You are new to the world of High Deductible Health Plans, and your new plan is   HSA eligible, or perhaps you have an HSA but haven't had the time to open a corresponding Health Savings Account.  Or you opened an HSA but have put no money in it this year.  With Christmas, Hanukkah and the general holiday season upon us, you are light on cash and thinking maybe you'll hold back on that contribution to your HSA.

You know in your mind that your healthcare is more important than the new Wii under the tree, but irrational spending behavior has taken over and that HSA contribution just ain't happenin'.

Here's the good news; December 31st 2008 is not D-Day for your HSA contributions.  Although it is for getting the account set up if you want to get the tax benefits of it on your 2008 tax returns.

As an individual you may contribute $2,900 to your HSA for 2008 and as a family you may contribute $5,800 to your HSA.   However, if you can't make it before the end of the year you're not SOL because if you fund the account before April 15th 2009, you can still take the tax deduction on your 2008 returns.   So if your brain is in the spend mode as opposed to the save mode, you get a 100+ day grace period to put $s into your account and still get the full tax advantages of your contribution.  But in order to get the benefit, you MUST set up your HSA account set up before the end of this year.  It's holiday season, can you say grace?

  One thing everyone agreed on regarding the Obama presidential campaign was  that he picked his messages and stuck to them.  And one of the ones that stuck to me, in fact, with all the media coverage I felt like it was nailed to me with a hammer and sixteen penny nails, was the notion that if you liked the health plan your employer offered you could keep it, but if you didn't you could have the same insurance federal employees enjoy.  And for employers if they didn't provide insurance for their employees, they would have to contribute to a medicare type plan to cover the uninsured.

As I tried to read the tea leaves of Obama's healthcare reform, being the conservative guy that I am and generally distrusting of the U.S. Government, my interpretation of the above campaign message was that it cloaked  of a movement toward government run healthcare.  After all, healthcare in America is a multi-trillion dollar industry, power follows money, and the Government loves power.  Being somewhat cynical, I figure the underlying message of the stated policy was that if the new administration could get some traction around healthcare reform, it would make employee sponsored insurance so untenable for employers they would be forced to pay into the Government sponsored plan, and that would be the end of healthcare as we knew it.

But there is another possibility here, one that a conservative and somewhat cynical blogger hadn't really given much thought to.  There is an article in the November 17^th edition of Business Week entitled Heath Care-Immediate Relief From Rising Costs which made me wonder if rather than putting so much pressure on businesses their only option is to default into the Government plan, the Government might create enough incentives for employers to cover their employees meaning that less of the insurance market and burden would fall to the Government.

Personally, I think we need to tools to rely on ourselves when it comes to healthcare.  The Government needs to be an advocate for us, not control us or our employers.  Consumer Driven Healthcare, and specifically High Deductible Health Plans (HDHPS) and Health  Savings Accounts (HSAs) are tools the Government has given us.  Could they be better?  Absolutely, they are far from perfect.

If you are one of those folks who dreads the open enrollment period for your health benefits, who puts their heads inside of their shell and basically runs and hides, I'm sorry to say, you are the hunted.  If you simply sign up for whatever you had last year (but likely at a higher price, and possibly with reduced benefits) without doing your homework, you are the hunted.  If you haven't figured out things like HSAs, HRAs, or FSAs, then you are the hunted.  If you simply do what your office "best friend" does, then unless they are a hunter and your family situation mirrors theirs exactly, then you are the hunted.

• On the other hand, if you read the insurance materials from cover-to-cover;
• If you know which doctors come with which insurance plan;
• If you understand the difference between the various premiums as well as the deductibles;
• If you understand the difference between HSAs, HRAs, and FSAs and fully utilize them within your plan;
• If you understand the differences between the drug coverage offered;
• If you know what you spent on health care in the current year for yourself and family including premiums, medications, OTC costs, and doctors visits;
• If you spent every nickle out of your FSA or made the maximum contribution to your HSA;
• If you understand the tax benefits of an HSA (if you have one or are considering one); then you are definitely the Hunter.

If you are the Hunted, it may not be too late and you still have a chance.

Hunters, to the extent you can "kick ass" when it comes to making healthcare decisions, you do it!!  

 When I was a kid, up until the age of about eleven, my Grandmother used to conduct Doctor Jekyl-like experiments on my hair with her handy scissors.  I was a total toe head and when she was done they could have slapped me on the side of a paint can and called me the Little Dutch Boy.

I revolted at eleven and began a 30 plus year quest to find the perfect barber.  Recently though, in my quest to save more money into my health savings account I decided to give Betty, my barber, a little vacation and let my wife cut my hair.

The first haircut she gave me was disasterous and fully documented in an article on this site entitled "Hair Savings Account,"  and the second haircut, well that one was nearly apocalyptic and covered in "Health Savings Accounts and my Left Ear."

