As you may know, in order to contribute to a Heath Savings Account (HSA) you need to be in a High Deductible Health Plan (HDHP) and you can’t have other health coverage. Many people don’t realize that just having a high deductible isn’t by itself sufficient to make a health insurance plan a High Deductible Health Plan. It’s possible even though your health insurance has a high deductible you are still not eligible to contribute to an HSA.
Therefore if your insurance from work has a high deductible but the company is not offering an HSA, it’s likely that the plan doesn’t qualify as an HDHP. If you’d like to contribute to an HSA on your own, you should ask specifically whether your insurance qualifies as an HDHP under the IRS definition. If a plan from the ACA marketplace doesn’t say HSA in its name, chances are it isn’t HSA-eligible.
Besides a high deductible, in order to qualify as an HDHP, a health insurance plan must also not offer any benefit beyond preventive care before you meet the annual deductible. An otherwise high deductible plan fails the HSA qualification when it tries to be nice and it gives you some benefits before you meet the deductible.
Prescription Drugs
Prescription drugs are expensive. A small tube of generic cream can cost over $200 (see previous post High Deductible Health Plan and Expensive Prescriptions). If you can get non-preventive prescription drugs covered through your insurance by paying only a co-pay, without having to meet the annual deductible first, your insurance plan is disqualified from being HSA-eligible.
Office Visits
Besides preventive care such as physical checkup or immunization, if the plan offers a limited number of office visits with only a co-pay before you meet the annual deductible, the plan doesn’t qualify as an HDHP no matter how high the deductible is.
Emergency
If a plan covers emergency with a co-pay, before you meet the deductible, the plan is again not HSA-eligible.
You see the theme here. The plan isn’t HSA-eligible when it gives you more. If you have a plan like this, although it’s a bummer you can’t contribute to an HSA, the consolation is that your plan is a little nicer than an HSA-eligible plan.
Individual Deductible In a Family Plan
If a family plan offers both an individual deductible and a family deductible, in other words the plan will pay for one person when that person meets the individual deductible before the entire family meets the family deductible, the individual deductible must be higher than the minimum deductible for HDHP family coverage.
Example 1: A family plan has an individual deductible of $2,000 and a family deductible of $4,000 for 2019. Because this family plan will start paying on non-preventive care before the family spends the minimum deductible for HDHP family coverage, this plan isn’t HSA-eligible.
Example 2: A family plan has an individual deductible of $4,000 and a family deductible of $8,000 for 2019. Because the individual deductible is higher than the minimum deductible for HDHP family coverage, this family plan can be HSA-eligible if it also meets other qualifying criteria.
Out-of-Pocket Maximum Too High
Besides the minimum deductible, the out-of-pocket maximum of an HSA-eligible plan also can’t be higher than an inflation-adjusted number published by the IRS every year. If your plan has a high deductible and a high out-of-pocket maximum, higher than the IRS published number, it’s also not HSA-eligible.
***
If you want to contribute to an HSA, your insurance must make you take the first hits in non-preventive care. If you are healthy and you don’t consume much health care, it almost feels like you have no insurance. Every time you go to the doctor or you get a prescription, you are paying 100% out of your own pocket. You get the benefit of in-network negotiated billing rates. That’s about it.
You just have to remember insurance is supposed to be for unpredictable things that cost a lot but don’t happen often. You don’t use auto insurance when you get an oil change or when you have your brakes replaced. You don’t use homeowner’s insurance when you replace a worn-out garage door. You just have to get used to your health insurance working the same way. I’ve been on HDHP for a few years. I’m still getting used to it. It’s not easy.
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Vivek A says
It all comes down to what saves you more money overall. If you have a chronic condition or you and your spouse are planning to get pregnant, then really there is no point going down the HDHP route. But if you have a good year with less visits to the doctor than average, then the potential for savings is substantial.
Regardless, HDHP without HSA makes very little sense. You need to have HSA and hopefully some employer contribution towards HSA as well.
Anonymous says
If you do the math often times the full monthly cost difference comes close to the actual deductible difference. Therefore, the low deductible plan is often just a way of spreading out the cost over more months. Now often times you don’t see that because your employer is subsidizing 50%+ of the health insurance. So unless you’re consistently running up bills over $5k a year it’s likely that the HDHP is still a better deal.
