If an enrollee uses HSA money for non-medical expenses and is under the age of 65 or not disabled, he or she will incur a 10 percent penalty in addition to owing regular federal income tax on such amounts. The federal law, called ACA or Obamacare for short, eliminated the use of HSA dollars to pay for over-the-counter drugs, unless obtained with a prescription or doctor's orders. Actuarial value generally includes deductibles, copayments and coinsurance. To pay for those costs, enrollees can tap their HSA. Beginning in , employee contributions may not be counted in the actuarial value -- unless future HHS guidance or regulations specify that they do count.
Never heard of a health savings account? That has many in the industry predicting big changes in the fast-growing HSA market. HSAs are different. Plus, money in them can be invested for tax-free growth, and funds withdrawn to pay for qualified medical expenses are never taxed. In fact, he believes HSAs are a better deal, thanks to their triple tax advantage. A growing number of employers, however, are moving to high deductible plans as a way to lower premiums.
Nearly 30 percent of employers offered an HSA eligible plan in , according to the Employee Benefit Research Institute , and the number is expected to keep rising. Some employers offer only high deductible options, but others include high deductible plans as one of several options that also might include traditional HMOs and PPOs.
Employees with high deductible plans typically get an account linked to a debit card that can be used to pay their qualified medical bills.
But the benefits are far more advantageous for people who have the resources and are willing to save their HSA money. They can invest those pretax HSA dollars, let them grow tax free, and then take money out at any time to cover medical expenses, even those that might have been incurred years before.
All without paying any taxes. Given all the complexity, some number crunching is critical Dept of Treasury staff, Excerpt: "Between and , the share of employers whose employees had health savings accounts HSAs and the share of employees working at these employers grew more than tenfold. High-income and older tax filers both established HSAs and fully funded their HSAs at least four times as often as did low-income and younger filers. Source: Physician Practice Perspectives. The proliferation of high-deductible health plans is having a ripple effect throughout the industry and forcing many medical practices to change the way they do business.
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And some of those changes are affecting the way physicians discuss treatment options with their patients. NCOIL claims, " Based upon our analysis of the regulation, it will effectively eliminate HSA qualified health plans from the insurance exchanges next year. Additionally, the regulation requires plans to cover numerous services below the deductible such as a limited numbers of primary-care visits, specialty-care visits, mental-health and substance-use-disorder outpatient services, urgent-care visits and drug benefits.
However, IRS qualified HSA health plans are not permitted to cover any services below the deductible except for preventive services.
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Released August 17, Healthcare financial leaders say high-deductible health plans, whether pushed by employers or offered through the exchanges, are rapidly expanding the risk of non-payment. Many consumers choose plans with the smallest upfront cost and largest deductibles, and they often lack a thorough understanding of the plans. A high-deductible health plan linked with health savings accounts reduced health spending initially, and over a four year period, according to new research from the nonpartisan Employee Benefit Research Institute EBRI.
But there are good reasons to think twice before making that choice. Regular high-deductible plans, on the other hand, offer many more options. In addition to covering preventive care at percent, some function like traditional plans, requiring only a copayment for doctor visits and medicines even before the deductible is met. Or they may offer a limited number of doctor visits with a copayment before people meet their deductible, says Carrie McLean, senior manager of customer care at eHealthInsurance. Consumers need to evaluate the full spectrum of costs and benefits for HSA plans, but the advantages may have nothing to do with medical expenses, she advises.
Cigna Corp. Finnell says FedEx, which is a bulwark in his hometown of Memphis, is being proactive by announcing its intentions now, well before open enrollment in the fall. The consumer-directed plans, like the account-based program FedEx will roll out, puts members in a position to help themselves by making healthy choices, joining incentive-based preventive care programs and shopping for services.
FedEx is no exception. Like many large employers, FedEx is self-insured and is working proactively to address rising coverage costs. Industry sources say the FedEx account-based plan likely will offer different levels of deductibles and will be tied to a health reimbursement arrangement HRA. All prescriptions, preventive care programs and member primary care doctor visits to in-network providers will be covered outside of the annual deductible, with coinsurance instead being used in those instances.
The itms below were published in or earlier and should not be used for current research purposes. They illustrate the rapid spread of interest and regulation of HSAs in the previous decade, but not more recent activity. States that a health care insurer that offers, issues, delivers, or renews a health care insurance plan in the state may apply deductible or copayment requirements to health care benefits and services that qualify the health care insurance plan as a high deductible health plan. Requires that the Department of Administration shall design for state employees a program for the use of health savings accounts with a qualifying state-sponsored high deductible health plan, as defined in Public Law Colorado SB Sen.