Because of the partial skinning I received last go round, it has taken longer for my hair to recover.  My wife, on the other hand still hasn't.

Still looking for ways to save, after considering allowing my teenaged daughter to have a run at it, or maybe that lady who I see walking around my house once a month reading the meter, I decided to take matters into my own hands.

I got out my Conair turbo pet grooming sheers, dropped a number 7 on them and let her rip.  It was absolutely exhilarating.  As a guy I felt like friggin' Rambo.  In control, self sufficient, even able to give himself his own haircut.  Now I did have to deal with hair pretty much everywhere. It was kind of like being in a New York tickertape parade.  Hair flying in my ears, all over my face, I was just covered up.  I was spitting out hair the whole time and I'm pretty sure it was multiplying as it fell toward the ground. 

Now, you may be thinking, big whip, he just shaved his head.  Hardly.  Cut and style baby, and if I say so myself it looks good.  Real good.  Well at least the parts I can see.

Are self haircuts a good idea?  Well, finding creative ways to save more money into one's Health Savings account is a good idea.  If I could figure out how to get my wife to do her own hair; now that would be big bucks but I don't see that happening.  With the right tools, a good vacuum cleaner, independence and creativity, you will be amazed at how you can save more into your HSA.

I have an HDHP.  When I go to the Doctor to have them look at the creatures crawling around in my throat, causing me to itch all over, or making my hair fall out in clumps, I am expected to pick up the full tab until I hit my deductible.   I even have a little stash of money, called an HSA to pay for it.  BUT, I don't pay a nickel when the Doctor is done with me.  Not immediately.

The Doctor has to put in a claim to my insurance company, the insurance company tells the Doctor how much they are going to pay, they then tell me how much I am supposed to pay, I then send the Doctor a check, the doctor tells the insurance company they received the check, and then insurance company tells me that the Doctor told them that they received the check.  If this laser-like process of precision breaks down in any way or God forbid, I don't send the check, honestly, I have no clue what happens.

For the past year, I have been writing for the Gradock Bulletin about health savings accounts, high deductible health plans, consumer driven health, healthcare and wellness and pretty much anything else that comes to mind that might be educational, worth a rant and/or is somewhat entertaining.

With that said, I have compiled Gradock's "Top Ten Reasons Why Healthcare Is So Friggin' Expensive!"  This is a very unscientific survey of one, but it points to a the gaggle of reasons that collectively (along with a few others I'm sure) that cause you and me to pay more when we go to the Doctor and put health insurance out of the reach of millions of Americans.

10.) We can't figure out how to spell "healthcare."

The fact that sometimes it is spelled as two words (health care) and sometimes as one scratches at the surface of inefficiency (it takes more keystrokes and kills more trees when spelled as two words)

9.) The right hand don't know what the left hand is doing:

See paragraph #2 above

8.) Americans are fat slobs:

Which makes us loveable and friendly, but contributes to chronic illness like heart disease, hypertension, and diabetes which cost us billions if not trillions of dollars a year in healthcare costs.

7.) State Mandates:

Did you know that your state may require insurance companies to cover certain illnesses no matter whether you are at risk of it or not, whether you are healthy or not, whether you care about the illness or not.  So for example, if you are a single male living in Arkansas or any of the other 20 states that require maternity coverage, you are paying, in your premium for someone else to have a kid.  Or if you live in Connecticut or any of 9 other states you get to pay for wigs.  Or if you are a non-smoker living in Maryland, you are paying for some lung burning smoker's, smoking cessation treatment when you pay your insurance premium.

6.) The uninsured and non-critically ill in hospital emergency rooms:

Emergency rooms, by their name and nature are set up to deal with emergencies, not the coughs of the illegals and uninsured, or the weekend colds of the insured.  This mindset may be compromising emergency rooms, and certainly is driving the cost of healthcare up for all of us.

5.) Regs on Meds:

My insurance company will not pay for, nor will they allow for money I spend on meds that come from Canada to count against my deductible.  Now some of this is to protect me from witch doctors, voo doo priestessesire and shady drug companies whipping up toxic drugs in oil drums on the streets of some third world country, and I understand that.  But part of this is driven by drug companies desire to tamp down competition.

4.) Three Card Monte Mindset:

Or in other words lack of transparency in healthcare.  Healthcare is set up so that we do not know what procedures, tests, and treatments cost, leaving us to guess where the most cost effective care is to be found.  And it is almost impossible to find the best doctors at the best prices in this environment.  There is some progress being made in this area with the establishment of minute clinics and services like outofpocket.com that are exposing the cost of healthcare which can help create more competition and ultimately drive costs down.

