There continues to be much uncertainty about the Affordable Care Act and how such uncertainty will impact health care costs. So it’s critical to leverage all tax-advantaged ways to fund these expenses, including HSAs, FSAs and HRAs. Here’s how to make sense of this alphabet soup of health care accounts.

If you’re covered by a qualified high-deductible health plan (HDHP), you can contribute pretax income to an employer-sponsored Health Savings Account — or make deductible contributions to an HSA you set up yourself — up to $3,450 for self-only coverage and $6,900 for family coverage for 2018. Plus, if you’re age 55 or older, you may contribute an additional $1,000.

You own the account, which can bear interest or be invested, growing tax-deferred similar to an IRA. Withdrawals for qualified medical expenses are tax-free, and you can carry over a balance from year to year.

Regardless of whether you have an HDHP, you can redirect pretax income to an employer-sponsored Flexible Spending Account up to an employer-determined limit — not to exceed $2,650 in 2018. The plan pays or reimburses you for qualified medical expenses.

What you don’t use by the plan year’s end, you generally lose — though your plan might allow you to roll over up to $500 to the next year. Or it might give you a grace period of two and a half months to incur expenses to use up the previous year’s contribution. If you have an HSA, your FSA is limited to funding certain “permitted” expenses.

A Health Reimbursement Account is an employer-sponsored account that reimburses you for medical expenses. Unlike an HSA, no HDHP is required. Unlike an FSA, any unused portion typically can be carried forward to the next year.

There’s no government-set limit on HRA contributions. But only your employer can contribute to an HRA; employees aren’t allowed to contribute.

Maximize the Benefit
If you have one of these health care accounts, it’s important to understand the applicable rules so you can get the maximum benefit from it. But tax-advantaged accounts aren’t the only way to save taxes in relation to health care.

If you have questions about tax planning and health care expenses, please contact us.

Jen:  This is the PKF Texas Entrepreneur’s Playbook.  I’m Jen Lemanski, this week’s guest host, and I’m here with Ann Tanabe, the Chief Executive Officer of BioHouston.  Welcome to the Playbook Ann.

Ann:  Thanks, Jen, thanks for having me.

Jen:  So BioHouston has been around for a while but I know you guys have really kind of ramped up a lot of your efforts in the Life Sciences community within the last 5 years; what have you guys been doing?

Ann:  So this is a really great and exciting time for the Life Sciences industry here in Houston.  I’m happy to report today we have over 200 companies that span therapeutics, med device, healthcare IT and digital health.  Most of that innovation is coming out of the Texas Medical Center as you can imagine and we’re really happy to say that not only the TMC but the member institutions like Baylor, MD Anderson, Rice University are all putting innovation at the forefront.

Jen:  That’s awesome.  Now do you guys ever work with – I know Life Sciences but do other industries come in and share technologies?

Ann:  Sure, so we’re seeing a lot of healthcare, digital health and the software and hardware development interchange and play with our therapeutic areas.  So at the TMC, for instance, AT&T has established what they call the AT&T Foundry which has been a great resource for our community.

Jen:  Perfect.  Now if somebody doesn’t know about what BioHouston does what’s just a quick synopsis of what you guys do for the community?

Ann:  We’re a hub and a connector and we like to call ourselves the information booth.  Anybody interested in looking for opportunities either to volunteer or be an intern with a company, if you’re a startup company looking for investors or if you’re a business wanting to transact business with companies we’re the place and we’re the place to come to meet and interact with folks.

Jen:  And your website is?


Jen:  Well I know there’s a whole host of other things I want to ask you so can we get you back?

Ann:  Sure, happy to do so.

Jen:  Perfect.  This has been another Thought Leader production brought to you by PKF Texas the Entrepreneur’s Playbook.  Tune in next week for another chapter.

Russ: This is PKF Texas The Entrepreneur’s Playbook. I’m Russ Capper, this week’s guest host. And today I’m here, once again, with Jeff Toal, CEO of Med-Enterprise. Jeff, welcome back to The Playbook.

Jeff: Thank you for having me back.

