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HSAs: What About the Fees?

Philip Betbeze, for HealthLeaders Media, July 18, 2014

Health savings account fees have the potential to eat away at a tool that's meant to help achieve a lot in healthcare. As more employers expect employees to fund first-dollar coverage of their health needs, little attention has been paid to this detail.

When I started covering healthcare 14 years ago, the best piece of advice I ever got was "follow the money." Money motivates people, actions, and events. But with money comes math. When you're following the money, sometimes it's necessary to break out the calculator, of course, which can be helpful in discerning why a certain hospital or health system is taking the action it is—motivation can be found deep in a balance sheet, bond offering or fee calculation.

This advice and experience came in handy when I was reviewing the statement for my health savings account, in which a bank holds the money that I and my employer contribute. The bank takes a $2.50 per month fee for essentially managing an FDIC-insured savings account with an accompanying debit card. Don't get me wrong. I appreciate that my company offers benefits. It's one of the reasons I like working here. And I chose the high-deductible option with HSA over another option. But critically, I didn't get to choose the account manager, as I would with a savings or checking account. I didn't shop for that service. My personal bank doesn't manage it.

The ultimate irony is that while I'm expected to shop around to find the economical choice when spending those dollars on healthcare services, I can't shop around for my HSA. And if $2.50 a month sounds reasonable, it isn't. These fees are substantial.

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