Personal Finance

A tax-free account for Medicare that very few people use

Key Points
  • About 5,000 Medicare enrollees use medical savings accounts.
  • Funds in these accounts grow free of taxes and may be used for medical expenses.
  • You need a high-deductible Medicare Advantage plan to participate.
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If you're 65 and healthy, you may want to check out this Medicare plan, which includes a tax-favored savings account.

Say hello to the Medicare medical savings account or MSA.

Funds in an MSA accrue interest and free of taxes. Beneficiaries can make tax-free withdrawals provided the money is used for qualified medical costs. Maybe best of all: Medicare seeds the accounts with cash each year.

The account is a cousin of the health savings account, which you may know if you have a high-deductible health plan at work.

Despite its virtues, the Medicare MSA has a small following.

Of about 19 million enrollees in Medicare Advantage, only 5,000 are in programs that use an MSA, according to Gretchen Jacobson, associate director with the Kaiser Family Foundation's program on Medicare policy.

"It's a great product if you have a beneficiary who is reasonably healthy and goes to the doctor just a couple times a year," said A.J. Tate, director of Medicare product development at MVP Health Care, in Schenectady, New York.

The marketing is a tough one for seniors who are accustomed to traditional health-care coverage, and never encountered high deductible plans at work.

"A Medicare MSA may be advantageous to a sophisticated person with a spreadsheet, but it's a difficult sales pitch," said Rob Pipich, a principal and consulting actuary for Milliman in Wayne, Pennsylvania.

"It'll be difficult for these plans to truly catch on in a mainstream way until the population is comfortable with a high deductible plan," he said.

It's a conundrum for insurance companies: People can't buy these plans because their availability is limited, and insurers need more members in order to make Medicare MSAs worth the effort.

"The insurer will need a fair bit of membership in order to cover the administrative and start-up costs," said Pipich.

Here's how Medicare MSAs work.

An introduction

Medicare MSAs came into use in 2007, as a result of the Medicare Modernization Act of 2003.

These accounts are intended to be used in tandem with a high-deductible Medicare Advantage plan. Shoppers can compare their options based on deductibles and additional benefits, such as dental or vision care.

Though Medicare MSA enrollees generally do not pay premiums aside from what they owe for Medicare Part B, they are expected to pay out-of-pocket expenses until they hit the annual deductible, which will vary by plan.

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For MVP Health Care — one of a handful of firms in the country that offer Medicare MSAs — that deductible is $8,000 in 2018.

Other providers include Security Health Plan of Wisconsin and Network Health in Menasha, Wisconsin.

Not all out-of-pocket costs will count toward your deductible: These must be expenses that are related to Medicare Parts A and B.

Also, these plans do not include prescription drug coverage, so you may need to buy a Medicare Part D plan for those costs.

Seeding the MSA

Each year, Medicare will pay a set amount of money to the insurance company that's offering your plan in order to fund your MSA.

The amount going into the account is determined by the insurance company through an actuarial calculation.

"The amount may change from year to year, but we are required by the Centers for Medicare & Medicaid Services to notify members of changes for the next year," said Tate.

Money in a special needs trust can cover supplemental needs not covered by Medicaid and SSI.
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Here's a key difference between the MSA and the HSA you may already have access to at work.

Medicare participants aren't permitted to add their own funds to the MSA; they get whatever funds are put into the plan. Any unused amounts roll over into the following year.

By comparison, participants in HSAs can put away $3,450 if they're in a plan with self-only coverage ($6,900 for family coverage), plus $1,000 if they're over 55.

Once an HSA investor enrolls in Medicare, you are no longer allowed to add new money to the account. However, you can tap it for ongoing medical expenses.

HSA holders can also invest their dollars, assuming the company that administers the account makes mutual funds and exchange-traded funds available.

For now, MSA accounts accrue simple interest at a low rate that's comparable to what you'd find in a savings account, said Tate. He said he is not aware of investment options being available to these account holders.

Trump's proposal

In his budget, President Donald Trump proposed permitting Medicare beneficiaries to make tax deductible contributions to health savings accounts or medical savings accounts.

The provision would permit beneficiaries in Medicare MSA plans to contribute to the accounts subject to the same contribution limits used for HSAs.

Beneficiaries would also have a one time opportunity to roll over funds from their HSAs to their MSAs, according to the Department of Health and Human Services. Individuals in these plans would not be allowed to buy Medigap or other supplemental coverage.

If Congress were to approve the proposal, MSAs could get a little more publicity.

Whether this will make more seniors comfortable with the idea of using a high deductible remains to be seen.

"As people age into Medicare, they tend to be rather risk averse," said Pipich.

"Even if they could pay a third of the amount and not have as much total liability, there's still a psychological bias," he said.

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