You’re right though that match changes without an HSA because your premiums are likely deductible (employer or self employed). If you don’t have an HSA it’s after tax dollars that are going towards the deductible payments (or itemized deduction subject to an almost unattainable AGI floor).
But there are numerous ways around this (which I’m now going to have to deal with). You could have an HSA open with funds from prior HSA compatible plan which you can tap. Or you can just save the receipts until you finally do get an HSA compatible plan and then contribute and take the distribution in the year you get an HSA compatible plan. Both have a pretty similar tax outcome as if you were able to contribute the year in which you had the non HSA compatible HDHP plan.
Tom says
Thanks for the clear explanation (as usual). I have asked our HR department a few times and only been told we don’t have a HDHP. No explanations of why. Now I know.
Anonymous says
As someone (under 30) who was just looking up individual plans yesterday, this was funny timing. I’m going contractor at end of year and losing my group coverage.
I was pissed when I saw the under 30 Catastrophic plans. How completely unnecessary it was for HHS to add 3 near free office visits to those plans. Not only did they make them more expensive compared to what they would have been without those office visits, but they made them HSA incompatible.
So now every individual buyer in the market under 30 has to choose between a more expensive plan for all ages that is HSA compatible (and doesn’t include 3 reduced cost visits) or one that is less expensive and isn’t HSA compatible.
It pisses you off because you know that HHS did this by design. Sebelius wasn’t a fan of the HSA so they added an unnecessary benefit to these plans to prevent those in the individual market under 30 from getting one.
I don’t need 3 office visits for $10 a piece plus full preventative office visits. For most issues you can just call in a physical and you’re doctor can give you some quick examination or prescription for the issue and not even separately code a diagnosis code.
Sorry this sounds like venting.
Harry Sit says
I agree. Polluting an inexpensive plan like that has to be intentional.
Mike Klein says
You blame HHS instead of Insurance co.? That runs contrary to my 35yrs experience buying my own insurance.
Hocus says
You are so right. My husband and I are in our 50s, self employed. Some evil mind(s) devised this system to screw specific interest groups. Re: Gruber.
This is no longer about medical coverage and cost control. And really the tax credit scheme doesnt benefit the working poor; they dont pay enough taxes. The coverage for them comes from Medicaid and expansion of adult child coverage. I dont resent their coverage, but it certainly doesnt require the ACA claptrap.
I would recommend looking into short term non-compliant plans and just pay the penalty. For us its a better deal, even with the penalty. For us (non-smokers, no priors) a max out of pocket that is $5000 (versus $14,700 Bronze ACA Compliant), our monthly premium for two drops from $1200 to $300. None of the ACA required BS is covered of course. This premium drop gives you an idea of how much of a rip off ACA is. And then pay cash to your doctor for anything below the deductible, you probably get a better deal.
And as to the culpability of insurers vs. HHS? Hey guess what, they are becoming one and the same now. And believe me the surviving insurers and hospitals will fight like banshees for the regulatory status quo, to create barriers for any competition. The whole thing is evil, evil , evil like the thousand Lilliputian snares of Gullivers Travels…..
TaxMule says
I have not found this effective:
“And then pay cash to your doctor for anything below the deductible, you probably get a better deal”
Insurance is a big rip off for sure. But without a plan, at least in Michigan, you do not get the negotiated rates for cash. In 2009 I “needed” an MRI. The full rate cost was $2700. The BCBS rate was under $700. That is huge.
We have an HSA compliant plan. It went up to $670 a month. In the gap year before ACA, we had a “temporary” plan that was only $200 or so, but it had an annual $20,000 deductible. The ACA limits how high a deductible can go – bummer.
When we had a group policy one year, we did get a check back after ACA. Less than $1,000 though. That is the rule on how much needs to be spend on medicine. I think the “system” broke that rule by having medical facilities acquire real estate. Then somehow group rates are more than individual policies. Its like wack-a-Mole with these guys.
I’ve been accumulating in my HSA for years. That is a significant asset now. Otherwise, I’d be complaining a lot more.
monica says
I second that! I’m in the same boat which i guess I will just let sink since the ACA, IRS, Sebelius loving scam artists don’t give a flying flip.
Anonymous says
Also, in Minnesota network negotiated rates are a negative not a positive for a lot of hospitals.
