Do You Still Pay a Copay for Prescriptions on an HSA Insurance Plan?

You'll need to weigh prescription-payment methods as well as copays.

You'll need to weigh prescription-payment methods as well as copays.

With a Health Savings Account health plan, you may have to pay copays, coinsurance or both, and they will probably apply to prescriptions. Your prescription costs count toward both your deductible and your maximum annual expenses. For 2014, an individual's deductible is at least $1,250 and a family's minimum is twice that. Not counting premiums, an individual's annual out-of-pocket cost tops out at $6,350; a family's, again, at twice that.

HSA Plans in Brief

HSA insurance plans always have high deductibles. That's part of their definition in the Affordable Care Act of 2009. You can pay out-of-pocket costs from money in your HSA, which is a tax-free savings account with investment options. Premiums are not out-of-pocket costs, but copays are, and so is coinsurance -- your portion of a medical expense if the insurer only pays for part of it. Including employer contributions, an individual can put up to $3,300 a year in an HSA, and a family can put in up to $6,550. HSA funds can be rolled over year after year.

Claim for Reimbursement

The Affordable Care Act requires insurers to pay 100 percent of your costs after you reach the out-of-pocket maximum, but there are variations in the method insurers use to cover prescriptions. As of this writing, for example, UnitedHealthcare offers a plan that requires you to pay for the medicine yourself using the insurer's discount card, and then file a claim for reimbursement. That may help lower premiums, but brand-name prescriptions can cost hundreds of dollars. You need to be okay with waiting to get that money back. All plans provide preventive services required by the Affordable Care Act at no extra cost.

Paid by Percentage

Kaiser Permanente in California offers HSA plans with coinsurance for prescriptions. As of this writing, one plan pays 60 percent of your prescription costs beyond a $4,500 deductible. Another picks up 80 percent of your prescription costs after a $1,500 deductible. The percentages only apply to the money you spend between the deductible and the out-of-pocket maximum -- outlays between $4,500 and $6,350 for the first plan and between $1,500 and $6,350 for the second.

Covered or Not Covered

Head eastward and you'll find that Medical Mutual of Ohio offers an HSA plan that, as of this writing, sets both your deductible and maximum out of pocket at $6,000. The plan pays only for the medicines on its formulary, as insurers' drug lists are called. Essentially all insurers have formularies, but many pay part of the cost for off-formulary drugs. Often, formularies separate drugs into price groups called tiers, and charge higher copays for the pricier tiers. The Affordable Care Act sets minimums for formularies, but if you use an expensive medicine regularly, you'll want to make sure it's there before you sign up for the plan.


About the Author

Sarah Brumley has written extensively on business and health-industry topics since 1995. Her work has appeared in publications ranging from Funk & Wagnall's yearbooks to "Medical Economics," a magazine for physicians. She holds a master's degree in finance from New York University.

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