Since the new Congress began in January, there have been more than 20 bills proposed that impact consumer-directed health care, and more specifically HSAs. In May, the House of Representatives narrowly passed the American Health Care Act.
A new report from HSA Bank provides insight into specific impacts on HSAs and consumer-directed health care outlined in the American Health Care Act, as well as examines the other proposed legislation.
“Whether they get passed or not, I don’t expect that to have a negative impact on HSAs,” Chad Wilkins, executive vice president and head of HSA Bank, told ThinkAdvisor. “We’ll continue to see that kind of growth going forward. And if they do get passed, we’ll see more wind at the back of high-deductible health plans and HSAs.”
The number of people enrolled in HSAs continues to grow, although more slowly than in previous years. According to America's Health Insurance Plan report, 20.2 million U.S. residents were covered through HSA-compatible, individual, small-group or large-group plans in 2016.
A Fidelity analysis shows a surge in health savings account in the third quarter of last year.
Wilkins, who co-authored the report with Kevin Robertson, senior vice president and chief revenue officer, attributes the growth in HSAs to both the cost standpoint for employers offering plans, as well as the cost savings for individuals both today and in retirement.
And he predicts this growth and popularity will continue to expand -- despite what happens in Congress.
“There’s been a lot of changes in legislators over the past 10 years and HSAs have stayed relatively stable in that world,” Wilkens said.
The report provides insight into the six specific impacts on HSAs and CDH plans outlined in AHCA, as passed by the House, with a focus on how they will positively impact individuals' ability to own their health.
The top-ranking Democrat on the Senate side of the Joint Economic Committee, though, has said expanding the health savings account program would do little to help ordinary Americans cope with cuts in Affordable Care Act coverage expansion programs.
According to Robertson, these impacts “focus on expanding access to health savings accounts and CDH plans for Americans.”
1. Raises HSA contribution limits to the high-deductible health plan (HDHP) out-of-pocket maximum.
The current 2017 HSA contribution limits are $3,400 for a single plan and $6,750 for a family plan. The proposed 2018 contribution limits would increase that to $6,550 for a single plan and $13,100 for a family plan.
2. Repeals the ACA contribution limit on flexible spending accounts (FSAs) (currently $2,600 for 2017)
Approximately 20 percent of Americans covered by private insurance are able to contribute to an HSA since they are enrolled in a qualified HDHP, according to the report. For those not covered by an HDHP, this change effectively allows for significantly higher contributions to help cover large out-of-pocket expenses.
3. Allows spouses to make catch-up contributions to the same HSA
“The most significant obstacle to maximizing spousal contributions has been the aggravation of having to open a second account,” the report says.
This change will make it easier for seniors to maximize their savings for retirement years, both in terms of lower administration costs, and simplification of the contribution process.
4. Repeals the prescription requirement for over-the-counter medications as qualified medical expense distributions from HSAs, FSAs, and health reimbursement arrangements (HRAs)
The ACA raised the prices for anyone purchasing over-the-counter medications, and with this repeal, it will immediately lower healthcare costs for people using HSAs, FSAs, and HRAs to purchase these products, according to the report.
5. Lowers the penalty for non-qualified HSA distributions made prior to age 65 from 20 percent to 10 percent
This penalty exists to ensure that HSAs are used as health care savings tools and not tax shelters for assets. The report says a lower penalty would make HSAs more attractive since “the fear of a 20 percent penalty may have been a detractor in individuals using HSAs as a savings account.”
6. Allows for qualified distributions to reimburse medical expenses incurred within 60 days of HDHP coverage but before HSA account is established
“Even though an individual may be covered by an HSA-qualified health plan, they are not allowed to claim their medical expenses as qualified distributions until they have met the legal requirements of establishing their HSA,” according to the report.
This provision would give individuals a 60-day window to cover these instances.
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