Russ: You bet. Well, I find your business fascinating. And I’m just curious. What trends did you see in healthcare, in the medical world, that motivated you to start the company?

Jeff: That’s a good question. I think it was one of the concerns – that with the evolution of the policies that were going on in healthcare, I kept seeing a sense that projects were changing and shifting. And it was losing the focus on capturing money and accounting for it accurately. So I kept seeing money left behind. So we took the opportunity of that technology I mentioned before and did some pilot testing with it, and we actually were finding money that was being left behind. Because there was that distraction to the newer trends that were going on. So we came back in, used a newer technology to capture what was missing.

Russ: Well, it definitely is a rapidly evolving space – and complex. And you are solving there?

Jeff: We are. It’s a fascinating – in a lot of ways, we’re actually helping to find money to fund projects that are dear to the hearts of our providers and healthcare system. So it’s a nice balance of finding money, so that they can move their initiatives forward.

Russ: Really cool. And I really appreciate you sharing this story with us.

Jeff: Thank you for having me.

Russ: You bet. And this has been another Thought Leader Production, brought to you by PKF Texas and The Entrepreneur’s Playbook. Tune in next week for another chapter.

Russ: This is PKF Texas, Entrepreneur’s Playbook. I’m Russ Capper, this week’s guest host, and today I’m here with Jeff Toal, CEO of Med-Enterprises. Jeff, welcome to the Playbook.

Jeff: Thank you for having me here.

Russ: You bet. All right. We’ve had your director of business development, Jay Comeaux on, real interesting model. I’m real curious though what motivated you to follow this path into health care and start this company.

Jeff: Well, that’s a good question. I asked myself that a few times myself, but I’ve been in health care for about 20 years and I’ve seen the evolution of health care itself in services and efficiencies and I thought that we had a pretty good tight ship on collecting information and collecting the revenue as it’s supposed to be collected but we were collecting what we knew to collect and I came across an opportunity in a meeting and they were describing how they go about using some technology and compliance with state law and contracts. I said, “My company does that.” And they said, “Well, just look at it.” So I did and when I looked at it, we weren’t doing that. It was intriguing that you could actually find things that are missing even though you think that you’re pursuing everything that’s available.

Russ: And you guys are finding lost money there, is what you’re doing.

Jeff: Amazing. It really is.

Russ: The complexity of health care is mind boggling. The complexity of the financial accounting side is over the top and you guys saw that, right?

Jeff: We have. The evolution of technology itself and the driver in health care has pushed technology to a point where you actually can see more information inside of there than the more arcane days of spreadsheets and abacuses and things like that. So it’s been fascinating to let the technology catch up to the revenue opportunities that we can find.

Russ: Fantastic. Well, thanks for sharing that with us.

Jeff: Thank you for having me.

Russ: You bet. This has been another Thought Leader production brought to you by PKF Texas Entrepreneur’s Playbook. Tune in next week for another chapter.

Russ: This is PKF Texas Entrepreneur’s Playbook. I’m Russ Capper, this week’s guest. And today I’m here once again with Jay Comeaux, Director of Business Development for Med-Enterprise. Jay, welcome back to the Playbook.

Jay: Thank you. Good to be back.

Russ: Okay, so last time you were here we talked about what you guys do, and that’s finding lost money in the healthcare maze. How do you do that?

Jay: We do it through a proprietary technology process. It’s actually called CIRCA, which is Claims Intensive Revenue Cycle Analysis.

Russ: Okay.

Jay: Through this process we are able to break apart, if you will, the invoicing between the provider and the carrier and then back to the provider from the carrier in our analysis.

Russ: Okay, and you can sit there and you can see where your client has not received money that they should get.

Jay: On a timely basis, mm-hmm.

Russ: Okay, well, now some people might think, “Well, maybe this is just a sophisticated collection agency.” Is that right?

Jay: That’s not exactly collect. You know, certain collection agencies do serve a purpose for the various providers in healthcare, but ours is a level of sophistication higher than that. We really get into the complexities of the billing cycles, if you will, between the providers and the carriers.

Russ: Okay. Would the collection agent actually potentially work with you at some time maybe or-?