3.) "The Doctor's Handwriting" and malpractice law suits:

If the Pharmacist can't read the Doctor's hand writing and mis-dispenses meds or has to spend more time figuring out what the thing says, then we are talking time and money.  Or if the Nurse in the hospital gives the wrong dose or the wrong medicine to a patient, that can be a bad day.  Do you know that if a drunken, illegal alien with not a nickel to his name rolls into the hospital with his arm half cut off and doesn't like the way the attending surgeon sewed it back on, he can sue the surgeon?  Now I believe the guy has a right to sewing but not suing, unless there is horrific and obvious gross negligence.    

2.) Cleanliness is next to godliness:

Now I'm not a germaphobe but do realize how much stephastrepasyphacoctolis gets spread around because folks don't practice basic hygiene.  That lands folks in clinics all the time with preventable illness and, yes, drives the cost of healthcare up.

1.) What about executive compensation?

We can't let that one slide.  I'm all for people making money and if they make armored cars full of it that's fine it they are truly responsible for creating most of the value.  But I do have a tough time with guys who get paid huge sums of cash for what sometimes ends up to be short term value, or get paid huge sums of money when they screw up and get fired.  Hey, I could screw up any big publically traded company for way less than these guys get paid.  And what kind of money are they making?  Well I took a look at the AFLCIO database on executive comp and here are a few examples:  In 2007 the CEO of Abbot Labs was paid $33 million in total comp; the CEO of Aetna got $23 million total comp; the CEO of Merck got paid $20MM in total comp; the CEO of Humana got $10 million in total comp: the CEO of UHC got $13 million in total comp and the CEO of Cigna got $26 million in total comp.

These were the ten I was able to rattle off without too much difficulty and I know there are many more.  Feel free to comment on this article with additional reasons.  Maybe we can compile it and share it an another article or post it on this site's forum.

You've just been enrolled in an HSA for the first time huh?  You might feel like you just hooked a big nasty line pulling pike.  That sucker is and bad and feels like he's pulling you all over the place.  How in the world are you going to deal with it?

If you have the right gear to reel it in, and maybe a cold Budweiser, you might just get him in the boat.  Except for the chilly beer, that's what HSAeducator.com is all about; having the right gear.

If you feel like your line was hit hard by this new HDHP/HSA insurance plan, or maybe you are the pike on the line and your employer just rammed turned you, HSAeducator.com can definitely help you out.

As an opinion maker of uno, I recommend you look at your new insurance and savings plan you have as a gift.  I believe high deductible health plans when combined with health savings accounts can be a major part of America's solution to healthcare.  While they turn a lot of the responsibility for our health and healthcare over to us, they give us control too, and control is power.  You may not know it yet but dude (and fisherdudesses) with your HSA you've got the power.   

But you are new to the HSA fishing tournament and, I'm getting ahead of myself.  Before you can harness the power of your new HDHP and HSA, you've got to learn the language. 

It all starts right here.  HSAeducator.com starts by answering the basic HSA questions.  Things like:

• Ÿ How much can I contribute to my HSA each year?
• Ÿ What can I spend money from my HSA for?
• Ÿ Can I buy fishing lures with money from my HSA or maybe a new boat?
• Ÿ What happens if I put too much money into my HSA?
• Ÿ Do I have to use the bank my company is pushing for my HSA?
• Ÿ If I change jobs what happens to the money in my HSA?
• Ÿ What if I don't spend all the money in my HSA each year?
• Ÿ Should I try to spend the money in my HSA every year or let it pile up for something major?
• Ÿ Can I pay my HDHP premiums from my HSA?
• Ÿ Can I take my HSA contributions off my taxes?
• Ÿ Can I spend my HSA dollars on a back snapper?
• Ÿ Is an HSA the same as my FSA?

Good questions and they're all answered on HSAeducator.com.  Plus, if you have really specialized questions you can check out the health savings accounts discussion forum , ask your question and they'll give you an answer or maybe or someone else with an HSA can give you some guidance 

One more thing that makes HSAeducator.com different from say, that slick brochure your employer gave you, is that it's written in English.  Not the Queen's English, but plain old every day conversational English, not something that looks like it was written by a the U.S. Congress or some lawyer.   So while it is no your favorite "fishin' magazine," it's a damned sight closer than the Harvard Law Review.

There are plans out there that have "high deductibles," but this, in and of itself does not qualify it as a high deductible health plan (HDHP).  While it is possible for an HSA qualified plan to restrict some benefits, it MUST provide significant benefits to qualify both a real high deductible health plan and for health savings account.

For example, if you are looking at a plan that offers you significant in-patient care (something happens and you get admitted to the hospital) that covers your hospital room, meds, tests, more tests, more tests, horrible food, more tests, a visit from the doctor, bandages, surgery (you get the picture), but does not offer much in the way of care when you are not in the hospital (trips to the doctor for a sore throat, physical exams, and other out-patient care), it is a "faux" HDHP and is about as real as that Llama skin purse you are so proud of.

