Handling a High-Deductible Plan
In a trend that seems to be increasing, many employers will be offering high-deductible health plans to their employees for 2013.
High-deductible plans, or HDHPs, include a minimum deductible from $1,250 for an individual to $2,500 for a family. The maximum out-of-pocket amount, which includes the deductible and co-insurance or co-pays, in 2013 is $6,050 for an individual and $12,100 for a family.
The More You Know
“Get all the information you can,” recommends Kris Erickson, senior health insurance manager at the Society. “Find out what the deductible is, and what the benefits are after the deductible.”
Most qualified HDHPs are accompanied by Health Savings Accounts, or HSAs. These allow people to pay for or reimburse themselves for medical services with pretax dollars and often include a contribution by the employer. In 2013, the annual maximum contributions are $3,250 for an individual and $6,450 for a family. Individuals who are at least 55 years of age can also make a $1,000 “catch-up” contribution.
HSA vs. FSA
HSA’s are not the same as Health Flexible Savings Accounts (FSAs). The law requires that the entire annual FSA election amount be available to an employee up front, but HSA funds are only available as deposits are made to the account.
The maximum annual contributions to an FSA are also different: in 2013, IRS rules limit them to $2,500 for an individual and $5,000 for a family. In addition, unlike FSAs, there is no “use it or lose it” forfeiture on an HSA and if someone leaves their job, they can take their HSA with them. HSA’s also can earn interest. For a full list of the “qualified medical expenses,” visit www.irs.gov/publications/p502.
Under the Affordable Care Act (ACA), private health insurance plans must cover certain preventive health services. (www.healthcare.gov/prevention) If someone is enrolling in a high-deductible plan, it’s important to know that annual physicals and preventive screenings are covered. For added motivation, medical costs are less expensive if a problem is caught earlier. In addition, vaccinations and checkups for children under a high-deductible family plan are also considered preventive.
MS Treatment & Care
Much of MS treatment and care is not considered preventive. For instance, the cost of having an MRI will not be covered until one’s deductible is reached. But a person with MS who has a high-deductible plan may be hit hardest by prescription drug costs. Even if only one person is incurring medical expenses, the full family’s deductible must be met by that individual before the insurance will pay for expenses. In these cases, Erickson recommends looking into patient assistance programs. For more information, visit www.nationalMSsociety.org/PAPs, or call an MS Navigator at 1-800-344-4867.
On the plus side, with traditional coverage, deductibles may or may not apply to the out-of-pocket maximum and co-pays never do. Knowing the true out-of-pocket maximum could be an improvement over traditional plans.
The Way Forward
The main reason employers are switching to high-deductible plans is lower premiums. Sometimes these savings may be passed on to employees. While not every employer will be switching to a high-deductible plan, it’s a trend to keep an eye on.
Ask the Employment Specialist: Telephone Q&A Session
- Do you have an employment question you would like answered?
- Are you curious about workplace disclosure, social security benefits, need a reasonable accommodation or are you thinking about returning to work?
Barbara McKeon, CRC, LMHC, Director, Employment Programs and Services at the National MS Society New York City-Southern NY Chapter, will be available to address your questions regarding employment concerns for people living with MS.
Calls are from Noon to 1:00 p.m.
The call-in number and passcode will be provided at time of registration.
Register early – space is limited.
Wednesday, February 13, 2013
Registration Deadline February 6
Wednesday, May 8, 2013
Registration Deadline May 1
Register at 800-344-4867 or online from the calendar.