Inexperience among employees and poor education efforts by employers and plan providers are hindering the use of health savings accounts as an investment vehicle.
According to a report by the nonprofit Employee Benefit Research Institute, most Americans who participate in HSAs are using the programs as specialized checking accounts rather than as a way to invest their funds on a tax-favored basis for current or future medical expenses, according to report author Paul Fronstin, director of EBRI’s Health Research and Education Program.
“People don’t have the money to fund the accounts, therefore … they’re just using it because they’ve got a high-deductible health plan and they need to pay for those expenses that they’re accruing as a result of the deductibles,” Fronstin says. That means HSA users are missing out on the tax benefits of any interest or capital earnings on assets in the accounts building up tax free, EBRI says.
HSAs enjoy a triple tax advantage: employee contributions can be deducted from their taxable income; any interest or other capital earnings on assets in the account can grow tax free; and distributions for qualified medical expenses are excluded from the employee’s taxable income.
Some of the factors preventing employees from using HSAs as an investment vehicle come down to hard economic realities: Stagnant American wages do not give workers leeway to use HSAs as an investment vehicle.
“There are some hurdles you have to get through in order to open up an investment account,” Fronstin says. “Like any brokerage account, you have to have a minimum balance before you can start investing.”
It takes time for people to build up an account balance, Fronstin says. “Most accounts are new, and they haven’t funded enough in the account or haven’t built up enough of a balance after using the account for whatever medical expenses they’re incurring to do the investments.”
EBRI’s analysis, which tracked trends in HSA usage from 2011–16 by combing through data from 5.5 million accounts, found that average annual HSA contributions — individual and employer contributions combined — increased from $2,348 to $2,922 from 2011 to 2016. This was just above the minimum allowable deductible amount for family coverage, but less than half the allowable contribution maximum for family coverage.
Sixty-three percent of HSA account holders withdrew funds, for example. EBRI also found that the average annual amount distributed was $1,771 in 2016, implying an average rollover of $1,151. Also, only 4% of HSA participants had investments other than cash last year.
There was some good news in EBRI’s analysis. The nonpartisan research firm found that the longer an employee used an HSA, the higher his year-end balance and the more he contributed to the plan. For example, EBRI found that HSA accounts opened in 2004 or earlier had an average $14,873 year-end account balance, while accounts opened in 2016 averaged $1,027. Also, individual contributions averaged $3,658 among employees who opened their accounts in 2005, compared to an average of $1,290 for accounts opened in 2016.
“Older, larger accounts offer a stronger hedge against unexpected bills. Those accounts opened in 2005 had an average annual distribution of $2,756, while those only opened in 2016 took $1,051 in distributions,” according to the EBRI report.
But there are still strides to make, EBRI says — particularly for employers, who have fallen short when it comes to education efforts.
“[Employees] haven’t figured [HSAs] out yet, and employers, health plan providers and HSA providers are probably not doing a very good job educating people about how these accounts work,” Fronstin says, noting that employers need to step up their education efforts and employees need to take more responsibility for understanding how HSAs operate.
“I’m not saying it’s easy. Maybe the industry needs to figure out a way to offer low-interest or no-interest short-term lending” to help employees fund the account during lean times. If a low-income employee knows she have to spend for a prescription or a procedure, that loan could help them fund the account for a week. “I could put the money in and take the money out so I can get the prescription,” says Fronstin. “And I can get the tax break.”
Overall, Fronstin says HSAs are off to a good start, but can still use improvement.
“Is [the HSA market] perfect? No. Are there people that this will never help? Absolutely, but I think there are improvements that could be made.”
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