of it–I had to pay $75 for the emergency room co-pay. If I’d still been enrolled in the HSA, I would have had to pony up $2,500, and then come January I would have had to pay more for any further medical bills that arose.

Another issue I had with the HSA is that you have very, very few choices of financial institutions to host your “savings.” All of them have OUTRAGEOUS charges. And once the money is in one of those accounts, it’s in there forever, or at least until you find ways to use it up on glasses and dental work and whatever other miscellany you can imagine to consume it. After you’ve quit the HSA plan, you’re not allowed to move the money anywhere else. It took me almost two years to get my money out of the HSA account, and during all that time I was being nicked $10 or $15 a month in service fees.

But: if my employer, a state government, came up with an HSA plan that did not rip me off and ensured that long-term costs of a single illness were covered from year year to year, as long as I was being treated for that illness, I would consider it. An HSA does allow you, IF YOUR HEALTH IS GOOD, to build savings that come back to you when you become Medicare-eligible. If you’re lucky.

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]]> By: Paula G http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-107174 Paula G Mon, 18 Feb 2008 17:08:16 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-107174 Interesting point Kathy. I wonder though - it seems it is only fundamentally flawed if you choose NOT to do routine care. Under these plans, it simply means you are responsible for your routine care, it doesn't say "don't go do preventative care". Whereas my experience with HMO is that you can have a preventative visit but "only with whom and how we the powers that be think that should look". Having had a few bad Dr experiences in the past (after all someone had to be LAST in their class, right?)...I think choice is most important both in who I see and how I choose to be treated/follow preventative care. I appreciate all your comments... and these of course are only my personal experiences and opinions! But I wanted to share what came up for me as I read your thoughtful response. Here's to hopes for a better system for all , whatever that might look like!<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-107174">0</span> <small>(to vote for this comment, please visit the site)</small></p> Interesting point Kathy. I wonder though – it seems it is only fundamentally flawed if you choose NOT to do routine care. Under these plans, it simply means you are responsible for your routine care, it doesn’t say “don’t go do preventative care”. Whereas my experience with HMO is that you can have a preventative visit but “only with whom and how we the powers that be think that should look”. Having had a few bad Dr experiences in the past (after all someone had to be LAST in their class, right?)…I think choice is most important both in who I see and how I choose to be treated/follow preventative care.

I appreciate all your comments… and these of course are only my personal experiences and opinions! But I wanted to share what came up for me as I read your thoughtful response.

Here’s to hopes for a better system for all , whatever that might look like!

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]]> By: vh http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-106979 vh Mon, 18 Feb 2008 04:17:51 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-106979 Thanks for this good discussion of HSAs and other options for the self-employed. I've posted a link to this at my Sunday round-up.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-106979">0</span> <small>(to vote for this comment, please visit the site)</small></p> Thanks for this good discussion of HSAs and other options for the self-employed. I’ve posted a link to this at my Sunday round-up.

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]]> By: Dima http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-106878 Dima Sun, 17 Feb 2008 20:27:59 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-106878 I will second the other healthy younger folks. I just started working last year and enrolled in EPO to do a few check ups since I have not been to a doctor in 4-5 years. This year I switched to HDHP and opened HSA. The only issue I am having is that our payroll system is not set up to process pretax contributionss to an HSA other than the one offered at work. So my plan is to put the money in there but then transfer it to Fidelity once they open their HSA for everyone.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-106878">0</span> <small>(to vote for this comment, please visit the site)</small></p> I will second the other healthy younger folks. I just started working last year and enrolled in EPO to do a few check ups since I have not been to a doctor in 4-5 years. This year I switched to HDHP and opened HSA. The only issue I am having is that our payroll system is not set up to process pretax contributionss to an HSA other than the one offered at work. So my plan is to put the money in there but then transfer it to Fidelity once they open their HSA for everyone.

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]]> By: Kathy http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-106775 Kathy Sun, 17 Feb 2008 13:22:54 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-106775 These are fundamentally flawed. Discouraging routine medical care through the market is not a way to reduce costs, it's a way to increase costs. This is why HMOs encourage primary care visits and require them to access higher cost services -- because regular contact with a physician reduces overall costs by treating problems in early stages when they are less expensive to treat. Consumer Driven Health discourages this type of behavior and encourages letting conditions get out of hand to the point where insurance takes over. Most importantly however, consumer behavior works very well for the distribution of optional consumer goods, but health care is not an optional purchase. Let's look at HIV infection. Everyone is quite aware that HIV drugs are expensive. So consumer driven health would solve this by creating a marketplace. Consumers would see the cost as too great and simply not purchase. After a generation chose not to purchase these drugs, pharmaceutical companies would be forced to lower prices, find more efficient solutions, etc. The problem here is that obtaining that result relies on a generation of HIV infected individuals deciding that death is preferable to being overcharged. The difficulty for the advocates of consumer driven health is in finding this large group of consumers willing to engage in behavior that is de facto suicide in order to nudge the marketplace. Simply put, death is not a viable consumer choice. And life or death advanced and long term medical treatment is where the real costs in the system lie. If one casts a rather jaded eye towards consumer driven health, including looking at its most ardent advocate, Newt Gingrich's think tank, and looking at the one indisputable benefit that it lowers costs for corporations, one might suspect that the real aim here is not to lower health care costs, but simply to produce a huge windfall for corporate America.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-106775">0</span> <small>(to vote for this comment, please visit the site)</small></p> These are fundamentally flawed.

Discouraging routine medical care through the market is not a way to reduce costs, it’s a way to increase costs. This is why HMOs encourage primary care visits and require them to access higher cost services — because regular contact with a physician reduces overall costs by treating problems in early stages when they are less expensive to treat. Consumer Driven Health discourages this type of behavior and encourages letting conditions get out of hand to the point where insurance takes over.

Most importantly however, consumer behavior works very well for the distribution of optional consumer goods, but health care is not an optional purchase.

Let’s look at HIV infection. Everyone is quite aware that HIV drugs are expensive. So consumer driven health would solve this by creating a marketplace. Consumers would see the cost as too great and simply not purchase. After a generation chose not to purchase these drugs, pharmaceutical companies would be forced to lower prices, find more efficient solutions, etc.

The problem here is that obtaining that result relies on a generation of HIV infected individuals deciding that death is preferable to being overcharged. The difficulty for the advocates of consumer driven health is in finding this large group of consumers willing to engage in behavior that is de facto suicide in order to nudge the marketplace.

Simply put, death is not a viable consumer choice. And life or death advanced and long term medical treatment is where the real costs in the system lie.

If one casts a rather jaded eye towards consumer driven health, including looking at its most ardent advocate, Newt Gingrich’s think tank, and looking at the one indisputable benefit that it lowers costs for corporations, one might suspect that the real aim here is not to lower health care costs, but simply to produce a huge windfall for corporate America.

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]]> By: Becky@FamilyandFinances http://queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/comment-page-1/#comment-106325 Becky@FamilyandFinances Sat, 16 Feb 2008 01:56:55 +0000 http://www.queercents.com/2008/02/15/what-is-a-high-deductible-health-plan-with-hsa-and-is-it-for-you/#comment-106325 I have had an HSA for over 2 years now and I really love it! It works for me because I am young and healthy, which is really who the HSA is geared for.<p class="top-comments">Current score: <span class="top-comments-karma" id="karma-106325">0</span> <small>(to vote for this comment, please visit the site)</small></p> I have had an HSA for over 2 years now and I really love it! It works for me because I am young and healthy, which is really who the HSA is geared for.

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