Want to stretch your healthcare dollars? Learn about flexible spending plans
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Saving money for healthcare expenses is a simple idea. But, there are ways to save money that, although a little more complex, give you more money to save. That’s the idea behind flexible spending plans.

With flexible spending plans, you set aside pretax money from your paycheck (or your employer contributes pre-tax money) to pay for healthcare expenses. Because the money isn’t taxed, you’ll have more money to spend than if you use income that has been taxed. In effect, you’re stretching your healthcare dollars.

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There are three basic types of flexible spending plans. What they all have in common is that you only can use the money for what are called “qualified medical expenses.” Those are items that the Internal Revenue Service (IRS) says you can deduct as a medical or dental expense when you file your taxes.

Examples include copays and other out-of-pocket expenses for doctor visits, dental visits, hospital services, prescription drugs and eyeglasses. The list is subject to change, but the current version can be found here.

Two kinds of flexible spending plans are available only if you’re employed by someone else—the flexible spending account and the health reimbursement account. A third kind, the health savings account, is also available to self-employed people.

Flexible spending account

A flexible spending account (also called a flexible spending arrangement, or FSA) is set up by your employer. You decide whether to participate and, if so, how much you want to contribute each pay period. For 2017, you can contribute up to $2,600 per year. The employer can contribute to your FSA too, if the employer wishes.

You can use the money in your FSA to pay for any qualified medical expenses. The FSA operates on a “use it or lose it” basis. You generally have to use up the money within your health plan year. If you don’t, you lose whatever is left over.

There are two exceptions. Your employer may choose to give you a grace period of up to two and a half extra months to use the money, or can allow you to carry over up to $500 to use the following year. Your employer can offer either option but not both, and isn’t obligated to offer either.

Because of the “use it or lose it” restriction, it’s important to think carefully about how much you want to contribute per year to the FSA. Too much, and you may lose funds; too little, and you lose a potential tax advantage.

Health reimbursement account

A health reimbursement account (also called a health reimbursement arrangement, or HRA) is set up by your employer. Only your employer contributes to the account. There’s no limit on how much can be contributed. You’re reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused funds may be rolled over to be used in later years.

Health savings account

You establish a health savings account (HSA) yourself. You set it up with a qualified HSA trustee, such as a bank or insurance company. An HSA is meant to be used by people with a high-deductible health plan (HDHP); to qualify, you must have such a plan. That’s a plan where the annual deductible — the amount you must pay for healthcare before your insurer begins to pay—is higher than it is for typical plans.

For 2017, the deductible for an HDHP must be at least $1,300 for self-only coverage and $2,600 for family coverage. (There are other restrictions on what makes a plan an HDHP and how to qualify for an HSA; see the IRS rules here. For information on how much you can contribute to an HSA in 2017, see here.)

An HSA is tax-exempt. You can claim a tax deduction for any money you contribute. The money you take from it isn’t taxed as long as you use it for qualified medical expenses. Interest or other earnings on the account are tax-free. The contributions you make to your HSA stay there until you use them.

You can set up an HSA whether you’re self-employed or work for an outside employer. The money stays with you if you change employers. Your employer can contribute to your HSA, and such contributions aren’t taxed as income.

Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit with the mission of bringing transparency to healthcare costs and insurance reimbursement. FAIR Health oversees the nation’s largest repository of private healthcare claims data, comprising over 22 billion billed medical and dental charges that reflect the claims experience of over 150 million privately insured Americans. Follow them on Twitter: @FAIRHealth


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