I wasn't home an hour today after taking my middle child to the doctor when the nurse called to let me know that my oldest child just vomited at school. That pretty much completed the trifecta since my youngest child was at the doctor over the weekend with a nasty cough and a low-grade fever. Cold and flu season has officially arrived.
Thank goodness for my health reimbursement account (HRA). Without it, I’d feel a lot worse about all of these out-of-pocket expenses that I’m paying while my kids get better.
Most years, we don’t get the benefit of claiming our medical expenses on our federal income tax return. That’s because in prior years, even though we itemized our deductions on Schedule A, we have rarely met the threshold. Until this year, under the Tax Code, you can only claim eligible medical expenses as a deduction to the extent they exceed 7.5% of adjusted gross income (AGI).
You can find your AGI at line 37 of the form 1040:
It’s even worse now. For 2013, we definitely aren’t going to hit the threshold. This year, taxpayers younger than 65 (that’s us!) can only deduct medical expenses to the extent those expenses exceed 10% of AGI; those taxpayers who are 65 and older in 2013 keep the 7.5% threshold through 2016. That new threshold is a pretty high bar – even with a busy cold and flu season.
It’s not just my family: more taxpayers will find that their expense won’t hit the necessary numbers in 2013 to take advantage of the deduction.
According to the most recent census report, median household income, adjusted for inflation, was $51,017 in 2012. Using that number as our example for AGI, to claim the medical expense deduction, a family reporting those kinds of dollars would have had to spend $3,826.27 (7.5% x $51,017) on qualified medical expenses in 2012 before deducting a single dollar: that’s a lot of co-pays. That explains why only about 6% of taxpayers have traditionally claimed the deduction. With Obamacare, that percentage of taxpayers is about to get a lot smaller.
In 2013, the threshold for the same level of income will increase to $5,101.70 (10% x $51,017). That means that the family in the example would have to spend $5,103 on qualifying medical expense before claiming a single dollar of deduction. And I literally mean a single dollar. Remember that you can only deduct expenses over that the threshold amount. If the family spent $5,000 in medical expenses, there would be no deduction ($5,000 – $5,102 = less than zero); if the family spent $6,000 in medical expenses, the allowable deduction would be $898 ($6,000 – $5,102 = $898).
With those kind of hurdles, I asked around about alternatives and landed on the idea of an HRA. It’s one of a handful of special accounts available to taxpayers for medical expenses.
A health reimbursement arrangement (HRA) is a 100% employer-funded spending account. In other words, it’s not an employee savings plan but a tax-favored perk: contributions to the account are available to employees, tax free, as reimbursements. In fact, amounts in the HRAs aren’t even reported on a federal income tax return.
It’s not just current employees who can participate. Under most plans, current or former W-2 employees, as well as qualified dependents, may participate. But read the fine print: each plan is employer-specific.
Here’s how it works. The contribution amount for each employee is determined each year by the employer. The employer also determines which expenses qualify: typically, the HRA is used to help pay for eligible out-of-pocket medical expenses. Eligible expenses are generally the same sort of out-of-pocket costs that qualify for the medical deduction. That includes the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. That tends to include the costs of visiting to medical professionals as well as the purchase of any medicine or drug which requires a prescription of a physician for legal use.
When expenses are incurred – a good example is a co-pay for a doctor’s visit – those expenses can be reimbursed to the employee, assuming that the expense qualifies and is backed up by documentation. In my case, expenses do include co-pays as well as medications and, thankfully, vision and dental. In terms of documentation, a detailed receipt will generally do – I’m allowed to snap a photo of the receipt on my smartphone and send it electronically for processing.
After the expense is approved, the reimbursement shows up in the form of a check – most commonly included on a paycheck – and it’s tax free. That means that the expenses are paid for with the equivalent of pre-tax dollars: these dollars are subtracted from gross pay before any income or payroll taxes are calculated. In other words, if you earn $50,000 in wages and get $1,000 in reimbursement, your form W-2 will reflect just $50,000.
But what if your employer doesn’t offer an HRA? All is not lost. An individual can, without an employer-sponsored plan, create their own health savings account (HSA).
The HSA is a bit like an IRA for medical expenses. Contributions are made by the taxpayer, or a combination of the taxpayer and his/her participating employer. Those contributions are capped: for 2013, the limits are $3,250 for individuals and $6,450 for families and those numbers increase to $3,300 for individuals and $6,550 for families in 2014. Contributions are not subject to federal income tax. Taxes are handled one of two ways: either the contribution is made with pre-tax dollars if related to an employment benefit or made with post-tax dollars subject to a corresponding deduction if made by an individual or family.
The HSA is a bit like an IRA for medical expenses. Contributions are made by the taxpayer, or a combination of the taxpayer and his/her participating employer. Those contributions are capped: for 2013, the limits are $3,250 for individuals and $6,450 for families and those numbers increase to $3,300 for individuals and $6,550 for families in 2014. Contributions are not subject to federal income tax. Taxes are handled one of two ways: either the contribution is made with pre-tax dollars if related to an employment benefit or made with post-tax dollars subject to a corresponding deduction if made by an individual or family.
As with an HRA, the payment of qualified medical expenses is federal income tax free. Generally, this is accomplished by pulling the dollars straight out of the HSA. Many accounts offer special debit cards or checks to make this easy; alternatively, other HSAs may operate on a reimbursement basis, as with HRAs.
It’s not a spend or lose it account: if the dollars in the HSA aren’t used up in one year, the account can be rolled over from year to year with no penalty. You cannot, however, roll them into another kind of tax-favored account, like an IRA.
Both accounts, HSAs and HRAs, have advantages and disadvantages to taxpayers. And as with all tax-favored breaks, there are rules, exceptions and limitations which apply. The fine print matters. Check with your human resources office for more information – or your insurance or tax professional if you are setting up a plan on your own.
Don’t assume that these plans are for somebody else: there are so many different variations that you’re liable to find one that benefits you either on its own or, occasionally, in tandem with another plan (MSAs and FSAs, for example). This alphabet soup of accounts and plans could be the tax-favored cure for what ails you
if you'd like to look into an HRA or HSA for your family or small business, give us a call.
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