Most hospitals (not clinics but hospitals) have signed the MN Attorney General’s Agreement (you can call billing and inquire if they have signed it before going to the hospital). As a self payor you automatically get the discount rate the best private insurer has negotiated (the small network/HMO negotiated rates). Rough numbers is that a PPO will negotiate around 30-40% off the rack rate. The best discount is typically 50%+.
I should point out that you then have to inform the hospital that you’re not giving them permission to use a provider portal to find your insurance on their own and submit a claim. They’ll do it automatically if you don’t say anything and then they’ll try to make the MN AG discount disappear.
Jeff U says
Excellent article. I have a comment on this sentence from your post, “Therefore if your insurance from work has a high deductible but the company is not offering an HSA, chances are the plan doesn’t qualify as an HDHP and you are not eligible to contribute to an HSA on your own.”
Some employers offer an HSA-eligible HDHP but do NOT offer an HSA to their employees. There are a few possible reasons for this:
1. The employer doesn’t want the potential administrative hassle of offering payroll deducted employee HSA contributions. This can be especially true for a small employer with a relatively simple payroll system that contains only so many “buckets” for deductions.
2. The employer doesn’t want to pay the monthly admin fee for each employees’ HSA – usually $4 to $5 per month – and, again, doesn’t want to have to deduct that fee from employees’ paychecks.
3. The employer is offering the HSA-compliant plan only as an option to ensure they will not run afoul of the “affordable coverage” provision within the Affordable Care Act. In a case like this, the employer could care less whether employees choose the HSA-compliant plan or not; they just need to offer a “cheap” plan as a strategy to pass the testing requirements.
Bottom line, I know you stated “chances are”, but it’s important for employees to ask the question whether a high deductible plan is HSA-compliant even if the employer isn’t offering an HSA. If the plan IS HSA-compliant, the employee can go to almost any financial institution and open an HSA themselves.
Harry Sit says
Good point Jeff. I changed the wording from “chances are” to “it’s possible.”
Doug says
I work for a large corporation with generous benefits. In our case, choosing the HDHP is always better financially. The company has made it that way. The savings in premium cost exceeds the deductible. In addition, they put $500 in your HSA, and match the first $500 you put in for a total of a $1000 contribution to your HSA. So, even if you max out the deductible, you are still over $1000 ahead with the HDHP. And yet, there are still a significant number of people who opt for the traditional plan. I think that sort of shows the mindset we have (in the USA) that health care is not something you should need to pay for. And, that, of course, has contributed to the supposed runaway healthcare cost. (Those folks are paying for it, of course, but they are sort of fooling themselves into thinking they are not.) Personally, I don’t mind paying for quality healthcare. And I hope that the country comes to realize that quality health care is worth paying for. Recently there was a huge controversy over the cost of a pill that would cure Hepatitis C. People slowly dying from a disease that was destroying their liver thought that a treatment that would cure them wasn’t worth the cost of a luxury car? And, of course, the insurance companies thought that cure wasn’t worth it? If we are not willing to pay for them, those cures for cancer and Alzheimer’s, etc are not going to materialize. Maybe the HDHPs will help people start to understand that their health is more important than a new big screen TV.
Harry Sit says
They all think it’s worth it. They just want someone else to pay.
TaxMule says
I’ve had an HSA compatible plan for years. It has been a huge hassle for sure. But now I have a bunch of money stashed away for a rainy day.
The one gap year – 2013 or 2014 – was not HSA compatible. That was after the ACA, but before the new plans were really ready. That had a super high deductible – 20K or so – but was super cheap – $220 a month for the family. That was easy money, we saved $400 a month and invested it. The ACA limited the top end of the deductibles to the 12.7K number. Bummer.
In 2009, I messed up my ankle skiing. I needed a MRI. The retail price was $2,700. The negotiated rate was under $600 or $700. Huge.
I have an HSA at a bank that allows me to use a pure brokerage account to invest. I’m not sure if I can post the name here, but it is pretty easy to find. Then I can invest in corporate bonds that pay fat coupons. That has worked out nicely.
I’m the owner of a small business. When I was considering merging with another place a few years back, they said they paid $22,000 for health insurance per family. As a shareholder, I’d have to pay that. Hmmm. I’d rather pay $563 per month, slap $6,750 into the HSA, and have the roughly 9k left for actual medical expenses, or other investments.
