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Finding the Best Health Care Coverage for Your Family

3 questions that can help you navigate the varied, complex choices your employer may offer, to make appropriate—and cost-effective—decisions


WADING THROUGH THE WORLD OF DEDUCTIBLES, out-of-pocket maximums and co-payments is a challenge many of us face annually as we sift through our employer’s menu of health care plan options. Figuring out how to efficiently manage health spending for you and your family can seem a tall order, but if you invest a little additional time and thought into the process, you’re more likely to end up with a plan that fits your needs without costing the moon. As you weigh all the possibilities, your financial advisor can be a valuable resource and sounding board.


“Instead of reflexively choosing the same health plan during open enrollment season each year, it’s important to consider all your options,” says Danovan Clacken, Health Benefit Solutions Sales Manager at Bank of America.


Here are three questions you might want to ask yourself as you go through your options.


How much health care coverage do I really need?

Because health insurance premiums can be costly, you want to find the sweet spot between sufficient coverage and over-insuring, says Roger W. Gray, director of Health Benefit Solutions at Bank of America. That can take a little bit of extra work when you’re married, especially if you have children.  "If both you and your spouse have employer-provided health insurance, compare benefits and premiums with your family's particular health history and needs in mind," Gray says. For couples with children, it’s worth investigating to discern whether the most cost-effective option might be for each spouse to take their own employer-sponsored plan, including the children, on the plan that seems to best meet the family’s specific needs.


As you go through the options with your advisor, focus on two key elements:


Deductibles. What is the amount you'll pay for covered services before the co-insurance starts? (That’s when the insurer begins to share in the cost.) "With a lower deductible, you may pay higher premiums,” Gray says. “If you and your family have few medical expenses and don't think you'll reach the deductible, you might want to consider a high-deductible health plan (HDHP) and put the money you've saved with the lower premium into a health savings account (HSA)." (See more about HSAs below.) You must be in an qualified HDHP plan in order to contribute to an HSA.


Out-of-pocket maximums. ‘That’s the highest total amount you'll be expected to cover every year—and should be an important part of your evaluation," Gray says. Beyond the maximum, the insurer picks up all expenses, so if a family member has a medical condition that could cause medical costs to balloon, you might think about a plan with a lower deductible and lower out-of-pocket maximum.


One such plan is a PPO (preferred provider organization), which may be offered by your employer or (if applicable) your spouse’s. While it offers a lower deductible as well as a lower out-of-pocket maximum, it also has co-payments and higher premiums. If, for instance, you're planning on having a baby, expecting to need surgery or anticipating that your active kids will be paying visits to the ER, a PPO plan might be an appropriate choice, Gray says. A young single person with no history of chronic illness may not need the extra coverage or want the added cost of such a plan.


3 Most Common Health Accounts

These tax-advantaged plans can all be valuable, but they differ in key ways.


Health Savings

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MAX CONTRIBUTION (2021): $7,200 when enrolled in family coverage in an HSA-qualified health plan, $3,600 when enrolled in single coverage, plus an additonal $1,000 if 55 or older; employer may also contribute

WHO IS ELIGIBLE: Anyone with an HSA-qualified high-deductible health plan (HDHP)

TAX BENEFITS: No federal taxes on contributions, earnings, or withdrawals for qualified medical expenses


DO FUNDS ROLL OVER? Yes. Participants own the account


Spending Account

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MAX CONTRIBUTION (2021): Up to a projected $2,750; employer may also contribute

WHO IS ELIGIBLE: Employees of companies that offer one

TAX BENEFITS: No federal taxes on contributions, or withdrawals for qualified medical expenses


DO FUNDS ROLL OVER? Up to $500 a year, if employer allows, or company may offer a short grace period to use unspent funds. An FSA terminates when you leave the company


Reimbursement Arrangement

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MAX CONTRIBUTION (ANNUAL): Determined by employer, who funds the HRA

WHO IS ELIGIBLE: Employees who enroll in an HRA-qualified HDHP offered by employer

TAX BENEFITS: Employer funded. No tax benefits to the participant


DO FUNDS ROLL OVER? Yes, if employer allows; you lose the funds when you leave the company

What are the potential advantages of combining a high-deductible plan with a health savings account?

This combination has become the fastest-growing type of health insurance today. Americans own more than 29 million HSAs, an increase of 3 million over last year, reports Devenir Research.1 One reason they’re popular: you can put funds into an HSA without federal taxes on contributions or qualified withdrawals, to use for out-of-pocket medical expenses not covered by your high-deductible health plan (HDHP).


In 2018, workers who were enrolled in a family-coverage HDHP paid 40% less in premiums on average than those who chose a traditional preferred provider organization (PPO), according to Benefitfocus.2

“When an HSA-qualified health plan is selected, participants can save on their premiums and put those savings toward their health care expenses,” says Ed Shehan, Senior Vice President, Retirement and Personal Wealth Solutions, Bank of America. What’s more, he adds, you can invest funds in an HSA, and the earnings, as well as contributions and withdrawals, are federal tax-free.


If you invest the money, it can grow tax-free year after year, even into retirement. HSAs offer a variety of investment options. They can be interest-bearing accounts or, if the provider permits, you may be able to invest your contributions in certain securities such as mutual funds. Note that some HSA providers have minimum account balance requirements before certain investment options are available.


You can contribute to an HSA only if you’re enrolled in a health plan that’s a qualified high-deductible health plan and you do not have other disqualifying health coverage—for information on health plan deductibles, see our annual Contribution Limits and Tax Reference Guide. In addition, qualified high-deductible health plans must also comply with the rules on annual maximums for out-of-pocket expenses. Learn more about how HSAs work and ask your financial advisor how having one might help your investments last longer in retirement.


Are there other ways my employer can help me keep out-of-pocket costs under control?

If you have a low-deductible plan. While having a traditional PPO plan makes you ineligible to contribute to an HSA, your employer may offer an optional flexible spending account (FSA), which lets you contribute pre-tax dollars to pay for out-of-pocket health-care costs. The FSA provides a tax-advantaged account available for medical expenses in that plan year, but does not let you accumulate funds to save for health care in retirement, notes Shehan.


If you have a high-deductible plan. To supplement an HSA, your employer might also fund a health reimbursement arrangement (HRA). “In the HRA, the employer provides some funding to help employees pay a portion of the deductible,” Shehan says. HRAs, like FSAs, are typically for the specific plan year only. In addition, they don’t provide the same tax advantages to the account holder as HSAs and aren’t portable if you leave your job, he notes.


Finally, some employers may also offer a limited purpose flexible spending account for dental and vision expenses, typically in combination with an HSA. “Paying vision and dental expenses from a limited-purpose FSA keeps more money in your HSA and allows it to grow,” says Clacken.

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This material should be regarded as general information on healthcare considerations and is not intended to provide specific healthcare advice. If you have questions regarding your particular situation, please contact your legal or tax advisor.


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