Alston & Bird LLP and Aflac
Coupling health savings accounts (HSAs) with high deductible health plans (HDHPs) is a popular way to provide employer-sponsored health care. HSAs give employees the ability to save and pay for health expenses not covered by health insurance on a tax-free basis. These tax-free contributions may be made by both employers and eligible individuals through pre-tax salary reduction.
Recent changes to HSAs and HDHPs:
Pre-tax salary reduction contributions are exempt from both the employer and employee portions of payroll taxes, depending on the contributor. This includes Social Security and Medicare taxes. Amounts withdrawn from an HSA for qualifying medical expenses are also free from tax.
Withdrawals for non-medical expenses can be made at any time but are taxable and subject to an additional 20% tax unless the withdrawal is made after age 65, disability or death.
An individual must meet both of the following requirements to be HSA-eligible:
HDHPs must meet three core requirements:
Minimum annual deductible
|HDHP maximum out-of-pocket limit||Self-only: $7,050
|ACA maximum out-of-pocket limit||Self-only: $8,700
HSA contribution limits
Both employers and employees may contribute to an HSA. Employer and employee contributions made through pre-tax salary reduction are not subject to tax. Contributions are subject to overall dollar limits on the total of employer and employee contributions.
|HSA contribution limits||2022||2023|
|Catch-up contributions for individuals age 55 and up (this limit is not indexed for inflation)||$1,000||$1,000|
HDHP benefits that may be covered before meeting the deductible
A key requirement of HDHPs is that an individual must pay 100% of covered medical expenses before the deductible is met. Limited exceptions to this rule include certain preventive care services and some specified non-preventive care services. Over time, the scope of preventive care services has expanded.
Telehealth services (temporary)
The Coronavirus Aid, Relief, and Economic Security (CARES) Act allows HDHPs to cover telehealth and other remote care services before meeting the deductible and without jeopardizing HSA eligibility. The provision applied to plan years beginning before Jan. 1, 2022, but Congress extended the provision for coverage months beginning after March 31, 2022, and ending before January 1, 2023.
COVID testing and treatment
IRS Notice 2020-15 provides that COVID-19 testing and treatment can be covered before the deductible is met. It is important to note that this exception is not tied to the COVID-19 public health or national emergency, so it remains in effect until the IRS issues guidance that terminates or modifies the exception.
Preventive and chronic care:
Treatment of drug coupons and manufacturer rebates
The IRS position is that only the amount an individual actually pays for a drug may be counted toward the HDHP deductible. For example, if the price of a covered drug is $800 and an individual has a coupon for $300, thus reducing the amount the individual has to pay to $500, only the $500 should be counted toward the HDHP deductible. Some state laws may be contrary to the IRS position and require counting the full amount; employers should consult with their advisers on these complicated issues.
HDHPs coupled with an HSA may be an attractive choice for many employers and employees. This article has provided a high-level summary of key requirements for HDHPs, focusing on more recent developments. Employers and individuals should consult with their own advisers as to the compliance details and what options may work best for them.
Content within this article is intended to provide general information about an evolving topic and does not constitute legal, tax, accounting or medical advice regarding any specific situation. We strongly encourage employees, businesses, employers and other individuals to consult their own advisers about their situations or to visit the CDC website for more information. The content herein does not provide tax, legal, health or financial advice for any person or for any specific situation. This article is for informational purposes only and is not a solicitation for insurance.
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