Health Savings Accounts Require Close Attention

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AS health care open enrollment gets underway at many workplaces across the country, employees should take special care to do their homework when signing up for plans that offer health savings accounts, new research suggests.

Health savings accounts, or H.S.A.s, are offered only in tandem with specific high-deductible health plans, which are becoming more prevalent as employers seek to manage costs. The lofty deductible — at least $1,300 for an individual, and $2,600 for a family — means that workers pay more for medical care out of pocket before insurance pays.

The plans can be a boon for workers who understand how to take advantage of the tax benefits that H.S.A.s offer. (The money is tax-free as long as it’s spent on eligible health care, and workers take the money with them if they switch jobs.) But there may be caveats — for lower-income workers, in particular.

A new analysis by the Employee Benefit Research Institute found that while workers over all in a health plan with an H.S.A. visited the doctor less often for nonpreventive care, the decline was more than twice as large for workers who made $50,000 or less, compared with those who made $100,000 or more.

Lower-income workers were also more likely to reduce their use of important preventive services, like flu shots and breast cancer screenings, even though such services aren’t subject to the deductible and are covered at no cost.

The study focused on more than 150,000 workers at a single large employer over six years.

Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute and an author of the study, said although H.S.A.s had been around for more than a decade, they are complex and new to many workers. “It just takes some time, to understand how their benefits work,” he said.

Alison Galbraith, an assistant professor at Harvard Medical School who has studied the effects of insurance policy on health, said lower-income patients may avoid free preventive care because they don’t understand the details of their policies. “The plans are complicated,” she said, “and they may not be sure what’s covered.”

It’s also likely, she said, that because they may avoid office visits, in general, to avoid incurring costs, lower-income workers are less likely to be reminded to follow up with free services, like immunizations. And they may be concerned that while visiting a doctor for a covered screening, they may also end up with extra care — say, a chest X-ray — that’s not covered.

So should lower-income workers avoid H.S.A. plans if they have a choice?

Not necessarily. Monthly premiums are usually lower with such plans, and employers often make contributions to H.S.A.s that can help cover the cost of care. The typical contribution by large employers to an H.S.A. is $600 for an individual and $1,100 for family coverage, according to the National Business Group on Health.

To encourage workers to get preventive care, some employers attach strings to their contributions, said Steve Wojcik, vice president of public policy with the business group. They may, for instance, require workers to designate a primary care physician or complete recommended no-cost screenings to be eligible for contributions.

It may make sense, Mr. Fronstin said, for employers to base H.S.A. contributions on a worker’s income, so lower-income employees would receive more funds to help cover costs.

In the meantime, he advised, workers should read health plan documents carefully and contact their human resources department to clarify anything that’s confusing.

Here are some questions and answers about health savings accounts:

How much can I contribute to an H.S.A. in 2017?

Individuals can contribute up to $3,400 next year, up $50 from this year’s limit. The maximum contribution for families remains $6,750.

Also, if you are 55 or older, you can contribute an extra $1,000 to the account annually.

Are funds contributed to an H.S.A. by my employer available right away?

That depends, Mr. Fronstin said, and it’s an important detail to nail down. Some employers make lump sum contributions that are immediately available at the start of the plan year. But others may contribute monthly or quarterly and you must wait until the balance grows before using the funds to pay for care. Workers accustomed to other types of health care spending accounts that make employer funds available right away may be surprised to find that H.S.A.s can work differently.

Can veterans contribute to H.S.A.s through workplace health plans, if they also receive health care through the federal Department of Veterans Affairs?

Yes, under certain conditions, said William J. West Jr., senior vice president with HealthEquity, which administers H.S.A.s. The Internal Revenue Service recently clarified that veterans may contribute to an H.S.A. while receiving V.A. benefits, as long as the veteran has a disability rating from the V.A., which indicates the disability is connected to military service, Mr. West said.

Previously, veterans generally couldn’t contribute to an H.S.A. if they had received treatment through Veterans Affairs in the previous three months.