Understand Your Spending Power: What You Can Buy with Your FSA, HSA, or HRA

Understand Your Spending Power: What You Can Buy with Your FSA, HSA, or HRA

by | Aug 5, 2024 | Flexible Spending Accounts, HSA/HRA

Medical expense accounts can help you save on all kinds of healthcare costs. Here are some you may not know about yet.

HSA, FSA, and HRA can typically be used for:

  • Medical expenses: Doctor visits, surgeries, prescriptions, dental and vision care, and mental health services.
  • Over-the-counter (OTC) medications: Many OTC medications, including pain relievers, allergy medications, and cold remedies, are now eligible.
  • Medical equipment: Items like crutches, wheelchairs, and diabetic supplies often qualify.
  • Qualified medical transportation: Expenses related to getting to and from medical appointments
  • Women’s healthcare products: As of 2020, many women’s healthcare and hygiene items—including pads and tampons—were added to the list. Birth control and other contraceptives also count as qualified medical expenses with a prescription.
  • Sunscreen: If you buy sunscreen with a sun protection factor (SPF) of 15 or higher, you can pay for it with your FSA or HSA account.
  • Health insurance premiums: In some cases, you can use HSA or FSA funds to pay for COBRA premiums or health insurance premiums during periods of unemployment.
  • Alcohol or drug treatment: If you need treatment at a hospital for alcohol or drug abuse, you can cover those costs with your FSA or HSA. That includes meals and a treatment center stay. You can also include rides to and from meetings for groups like Alcoholics Anonymous.

Expenses that might be covered, but check your plan:

  • Long-term care: Some plans may cover long-term care expenses, but this is often limited.
  • Cosmetic surgery: Generally not covered unless medically necessary.
  • Weight loss programs: May be eligible if medically supervised.
  • Gym memberships: While some plans cover gym memberships, it’s often dependent on specific medical conditions or doctor referrals.

Important Considerations:

  • Keep receipts: You’ll generally need receipts to claim reimbursement for your purchases.
  • Check eligibility: Not all items are covered, so verify with your plan administrator.
  • Maximize your savings: Use your accounts strategically to reduce out-of-pocket costs.

Additional Tips:

  • Shop around: Compare prices for medical goods and services to maximize your savings.
  • Take advantage of online resources: Many health insurance providers offer online tools and resources to help you understand your coverage.
  • Consult with your healthcare provider: Your doctor can recommend treatments and products that may be eligible for reimbursement.

By understanding the nuances of HSAs, FSAs, and HRAs, you can make informed decisions about how to use these accounts to your advantage and maximize your healthcare savings.

Exploring Benefits Lingo

Exploring Benefits Lingo

by | Aug 24, 2021 | Benefit Management, Flexible Spending Accounts, HSA/HRA

We all know how confusing and complex benefits and healthcare terms can be- the difference between deductible and co-insurance is a common question for many and there are plenty of others like it.  When you are comfortable and confident in how your plan works, you can make an informed decision on HOW to use and take advantage of your benefits!

We have created a list and explanation of the most common terms to help you understand and better utilize your health benefits:

  • Co-payment:  An amount you pay as your share of the cost for a medical service or item, like a doctor’s visit.  Co-pays are most common for emergency room, urgent care and prescription drugs. In some cases, you may be responsible for paying a co‐pay as well as a percentage of the remaining charges.
  • Co-insurance:  Your share of the cost for a covered health care service, usually calculated as a percentage (like 20%) of the allowed amount for the service. For example, if your plan has a 30% co-insurance rate, the carrier will pay 70% of the allowed amount while you pay the balance.
  • Deductible: The amount you owe for covered health care services before your health insurance or plan begins to pay.  For example, many plans require an individual to pay $1,000 in cumulative deductibles before they begin paying out.
  • Dependent coverage:  Health insurance coverage extended to the spouse and unmarried children up to age 26 who are totally or substantially reliant on their parents for support, thereby defined as “dependent children”.
  • Explanation of Benefits (EOB): Every time you use your health insurance, your health plan sends you a record called an “explanation of benefits” (EOB) or “member health statement” that explains how much you owe. The EOB also shows the total cost of care, how much your plan paid and the amount an in-¬network doctor or other healthcare professional is allowed to charge a plan member (called the “allowed amount”).
  • In-Network Provider: A provider who has a contract with your health insurer or plan to provide services to you at a discount. In-Network Providers have contracted with the insurance carrier to accept reduced fees for services provided to plan members. Using in-network providers will cost you less money. When contacting an In-Network Provider, remember to ask, “are you a contracted provider with my plan?” Never ask if a provider “takes” your insurance, as they will all take it. The key phrase is contracted.
  • Open Enrollment: A period during which a health insurance company is required to accept applicants without regard to health history.
  • Out-of-Network Provider: A provider who doesn’t have a contract with your health insurer or plan to provide services to you at a pre-negotiated discount. You’ll pay more to see an out-of-network provider, sometimes referred to as an out-of-network provider.
  • Out-of-Pocket Maximum: The limit or most you’ll pay out of your own pocket for services during your insurance plan period (usually one year).
  • Premium: The amount you pay for your health insurance or plan each month.
  • Qualifying Life Event (QLE): A change in your life that allows you to make changes to your benefits’ coverage outside of the annual open enrollment period. These changes include a change in marital status (marriage, divorce, death of spouse), a change in the number of eligible children (birth, adoption, death, aging-out), and a change in a family member’s benefits eligibility under another plan (losing a job, Medicare or Medicaid eligibility, etc.)