Mister Saver says
Just some information that isn’t as well known: if you’re on a HDHP (HSA or non-HSA) or other “bad” plan without prescription benefits, SHOP AROUND. Besides those “coupon” places, one thing many people don’t know: in many states, ANYONE can use a MEMBERSHIP store’s (ie, Costco, Sam’s Club, etc) pharmacy, REGARDLESS IF THEY’RE A MEMBER OR NOT. If you find yourself needing a lot of prescriptions and don’t have a low co-pay, it pays to call your local membership store and ask them. For instance, I am not a member of either Costco or Sam’s Club, but have used them to buy prescriptions, because it’s a state law that pharmacies have to be open to all. So while I can’t buy my 10-gallon mayonaise jar without being a member, I can walk in and buy stuff from their pharmacy at their prices.
A lot of times, they’re cheaper even than the hospital chain pharmacies. For instance, a family member has Kaiser. And, unless your Kaiser plan gives you a low co-pay for prescriptions, Kaiser’s own pharmacy is extremely expensive (they even admitted to me they are a full-price pharmacy, not a low-cost one). So someone in my family needed a cream for the skin. It was $410 at the Kaiser pharmacy (he had a HDHP). Costco was $208 for the exact same thing, Sam’s Club was $201. Went to Sam’s Club, saved $200, or over 50%. Even on the little things, a CVS pharmacy might be $48, and Costco $29. I’m not sure how it works in all states, but I know here at least, it’s the law that anyone can use the pharmacy of a membership store, you don’t have to be a member. Worth checking out in your area.
Cat says
Let’s say you didn’t know that your plan wasn’t eligible for an HSA before you opened up the account. How can you close the non-eligible HSA with no/minimal penalties?
Harry Sit says
Ask your HSA trustee/custodian what form you need to fill out to request a withdrawal of excess contributions.
Brighter says
Interesting to observe that many, many plans on Healthcare.gov appear to meet all the deductible and out-of-pocket IRS criteria for HDHP, but list “No” in the line about being HSA eligible. Confusion reigns, because no one at the Marketplace knows the details to the level described on this page. What’s missing is a detailed reference at the IRS.
So, how about some references to pages/lines in iRS Pub 969? And (if it exists) an IRS letter or publication reference to back up “a health insurance plan must also not offer any benefit beyond preventive care before you meet the annual deductible”?
Please?
Harry Sit says
As an individual, all you have to do is check or ask whether a plan you are considering is HSA eligible. You are not in a position to determine whether a plan is HSA eligible. The marketplace plans already tell you yes or no. You don’t have to know why the plan isn’t HSA eligible when it says it’s not eligible.
Elizabeth Marsh says
I second this request. This article is great and definitely answers my questions for why my HDHP wasn’t HSA compliant… but I would really like to know the source …where these other rules/regs are actually set out.
Harry Sit says
IRS Notice 2004-2.
https://www.irs.gov/irb/2004-02_IRB/ar09.html
“Q-3. What is a “high-deductible health plan” (HDHP)?
A-3. … … However, except for preventive care, a plan may not provide benefits for any year until the deductible for that year is met. … …”
Rhonda M says
an update to IRS Notice 2004-2.
https://www.irs.gov/irb/2004-15_IRB/ar10.html
Here is a clarification of the term “Preventive Care”. It appears to have a different meaning then the ACA definition of minimum essential benefits.
It appears that the IRS determines what is a HSA qualified health insurance plan not the Health Insurance Companies trying to sell you the plan.
NC says
Our ACA plan for 2016 was listed as HDHP and HSA eligible. On Dec 28 2016 we got a letter from the ins co stating that Healthcare.gov was in error when it listed the plan as HSA ok because it exceeded the IRS max oop limit of $13,100 (it’s $13,700). We had already renewed this same plan for 2017. Aside from exceeding the max oop limit, there is nothing in our policy that would disqualify it from the HSA. Nothing. We now need to change plans and withdraw the 2016 HSA contribution, and not claim the planned 2017 contribution as an income exemption if we keep this plan (which will significantly reduce our subsidy).