Jay: Perhaps, yes.

Russ: Okay.

Jay: There could be some parallel efforts that go on between the – for the benefit of the provider, yes.

Russ: Okay. Well, I really appreciate this business completely; it sound exciting and definitely needed in healthcare.

Jay: It definitely is. Definitely is.

Russ: All right. Thanks a lot, Jay.

Jay: You’re welcome.

Russ: This has been another Thought Leader production brought to you by PKF Texas Entrepreneur’s Playbook. Tune in next week for another chapter.

Russ: This is PKF Texas Entrepreneur’s Playbook. I’m Russ Capper, this week’s guest host. Today here with Jay Comeaux, Director of Business Development for Med-Enterprise. Jay, welcome to the Playbook.

Jay: Thank you very much. It’s good to be here.

Russ: Tell us about Med-Enterprise.

Jay: Med-Enterprise, as our name implies, is a consulting group for the healthcare industry, primarily for the providers in healthcare – hospitals, physicians groups, pharmacies, and the like. We have a, a proprietary technology process that helps hospitals find or locate found money if you will.

Russ: Wow. Well I know there’s a tremendous complexity in that world these days.

Jay: Yes.

Russ: So I would assume that there are quite a few customers for your service.

Jay: There are quite a few customers. They vary in size and complexity, if you will. But at the end of the day what we do is add value by helping them improve their bottom line at no cost to them whatsoever.

Russ: Which we all know is very important. Is there very much lost money out there?

Jay: There’s a lot to be found. There’s a lot of things that tend to slip through the cracks, if you will, and we try to gather that as it falls.

Russ: Well I really appreciate that, Jay.

Jay: Yeah.

Russ: This has been another Thought Leader production brought to you by PKF Texas Entrepreneur’s Playbook. Tune in next week for another chapter.

The U.S. Department of Labor’s Employee Benefits Security Administration today announced an upcoming webcast. “The Affordable Care Act: How Will It Affect Me?” will take place Thursday, Aug. 29 from 1-2 p.m. EDT. EBSA staff will be joined on the webcast by colleagues from the Department of Health and Human Services.

The webcast discusses the impact of the ACA (Affordable Care Act) on group health plans. This is especially important for those companies of 50+ employees that have never had medical coverage. These companies will also learn about the Health Insurance Marketplace where they will find affordable, compliant providers.

IRS creates “Healthcare Law Online Resources” site and Publication The IRS has posted Publication 5093, Healthcare Law Online Resources, on its website. The page has a section for employers as well as individuals that has links to employer resources for information on health insurance, tax/legal responsibilities, and small business resources.

The link to health insurance information has a quick survey to help employers and individuals get to the best plans and prices for their needs.  The Small Business Health Options Program (SHOP) is a new way for a small business to buy high-quality health insurance for its employees. The Marketplace opens for business on Oct. 1, 2013.

The tax benefits and responsibilities link goes to the IRS webpage for Affordable Care Act (ACA) tax provisions.

The link to small business resources contains information from the site on the key provisions in the ACA.

The link for legal guidance on the labor provisions is to the U.S. Department of Labor’s webpage on the ACA. The web page includes ACA regulations and guidance.

The U.S. Government business portal link includes a link where employers may learn about the new health care changes. There is a wizard that asks a series of questions (e.g., “How many full-time equivalent employees do you have?”) to help employers determine how they are affected by the new health care law.

Thanks to RIA Payroll Newsletter for up-to-the minute tips on this quickly development for large and small employers alike.

January 1, 2014 (as of now, anyway) the Health Insurance Marketplace will open, meaning more work on the employers part for providing health insurance to employees.

Open enrollment begins October 1, 2013. If I wasn’t in payroll, I wouldn’t have a clue about this. There’s been little media coverage, and the Department of Labor (DOL) isn’t known for their promotional expertise.

The Affordable Care Act created new requirements for FLSA that say the employer must provide a notice with specific information to employees about the Marketplace. This notice has to be provided by October 1, 2013.

What has to be on the notice? A model letter is available at . It’s a bit lengthy at 3 pages, but it seems very comprehensive. You can get more information on .