In addition to understanding these common terms, there are other ways to utilize your benefits, save money and make an informed decision based on your specific needs.

  • Flexible Spending Account (FSA): Funded through pre-tax payroll deductions, an FSA is a cost-savings tool that allows you to pay for qualified healthcare-related expenses with pre-tax dollars. Funds deposited in an FSA must be spent in the same year in which they are set aside, or they are forfeited. This rule is often referred to as “use it or lose it.”
  • Health Reimbursement Account (HRA): An employer-funded savings plan that will reimburse you for out-of-pocket medical expenses. Unlike an FSA, however, you don’t “use it or lose it” – unused balances will roll over and accumulate over time, though the account cannot be “cashed-out.”
  • Health Savings Account (HSA): A savings product that serves as a substitute for traditional health insurance. HSAs enable you to pay for current health costs. They also allow you to save for future medical and retiree health costs tax-free. Unlike an FSA, however, you don’t “use it or lose it” – unused balances will roll over and accumulate over time and can be “cashed-out.”

Understanding all of the terms and acronyms can feel like learning a new language, so it’s helpful to have a basic reference chart.  With a good understanding of what some healthcare “benefits lingo” means, it will be easier to find a plan that meets your needs and budget. To explore more healthcare terms, visit https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/common-health-benefit-terms-glossary.aspx

Don’t Leave Your FSA Money on the Table this Year!

Don’t Leave Your FSA Money on the Table this Year!

by | Oct 17, 2019 | Flexible Spending Accounts, Open Enrollment

As 2019 is nearing an end, many people are looking at this year’s medical expenses to plan for how much they should set back for next year. In investigating these expenditures, you may notice that you still have money in your Flexible Spending Account (FSA) for 2019. FSAs are unique in that any unused money from this plan year is forfeited once the new year begins. You definitely do not want to leave money in your FSA once 2020 rolls around. To help, we’ve compiled a list of some ways to use up your hard-earned FSA money that you may not have thought possible!

  • Acupuncture
  • Acne treatment
  • Breast pump and supplies
  • Chiropractic treatments
  • Dental treatments—orthodontia, medically necessary water fluoride treatments, caps, fillings, x-rays
  • Eyes—glasses, surgery, contact lenses
  • First aid kit
  • Genetic testing—including BRCA gene testing
  • Motion sickness medicine
  • Nutritionist consultations
  • Sunscreen
  • Smoking cessation program
  • Vaporizer
  • Vasectomy
  • Weight loss programs/surgery

There are even some high-tech gadgets that may fall into the medically qualified expenses category:

  • Acne light therapy
  • Electronic stimulation instruments for pain
  • Medically necessary mattresses
  • Smart thermometers

Don’t leave your FSA money on the table in 2019! You have earned this money so make sure you use it to its full potential.
This list is not an exhaustive list of ways to spend your FSA money nor does it guarantee your insurance program considers these to be qualified expenses. Check with your HR department and insurance agent if you have questions about qualified expenses.

Choosing the Right Flexible Benefit for Employees

Choosing the Right Flexible Benefit for Employees

by | Oct 30, 2018 | Benefit Management, Employee Benefits, Flexible Spending Accounts, Group Benefit Plans

Trying to decide which of the many employer-sponsored benefits out there to offer employees can leave an employer feeling lost in a confusing bowl of alphabet soup—HSA? FSA? DCAP? HRA? What does it mean if a benefit is “limited” or “post-deductible”? Which one is use-it-or-lose-it? Which one has a rollover? What are the limits on each benefit?—and so on.
While there are many details to cover for each of these benefit options, perhaps the first and most important question to answer is: which of these benefits is going to best suit the needs of both my business and my employees? In this article, we will cover the basic pros and cons of Flexible Spending Arrangements (FSA), Health Savings Accounts (HSA), and Health Reimbursement Arrangements (HRA) to help you better answer that question.
Flexible Spending Arrangements (FSA)
An FSA is an employer-sponsored and employer-owned benefit that allows employee participants to be reimbursed for certain expenses with amounts deducted from their salaries pre-tax. An FSA can include both the Health FSA that reimburses uncovered medical expenses and the Dependent Care FSA that reimburses for dependent expenses like day care and child care.
Pros:

  • Benefits can be funded entirely from employee salary reductions (ER contributions are an option)
  • Participants have access to full annual elections on day 1 of the benefit (Health FSA only)
  • Participants save on taxes by reducing their taxable income; employers save also by paying less in payroll taxes like FICA and FUTA
  • An FSA allows participants to “give themselves a raise” by reducing the taxes on healthcare expenses they would have had anyway