Brighter says
As an example of the confusion, take the Anthem Marketplace plan ID 29276OH0740024 that is described as “Anthem Blue Cross And Blue Shield · Anthem Silver Pathway X PPO 10 For HSA” — the title of the plan indicates it is “for HSA.” However, the deductibles are clearly not compatible with IRS rules (deductibles: $1,150 Individual total, $1,150 Out-of-pocket maximum for Individual) and further in the plan details there is a “No” for “Health Savings Account eligible plan.”
In addition, this plan was displayed with the filter for “See plans you can use a Health Savings Account (HSA) with” was checked.
CLEARLY, there are software bugs in the Healthcare.gov site and NO MECHANISM to notify CMS/HHS of these bugs.
Harry Sit says
The base version of the plan may be HSA eligible, therefore the name “for HSA” but if you are eligible for cost sharing subsidy when your income is below 250% poverty level the enhanced cost sharing lowers the deductible and makes it not eligible for HSA. You can say with the cost sharing subsidy it’s no longer a high deductible plan. Then it’s not a surprise it’s not eligible for HSA.
James says
I wish I saw this article a few months ago. My plan’s deductible and out of pocket maximum meet the requirement for a HDHP, but I didn’t realize it cannot cover any expenses other than preventive care (my plan covers part of my prescription and office visits). Unfortunately I went ahead and opened a HSA without confirming HSA eligibility and contributed the full $6750 for our family for this year. After reading the IRS publication, it seems like I’m stuck having to pay a 10% tax to withdraw my money, unless there is some other way to get my money out?
Harry Sit says
See reply to comment #9. If you withdraw the excess contributions before a deadline you don’t pay a penalty. You just pay tax on the earnings, which you would have to pay anyway if you didn’t contribute to the HSA in the first place. The key is you have to work with your HSA provider and tell them you want to follow the special procedures to withdraw excess contributions. Just simply taking the money without following the special procedures won’t do it.
James says
Thanks Harry for the reply. Unfortunately I don’t think my situation applies as an excess contribution since I’m not eligible for HSA in the first place. According to the IRS publication,
“If you fail to remain an eligible individual during any of the testing periods, discussed earlier, the amount you have to include in income is not an excess contribution. If you withdraw any of those amounts, the amount is treated the same as any other distribution from an HSA, discussed later.”
It seems to me that the amount I withdraw would be taxed as an unqualified medical expense and hence be subject to a 10% penalty, unless I’m interpreting this wrong ?
Harry Sit says
If you search for “testing period” in the same publication you will see it’s about something else.
James says
Harry, I really hope you’re right! I’ll keep you posted. Thanks again for this wonderful blog.
Hocus says
For us (self employed buying off of the private market with no tax credits), no Bronze Plans were HDP eligible under the federal regs. Only Silver or higher. And the increase in premium for a Silver Plan was HIGHER than the maximum HSA contribution, thus wiping out any advantage of an HSA. So why would anyone trade a certain liability for a contingent liability?
REINER ROYBAL says
This blog has been very helpful in somewhat differentiating why not all high deductible health plans within the Marketplace offerings are HSA eligible or not. I have just enrolled in a plan that is supposedly Hsa eligible upon expiration of my employer COBRA sponsored plan (which is HSA eligible). Little confused about some answers proposed on this post regarding impact of PTC on maxing out my individual annual contribution going forward.
Shmuel W says
Follow up q to this excellent post. If i have any form of dental insurance in addition to my HDHP, would that preclude me from HSA eligibility during the same time period?
Harry Sit says
No.
Fab says
Thanks for the article.
Can someone confirm:
I am covered under my wife’s insurance plan which is called “High Deductible Plan” but do not meet high-deductible health plan requirements. The company where my wife works has a couple of other plans (more expensive) other than the one we selected with are HSA compliant. Also we have been using FSA option this year.
Question: if we were to stop using the FSA, would I be able to open a personal HSA? Does the fact that my wife’s company offers others plans with HSA compliance prevent me (as the added person on the plan) to use a HSA? Would we need to use one of more expensive plan?
Thanks a lot
Harry Sit says
If you are not in an HSA-eligible plan you are not eligible to contribute to an HSA.
