Health care stethescope

That other retirement account: Financial planning for HSAs

Health Savings Accounts (HSAs) may be the best deal out there, if you can get it. All of us like to beat the tax man, right? HSAs are what’s known as triple tax free: you get a deduction when you put money into the account, the account grows tax free, and as long as you make withdrawals for allowable health care expenses (pretty easy to do), you don’t pay any tax on that either. They’re like a traditional IRA or 401k going in, and a Roth coming out.
But like many good things, there are a few problems and things to watch out for:
1) I’ve probably repeated this for the millionth time now, but you don’t have to pay yourself back for the medical expenses in the year you spent the money. You can accumulate the receipts (and carefully file them so you can find them) and withdraw them in any year, as in when you actually retire. You’ll have to be able to pay your deductible and out of pocket costs out of pocket, but if these are fairly low, you can keep the HSA invested.
2) As with every financial account, watch the fees. Some accounts ding you heavily if you don’t keep a minimum balance. Some charge you a monthly fee. Some employers will pay fees while you’re employed with them, but if you leave they stop paying the fees and the account starts getting bites out of it. If this is the case, you can rollover your HSA into a servicer with different (hopefully, better) rules.
3) It doesn’t do you any good to park it in a savings account paying half a percent. In this case, woohoo it’s growing tax free. But the growth is infinitesimal. You want an HSA that allows you to transfer the bulk to a brokerage, or at least invest in mutual funds. Even if you still work for the same employer as when you deposited the funds, you can rollover the account (or most of it) to a provider of your own choosing. Be sure you carefully check fees and options at your current account, and at the one you are thinking of opening.
4) If you are working with an investment advisor, you may want to consider whether the HSA should be invested as part of your overall portfolio strategy. If it’s going to be untapped for years, it should be managed to build wealth.

Once you’re retired, it’s probably a good idea not to hoard that HSA. If you leave it to your spouse, it becomes their HSA. But for any other heir, it’s a lump sum distribution that they will have to pay taxes on.

So, how do you use it up? Well, of course you can submit those hoarded medical expenses you’ve saved. You can also use it to pay premiums for long term care insurance, premiums for Medicare Part B and Part D (drug), vision and dental care not covered by Medicare supplement insurance, and any copays and deductibles. You cannot use it to pay supplemental or Medigap premiums.

Since these accounts do not usually grow extremely large, it seems to me that it would be pretty easy to use it up during a normal retirement. It’s a nice way to build up a war chest for unexpected medical expenses that crash retirement budgets. Too bad I can’t use it for veterinary bills.

Why you need an emergency fund–20 reasons

Read any financial advice article (including mine) and you’ll be told you need an emergency fund. Usually this is attached to some number (like 3- or 6-months’ salary or expenses) that will make you feel hopeless that you’ll ever achieve it. I’m here to say that even having $1,000 or $5,00 stashed is going to help out a lot, and help you avoid a lot of bad results. And, if you don’t have an emergency fund you’ll never get out or say out of debt: we don’t know what the emergency will be, but unexpected things occur regularly. Having some emergency is definitely predictable. Here are a few reasons you need something.

  1. You lose your job. This is the first thing everyone thinks of—and probably requires the largest emergency fund, since being without any income (even if you collect unemployment) is pretty scary and can last more than a few months.
  2. You have a health issue and have to cover your deductible and out of pocket expenses. Depending on when this occurs in the year, you may need to cover more than one year’s deductible. Let’s say you get sick in November, but it lasts into February—2 years’ worth of deductibles and out-of-pocket.
  3. You slide in the snow, doing damage to your car (bad), or to someone else’s car (worse) or both (worst of all). Neither of these expenses is worth claiming to your insurance company know, but given the electronics in cars nowadays, one came up to $700, and the not very happy person whose care you hit cost $500. Damages to your home and car that are near the deductible are probably not worth claiming (because they’ll raise your rates or drop you.)
  4. You have a fire. Even if you have homeowner’s or renter’s insurance, moving immediately to a hotel, eating out exclusively for any time period, or even couch surfing at a friend’s is going to cost something.
  5. You have a fire and it only wrecks the kitchen. You’ll immediately incur higher food costs.
  6. Your refrigerator, computer, or other appliance suddenly goes kaput.
  7. If you’re a homeowner, the list is almost infinite: tree falls, sewer line gets clogged, hot water heater’s bottom drops out, furnace or air conditioning die, dog destroys couch or bed, cat decides they prefer your wall to wall carpet to their cat pan and you don’t discover it for a while…
  8. Pets need veterinary care.
  9. Someone dies and you have to travel to the funeral, or you have to bury someone.
  10. You lose your job and have to buy temporary health insurance.
  11. You lose your job and need assistance (coach, networking groups, lunches out, etc.) in helping you find a new one.
  12. A loved one needs immediate residential care or home assistance not covered by insurance.
  13. You or your child need a divorce.
  14. You need to hire a lawyer for any reason.
  15. Your child needs special testing or tutoring not covered by insurance or the school.
  16. You have to buy a car, unexpectedly.
  17. You have to move.
  18. You need dental work, glasses, or a hearing aid (which are not usually covered by insurance). Check your insurance, especially if you have children who need any of these.
  19. You have an accident or illness that requires you to pay others for services you routinely did for yourself (grocery shopping, rides, home maintenance and cleaning).
  20. You work for the federal government.