Cons:

  • Employers risk losing money should an employee quit or leave the program prior to fully funding their FSA election
  • Employees risk losing money should their healthcare expenses total less than their election (the infamous use-it-or-lose-it—though there are ways to mitigate this problem, such as the $500 rollover option)
  • FSA elections are irrevocable after open enrollment; only a qualifying change of status event permits a change of election mid-year
  • Only so much can be elected for an FSA. For 2018, Health FSAs are capped at $2,650, and Dependent Care Accounts are generally capped at $5,000
  • FSA plans are almost always offered under a cafeteria plan; as such, they are subject to several non-discrimination rules and tests

Health Savings Accounts (HSA)
An HSA is an employee-owned account that allows participants to set aside funds to pay for the same expenses that are eligible under a Health FSA. Also like an FSA, these accounts can be offered under a cafeteria plan so that participants may fund their accounts through pre-tax salary reductions.
Pros:

  • HSAs are “triple-tax advantaged”—the contributions are tax free, the funds are not taxed if paid for eligible expenses, and any gains on the funds (interest, dividends) are also tax-free
  • HSAs are portable, employee-owned, interest-bearing bank accounts; the account remains with the employees even if they leave the company
  • Certain HSAs allow participants to invest a portion of the balance into mutual funds; any earnings on these investments are non-taxable
  • Upon reaching retirement, participants can use any remaining HSA funds to pay for any expense without a tax penalty (though normal taxes are required for non-qualified expenses); also, retirees can use the funds tax-free to pay premiums on any supplemental Medicare coverage. This feature allows HSAs to operate as a secondary retirement fund
  • There is no use-it-or-lose-it with HSAs; all funds employees contribute stay in their accounts and remain theirs in perpetuity. Also, participants may alter their deduction amounts at any time
  • Like FSAs, employers can either allow the HSA to be entirely employee-funded, or they may choose to also make contributions to their employees’ HSA accounts
  • Even though they are often offered under a cafeteria plan, HSAs do not carry the same non-discrimination requirements as an FSA. Moreover, there is less administrative burden for the employer as the employees carry the liability for their own accounts

Cons:

  • To open and contribute to an HSA, an employee must be covered by a qualifying high deductible health plan; moreover, they cannot be covered by any other health coverage (a spouse’s health insurance, an FSA (unless limited), or otherwise)
  • Participants are limited to reimburse only what they have contributed—there is no “front-loading” like with an FSA
  • Participant contributions to an HSA also have an annual limit. For 2018, that limit is $3,450 for an employee with single coverage and $6,900 for an employee with family coverage (participants over 55 can add an additional $1,000; also, remember there is no total account limit)
  • Participation in an HSA precludes participation in any other benefit that provides health coverage. This means employees with an HSA cannot participate in either an FSA or an HRA. Employers can work around this by offering a special limited FSA or HRA that only reimburses dental and vision benefits, meets certain deductible requirements, or both
  • HSAs are treated as bank accounts for legal purposes, so they are subject to many of the same laws that govern bank accounts, like the Patriot Act. Participants are often required to verify their identity to open an HSA, an administrative burden that does not apply to either an FSA or an HRA

Health Reimbursement Arrangements (HRA)
An HRA is an employer-owned and employer-sponsored account that, unlike FSAs and HSAs, is completely funded with employer monies. Employers can think of these accounts as their own supplemental health plans that they create for their employees
Pros:

  • HRAs are extremely flexible in terms of design and function; employers can essentially create the benefit to reimburse the specific expenses at the specific time and under the specific conditions that the employers want
  • HRAs can be an excellent way to “soften the blow” of an increase in major medical insurance costs—employers can use an HRA to mitigate an increase in premiums, deductibles, or other out-of-pocket expenses
  • HRAs can be simpler to administer than an FSA or even an HSA, provided that the plan design is simple and efficient: there are no payroll deductions to track, usually less reimbursements to process, and no individual participant elections to manage
  • Small employers may qualify for a special type of HRA, a Qualified Small Employer HRA (or QSEHRA), that even allows participants to be reimbursed for their insurance premiums (special regulations apply)
  • Funds can remain with the employer if someone terminates employment and have not submitted for reimbursement

Cons:

  • HRAs are entirely employer funded. No employee funds or salary reductions may be used to help pay for the benefit. Some employers may not have the funding to operate such a benefit
  • HRAs are subject to the Affordable Care Act. As such, they must be “integrated” with major medical coverage if they provide any sort of health expense reimbursement and are also subject to several regulations
  • HRAs are also subject to many of the same non-discrimination requirements as the Health FSA
  • HRAs often go under-utilized; employers may pay an amount of administrative costs that is disproportionate to how much employees actually use the benefit
  • Employers can often get “stuck in the weeds” with an overly complicated HRA plan design. Such designs create frustration on the part of the participants, the benefits administrator, and the employer

For help in determining which flexible benefit is right for your business, contact us!
by Blake London
Originally posted on ubabenefits.com