Creates the Colorado Cares Rx generic drug discount program for uninsured residents under percent of federal poverty. Provides that the program "may expand eligibility" also to "underinsured" residents covered by a high deductible health plan. Authorizes commercial banks, savings banks, savings associations, credit unions, or industrial loan and thrift companies to act as trustees or custodians for health savings accounts under federal law.
Signed into law by governor as Chapter No. Mississippi HB 41 Rep. Provides that amounts received by an individual which may be excluded from income as foreign earned income for federal income tax purposes shall be excluded from gross income for state income tax purposes.
The amount deposited in a health savings account, and any interest accrued thereon, that is a part of a health savings account program as specified in the Health Savings Accounts Act created in Sections through ; however, any amount withdrawn from such account for purposes other than paying qualified medical expenses or to procure health coverage.
Beginning with the plan year, the board shall offer to all qualified state employees and retirees and participating public entities the option of receiving health care coverage through a high deductible health plan and the establishment of a health savings account. Requires the State and Education Employees Group Insurance Board to make the health savings account available to eligible employees; specifying time in which certain plan is offered; requires confirmation of health savings account to certain Board by employees; providing for codification; and declaring an emergency. Not only do a troubling number of African-Americans not understand depression to be a serious medical condition, but the stereotype of the strong black woman leads many African-American women to believe that they don't have the luxury or time to experience depression.
Some even believe it is only something White people experience.
African-Americans tend to cope with mental health problems by using informal resources like the church, family, friends, neighbors and coworkers. In many cases they seek treatment from ministers and physicians as opposed to mental health professionals.
“I’m absolutely terrified”
This form of coping can be beneficial for black women who are uncomfortable with traditional forms of mental health care. But it can also encourage beliefs about negative stigmas surrounding mental health in the black church. Orbe-Austin said attitudes and beliefs about mental illness and mental health services in the black community tend to lean towards the idea that therapy is not a traditional coping mechanism for blacks.
Those of us who are culturally competent try to bring in other experiences, other cultural experiences to our work so that we don't do it in this culturally bound way. The challenge, she said, is educating mental health care practitioners on the cultural beliefs of African-Americans and in turn educating blacks on the medical benefits mental health services can produce.
One of the greatest barriers to keeping black women from receiving treatment for depression is a history of discrimination and a deep mistrust of health care institutions in the U. Research shows that African-American women's use of mental health services may also be influenced by barriers including, "poor quality of health care, limited access to clinicians that are culturally competent , and cultural matching limited access to work with minority clinicians.
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A history of trauma and victimization experienced by African-Americans has also helped foster a cultural mistrust toward the U. Events like the Tuskegee Experiments are hypothesized to contribute to many black people's negative attitudes about health care. High levels of cultural mistrust have also been linked to a negative stigma of mental illness in the African-American community. Mental health professionals cite it as another significant barrier to treatment seeking for African-American women.
Despite the seemingly large challenges black women face with regard to mental health and depression, they have been able to develop alternative coping techniques to deal with various stressors and depression including support systems within families, communities and religious institutions. Mental health professionals hope, with more awareness, attitudes about depression among black women will shift even more in a positive direction. Have a story about depression that you'd like to share?
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In the U. They compare the experiences of older adults with and without a mental health condition in the Cash and Counseling demonstration in Arkansas. Sixteen percent of the elderly population in the Arkansas demonstration had a diagnosis of mental illness. Of those, According to the International Classification of Diseases, 9th Revision codes, 22 the low cost category includes, but is not limited to the following: neurotic depression, neurasthenia, depersonalization syndrome, hypochondriasis, other unspecified neurotic disorders, adjustment disorders, reaction adjustment to chronic stress, affective psychoses, brief depressive reaction, neurotic depression, psychogenic depressive psychosis, conduct disturbance as adjustment reaction, and destructiveness as adjustment reaction.
Shen and colleagues report that participants with a mental health condition who were in the treatment group and directing their own personal care services were more satisfied with their care arrangements, with the reliability and performance of their caregivers and had greater life satisfaction than those with a mental health condition in the control group. Older adults with a mental health diagnosis directing their own services were no more likely to experience adverse health events, such as falls or injuries, than those receiving agency services.
In interviews about their experiences with self-direction, consumers identified specific features of the approach that they valued. These underpin the overall increase in satisfaction reported in Figure 3 and Figure 4. One of the central messages from consumers interviewed for this report was the importance of the support and advocacy they received alongside the budget.
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