For those folks glued to this blog to learn about the whole ‘Grab Bag' thing, fear not.  For as best we can tell it pretty much goes into perpetuity.  However, it is definitely time for the staff at Gradock to take a break and cover some other ground.

It is hard to believe it's been almost a year since we plunged into the world of high deductible health plans (HDHPs) and health savings accounts (HSAs).  And brothers and sisters have we learned a lot.  If you were around to read this blog a year ago you might recall the Alice and Wonderland-like journey through the land of insurance and specifically HDHPs.  There were (and are) some amusing articles written about that little journey, the highlights of which are found in Hold the Lettuce   and Hold the Pickles (click on either link for your entercational  pleasure) both located on the HSAeducator.com website.

As luck would have it, we ended up not being real happy with our high deductible health plan because it said one thing, it actually did another.  Apparently accountability does not really apply to insurance companies when they seemingly make errors.  But one thing positive I can say is that it had great well care that covered our physicals this year.  Well care is a benefit can be found in a number of HDHP products.

So my wife still thinks I am too stupid to lead the process of finding a new plan.  She has taken this bull(ship) by the horns, sharpened her profanity skills, and thrown both feet and the rest of her body into the process.

Since last year we met this guy, whom we have mentioned in a couple of blogs before, named Scott Borden, a.k.a. "My HSA Guy."   Scott is hugely knowledgeable about health insurance and understands the ins and outs of HSAs, so I suggested that my wife give him a buzz.  Which amazingly, she did.

Anyway, she and Scott are big ole buds now, and after some consultation he set her down the path of a different HDHP policy from a different insurance carrier.   The new policy, if we are approved, should serve our families needs better than the one we have right now.

We'll do a "The Good, The Bad, and The Ugly" on our current and new plans here in the near future, but I want to offer up a small piece of advice to anyone who is either smart enough to allow their significant other to figure out their insurance, or to anyone who feels like brilliance is their own and wants to do it themselves. 

At such time you get ready to fill out the application, you will likely find it to be a lengthy and formidable form.  If you fill it out online, it is not good enough to merely save it in the in the software that is serving it up (the insurance company's).

My wife, after spending over an hour with the form (maybe more) filling medical history from the past ten years, hit "save" multiple times.  The next day, when she went back to work on it some more, "poof" it was gone.

Hell hath no fury like that of a woman who has filled out an encyclopedia of family medical history only to have it disregarded like a pair of old shoes.

So for goodness sakes print off a hard copy of all your hard work.  Save a copy on your hard drive if you can.  Do whatever it takes to keep from completely losing it.  Sounds ridiculous, I know, but fill out those forms one time, and you'll never want to do it again.

And the answer is......maybe.  Sorry, black and whiters, that's just the way it is.

It depends on the type of free or in this case, discounted care you receive.  So as an example if your employer has a clinic where you can go for a flu shot, or say get your allergy shots, or maybe to get an aspirin when you have a headache, or maybe to have a wart looked at or maybe get some antiseptic and a bandaid if you cut yourself opening a box or something you would still be eligible for an HSA.

On the other hand if you work at say, a hospital, and you get your medical care for free or at a deep discount, sorry Charlie (or Charlene) No HSA For You!! 

Sorry, couldn't resist.

So if this is your first exposure to the Gradock Bulletin's  ‘Grab Bag Series' you are kind of jumping into the middle of the game.   No problem with that but you may want to go back and read the first one or two in the series that started this little snowball (and it's still fairly little right now) down the hill.

Also, if you read this on a fairly regularly basis you might be used to a bit more humor (or attempts at it anyway) than has been injected into some of the more recent articles.   That said, we may have to make some detours away from the ‘Grab Bag' along the way.  Otherwise we may go totally insane here at Grab Bag Central.  For what it's worth, we'll do our best at spicing up this latest and highly gripping notice from your IRS and US Treasury.

If you want the full report got to IRS Notice 2008-59 attempt to read it, then come back here for the Cliffs Notes translations.

Ok, now that we've got all that out of the way let's take a look at another goodie from the grab bag.

How about Medicare Part D?  If you are eligible for Medicare part D (or any Medicare benefit for that matter) but not enrolled, fear not, you are still HSA eligible.  That said, if in any month you do enroll (in Medicare), you become ineligible.

Now this next one is a little wacky to me as it outlines a scenario, I would have never contemplated on my own. If an individual has an HDHP/HSA qualifying plan but then has insurance on top of that whereby the deductible exceeds that of the HDHP plan, does the second plan disqualify the first plan in terms of HSA eligibility?

Huh?  Here's the deal. If say you have an HDHP plan with a $ 1 million lifetime limit and then picked up a second plan with a $1 million deductible with a $2 million lifetime maximum benefit, that second plan would not disqualify you from HSA eligibility.

Breathtaking stuff, no?