Dean says
I signed up for an ACA-compliant high deductible bronze plan to bridge coverage for two months. I assumed that I could make 1/12 of the annual HSA contribution for each month, but then I looked again at the max out-of-pocket. My plan is like $250 over the $6550 max oop limit. That’s about 4% over. It really feel like something very cheezy is going on between the insurer and the gummint. I bit the bullet on paying the expensive premium. Now I feel pretty much cheated and nowI really hope more than ever I won’t need to test whether this plan will actually ever pay for a significant medical treatment event. Bummer.
Hope McCloud says
Seriously – how could anybody possibly spend over $6K in a calendar year on the following:
PREVENTIVE CARE SAFE HARBOR
Preventive care for purposes of section 223(c)(2)(C) includes, but is not limited to, the following:
Periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals.
Routine prenatal and well-child care.
Child and adult immunizations.
Tobacco cessation programs.
Obesity weight-loss programs.
Screening services (see attached APPENDIX).
However, preventive care does not generally include any service or benefit intended to treat an existing illness, injury, or condition.
Am I drawing the correct final conclusion:
You will pay for preventive care up to the Deductible.
You will pay for illness/injury care until you have paid the full deductible amount in preventive care. These costs do NOT count toward your Deductible.
Harry Sit says
No, you have it backwards. Preventive care is free. If you have anything outside preventive care, you pay in full until you reach the deductible.
Tara Nix says
I am currently contributing to an employer sponsored HDHP w/HSA. I am retiring 12/1/17. If I choose an ACA non-HSA plan in California for 2018, I have been told I cannot use the HSA funds I have already saved to pay for out of pocket expenses. Is this true??
Harry Sit says
Not true. You can always use your HSA money on eligible expenses regardless what insurance you have or don’t have.
EJ says
Before the ACA, I had a plethora of HSA-eligible health insurance policies to choose from each year, with monthly premiums less than $100.
At healthcare.gov there were no HSA-eligible policies for 2017. For 2018 there’s only one HSA-eligible ACA policy, and the monthly premium for me would be (put on your seat belt) $600. Obviously a no-go.
At agilehealthinsurance.com there are 158 non-ACA short-term policies (with monthly premiums starting at $75), but not one is HSA eligible.
At ehealthinsurance.com there are 48 non-ACA short-term policies, and not one is HSA eligible. According to an agent at ehealth, the ACA outlawed HSA eligibility for non-ACA policies (but I don’t know if he’s right about that — I’ve never read that anywhere).
If anyone knows of any non-ACA HSA-eligible policies, please post a comment with the info!!!
Kathy smith says
My account told me i could contribute 3500 to an HSA.
I am self employed. He didnt’ mention it was contingent upon
which health insurance I had. I have a marketplace bronze plan (no HSA eligible). I didnt figure that out until today as I am applying for next years plan.
I spent 2500 on health care expenses. Will the IRS charge me some type of penality for my dumb mistake? Honestly I took my accountants word for it and never thought twice. ouch.
Harry Sit says
When you aren’t eligible to contribute, the money you already contributed are “excess contributions.” You should work with the HSA provider to remove the excess contributions. They have specific procedures for it. When you talk to them, ask whether they can re-code the $2,500 you already took out of the HSA as returning excess contributions. If not you will have to pay 20% penalty for non-qualified distributions (costing you $500). After the excess contributions are removed, you will have to work with your accountant on reporting on your tax return and paying taxes and penalty.
elle says
Our employer sponsored United Healthcare plan meets the deductible and out of pocket max guidelines to be HSA eligible. But we don’t have co-pays for PCP appts and we have $100 deductible on Rx. So I’m assuming that disqualifies the plan? I chat messaged United and they said it was HSA eligible, but now I don’t believe them.
Also, I set up HSAs for both of us before I realized we may not be eligible. We haven’t funded them yet tho. So I’m assuming that we are okay as long as we don’t fund them.
Nina says
Wow. Thanks for the explanation. I had been wondering why some HDHP were not HSA eligible – even searching online for answers. Now I know.
Cristina Shipp says
glad I found this explainer. But does anyone know why there is a maximum OOP number for eligibility? Seems illogical.
I’m self employed so it seems like paying extra for the HSA benefit never makes sense for me, since I am only taking $3700 off the top of my income, and the cost of the HSA plans are usually more than $100 per month more expensive than the lowest priced HDHPs out there.