Stacey Robinson, MD, family physician, St. Petersburg, Florida
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The average premium for a typical low-deductible family health plan reached $12,680 last year, according to the Kaiser Family
Foundation. That's before any dollars are spent toward deductibles, co-pays, or uncovered services. It's no surprise that
consumers and employers are looking for ways to cut costs.
Since 2004, one option has been the health savings account, or HSA. Coupled with a high-deductible health insurance plan,
HSAs are a tax-free, interest-bearing investment tool in which funds deposited can be spent only on qualified health services,
including nearly all medical office visits, tests, treatments, and pharmaceuticals. When account holders turn 65, the funds
can be spent any way they choose.
The concept seems simple, but according to an academic journal survey last year, 43 percent of primary care physicians reported
little or no knowledge of such consumer-directed plans. What's more, the most frequent challenge employers cite in regard
to offering HSAs and high-deductible plans is educating its workforce about the options, according to the 2008 Employer Health
Benefits Survey of 1,927 public and private employers by the Henry J. Kaiser Family Foundation.
Despite this, the plans continue to grow in popularity with consumers and employers, due mostly to the lower premium costs.
On average, the premium savings over a low-deductible plan for employers in 2008 was about $530 per worker for single coverage
and $2,000 for family coverage, according to Kaiser. Employees saved about $250 in 2008 on premiums for single coverage and
$550 for family. Following is an overview of high-deductible health plans and HSAs, and how your practice can work with patients who have them
to ensure prompt, accurate payment.
WHO BENEFITS FROM HSAS
In January 2009, at least 8 million people held a HSA, up from 4.5 million in January 2007 and 1 million in March 2005, according
to industry group America's Health Insurance Plans (AHIP).
Despite economic woes, health savings accounts balances (the amount saved by consumers) is on the rise, according to a report
released in August by Canopy Financial, a company which administers HSAs with offices in San Francisco, Chicago and New Jersey.
The average HSA balance for a family was $1,720 in the first quarter of 2009, up 18 percent from the first quarter of 2008,
according to Canopy, and up 7 percent after two quarters of decline in the later part of 2008.
In order to open an HSA, the user is required to enroll in a high-deductible health insurance plan. Almost 100 health insurers,
including Aetna, Blue Cross and Blue Shield licensees, Cigna, and UnitedHealthcare, offer HSA products, according to AHIP.
United even owns its own bank, OptumHealth Financial Services, which offers HSA programs to consumers and employers.
But AHIP's HSA population estimate may be low, says Donald P. Mazzella, chief operating officer for Ridgefield, New Jersey-based
Information Strategies Inc., a market research, consulting, and publishing company that operates the HSA information web-
site HSAFinder.com. Information Strategies discloses that it has consulted health insurance companies and financial institutions and sells its
research studies about HSAs.
The firm, which has surveyed 34,000 HSA users and 4,300 physicians and medical practice staff members, argues there are closer
to 10 million HSA holders nationwide, and that figure is likely to reach 12 million this year; in other words, about 1 in
every 19 Americans with health insurance will have an HSA. More than 81 percent of HSA holders would recommend the savings
accounts to a friend or family member, while only 56 percent would recommend a traditional PPO plan, according to the firm.
Likewise, as many as 26 percent of employers who weren't offering HSAs in the past are at least "somewhat likely" to offer
the benefit to their employees in the coming year, according to Kaiser.
"This is probably the least-confusing form of payment in the entire healthcare system," says Sande Drew, 54, a media consultant
in Sacramento, California who holds an HSA through Anthem Blue Cross. "It is simply a credit card that you put money in, hand
to the doc or dentist, and he swipes it just like a credit card. There is nothing complex about it. I used it at the dentist
and at the emergency room when my husband had an accident. If both emergency room docs and hospitals accept it, how hard can
it be?"
The annual limit for tax-free contributions to an HSA in 2009 is $3,000 for single coverage and $5,950 for families, according
to the U.S. Department of Treasury.
Generally, HSAs work best for high-income patients and those who rarely visit the doctor. Chronically ill patients who frequently
visit medical offices would quickly reach their high deductible and would likely be unable to save for future care. Acccording
to Kaiser, HSA deductibles in 2008 averaged $2,010 for single coverage and $3,911 for a family; minimum deductibles for such
plans run around $1,100.
"It's not going to be for everyone," says family physician Jerry Miller, MD, president and CEO of Holston Medical Group in
Kingsport, Tennessee, who estimates he has 1,500 HSA-holding patients at his 100-physician multispecialty practice. Miller
worries about lower-income, chronically ill patients who avoid care because of their high deductibles, but he says the practice
has yet to notice any differences in access among such patients.
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