The Affordable Care Act and an alternate future

I’m one of those people who had a policy I liked, and I’ve been able to keep it. Sounds great? Not so fast. Look how lack of regulation has affected the premiums I pay per month:

Year Beginning of year End of year (September increase)
2011 $360.87
2012 $405.32 $437.77
2013 $507.67 $559.99
2014 $588.72 $641.04
2015 $845.35
2016 $934.50 $1,180.95
2017 (notified of increase) $1,669.87

 

I cover my daughter and myself, with a $3,500 per year family deductible, a 100% coverage (no co-pay) after the deductible is met, and the plan is Health Savings Account compliant. Nothing being offered to me via HealthCare.gov is even close—all have co-pays and out of pocket maximums that would double my paid out amount because my daughter has a chronic illness where medications and doctor visits total more than $1,000 per month. No matter the plan, we’ll meet the deductible and out of pocket maximums every year.  None of the ACA plans include the three doctors nor the hospital we most frequently use, and the “best” of them equal or exceed our highest monthly cost.

Yes, it’s dismal. I was and remain a supporter of the Affordable Care Act, because so many friends, family, and clients couldn’t have gotten insurance except in a high risk (and high cost) pool before the ACA, due to pre-existing conditions. In fact, I’ve heard more than one story about people staying legally separated but not divorced, so that a spouse could continue health coverage pre-ACA. But without universal participation in health coverage, rates are exploding. Why?

  • Many more sick people are now getting health issues addressed. This has been a bonanza for hospitals, who can now actually get paid, but a drag on insurance companies who now have to cover these people and payments
  • If you have a non-ACA policy that you’ve had for a long time, you’re aging, and you’re likely keeping it because it covers more than the ACA policies, ergo you’re costing the company more
  • There are no breaks on costs—it’s a “free” market after all.
  • Many doctors are exiting acceptance of ACA insurance. These are doctors who want to be able to bill at an even higher rate, and do. Many are choosing to be completely out-of-network, which means the consumer will bear all the higher costs, making the insurance supplementary rather than full coverage.

 

Actually, I think my premiums are a pretty good representation of what we’ll see if we lose the ACA rather than improve it—after all, these premiums are from the unregulated segment of the market. We’re in a horrible mess, particularly in Illinois. I laugh when I hear that vouchers are the solution. My prediction is that this will drive consumer costs up even further, because the system will become  bill +voucher add on. It’s like selling a house by owner to save the commission—the seller think he’s saving the commission, but the buyer also is expecting a lower price because the seller is “saving the commission”. In the end, nobody saves, but everyone gets less service.

I see the terrible effect of these stratospheric increases. My clients who are self-employed, or run small businesses, professional services, or consultancies are being priced not only out of the market but out of running their own businesses by these astounding increases. If we want a climate of business start up, expansion, or new ventures, something has to be done to contain the nuclear explosions. The inability to get individual health coverage for business start ups was one of the benefits the ACA was supposed to provide, but the current toxic effect of sky high premiums is instead crushing those same entrepreneurs.

We planners struggle to estimate foreseeable costs for retirees, entrepreneurs, and early retirees, but I don’t think anyone in 2011 was contemplating a 462% increase in premiums (which is what mine have increased). Just to put that payment in perspective, my 2017 monthly payment for health insurance would support a mortgage of about $350,000. I’m buying a house with no equity to show, and no term end in sight.

From my point of view, the only way to rein in costs and get a rational health care system is a single payer system, sometimes known as Medicare-for-all. Unfortunately, it looks like the current administration and Congress is hell bent on taking us in the other direction—solving the problem by forcing people off health care, or providing poorer and fewer services, rather than focusing on a way to provide better, more efficient care. Unless you can Pay. A. Lot.  Why can every other Western democracy solve this, but not the U.S.?