HSAs & Copay Assistance

Q: Do you expect to utilize copay assistance, coupons, and/or discounts?

A: If yes, it is important to be aware of the following when shopping for plans on the ACA Marketplace:

• If consumers choose any of the Health Savings Account (HSA)-eligible plans, then per IRS requirements they will need to pay the minimum out of pocket amounts of $1,400 (for self-only coverage) or $2,800 (for family coverage) FIRST before their copay assistance will count towards their remaining plan deductible or out-of-pocket maximum (if applicable). However, this restriction does not apply to preventive care. Please note that consumers can use copay assistance at any time, but only the amount that they actually pay will count toward their deductible or out-of-pocket maximum until they have reached the minimal amounts of $1,400 (self) or $2,800 (family).
  
• If consumers do NOT choose an HSA-eligible plan, the copay assistance will count towards meeting their deductible and out-of-pocket maximum without needing to meet a $1,400 or $2,800 threshold. However, they will not be eligible to contribute to an HSA.

Q: How do you know if a plan is HSA-eligible?

A: Healthcare.gov allows consumers shopping for plans on the ACA Marketplace to filter search results when viewing plans by selecting a “Health Savings Account Eligibility (HSA)” check box. Please see example below:

Additionally, when viewing each plan individually, the phrase “Eligible for a Health Savings Account” will appear under the premium if the plan is HSA-eligible. Plans without this designation are not HSA-eligible.

Health insurance plan documents such as, the policy, certificate of coverage, schedule of benefits, or summary of benefits and coverage (SBC) also might use the term HSA or HDHP (“high deductible health plan”) in the title headings to indicate HSA-eligibility.

NOTE: Consumers who have coverage through their employer should ask their health insurance carrier or employee benefits administrator whether their plan is designed to be HSA-eligible. Consumers who purchase coverage for themselves or their families directly from a health insurance carrier instead of enrolling through healthcare.gov should ask their carrier.

* Self-funded employer-based coverage is not regulated by the Illinois Department of Insurance.