That’s Eligible?! FSAs and Drug-Free Pain Management

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“That’s Eligible?! FSAs and Drug-Free Pain Management”

 By: Tabitha Jean Naylor

Many Americans suffer from some form of chronic pain. While over-the-counter medication can provide relief, many people prefer a drug-free option to help manage their pain long term. As technology advances, more and more options are now available for people to find drug-free pain relief right in their own home.

Many of these treatments are eligible for FSA reimbursement, meaning you can put your tax-free dollars to work.

Hot and cold pack and wraps

Hot and cold therapy is a popular option for many different kinds of aches and pains because of their simplicity and effectiveness. Most of these can simply be heated in the microwave or left in the freezer to cool. These treatments can be used to treat a variety of ailments, from swelling and inflammation to injury relief and rehabilitation.

Athletic support tape

Brands like KT Tape allow for better muscle movement, providing support, and quickening the healing process. It’s especially popular with athletes for pain relief, inflammation reduction, muscle relaxation, and injury recovery.

Many people choose to wear KT Tape during sporting events for the added muscle support and pain prevention. It is also used to help increase lymphatic drainage and improve blood flow. Because of its many benefits, KT Tape is popular with people for prevention and pain relief.

TENS units

TENS units work by using stimulating pulses to prevent pain signals from reaching the brain. These units send electrical impulses to the muscles and stimulate your nerves, which works to confuse pain signals received by your brain. They also help stimulate the production of endorphins, which are a natural pain reliever. For people with chronic pain, endorphins help to eliminate the discomfort and can even work as a mood booster.

Acupressure mats

Acupressure mats are a simple and drug-free method of pain relief. All you need to do is make contact with the mat to relieve pain and tension. Most people close to either stand or lie down on them which allows the spikes on the mat to put pressure on your acu-points and relieve pain.

Additionally, acupuncture is an extremely popular form of drug-free pain management. While you can’t do it yourself in your own home like the other options on this list, many people find the trip to the specialist to be well worth their while. If using your FSA, make sure to ask your administrator if they’ll require any specific type of documentation, such as a Letter of Medical Necessity, to allow the expense.

Supports and braces

Supports and braces are a popular option for people who are experiencing joint pain or to assist with rehabilitation after an injury. Some athletes also use them to prevent injuries while playing sports. Braces come in many shapes and sizes to fit different joints and provide different levels of support.


2020 Limits to Know

Many benefit plan limits have changed for the new calendar year. Here’s what those changes are:

Flexible Spending Accounts (FSA) Limits

  • Contributions: $2,750 (up $50 from 2019)
  • Employer may contribute greater of $500 or 100% match.

Commuter Benefits

  • Mass-Transit & Vanpool – $270 per month (up $5 from 2019)
  • Parking – $270 per month (up $5 from 2019)

Health Savings Account (HSA) Limits

Pre-tax contributions (all sources)

  • Single coverage: $3,550 (up $50 from 2019)
  • Family coverage: $7,100 (up $100 from 2019)

Catch-up Contributions (age 55 by 12/31/2020) $1,000 (no change)

High Deductible Health Plan (HDHP) Limits

  • Minimum deductible

    • Single coverage: $1,400 (up $50 from 2019)
    • Family coverage: $2,800 (up $100 from 2019)
  • Maximum Out-of-Pocket Costs

    • Single Coverage: $6,900 (up $150 from 2019)
    • Family Coverage: $13,800 (up $300 from 2019)

For more information on any of these limits, please contact gente today.

2020 FSA and Commuter Limits Announced

Washington D.C. – Better late than never, the IRS finally announced the much-anticipated increases to Flexible Spending Accounts and Commuter Benefits for 2020.


For Healthcare Flexible Spending Accounts with plan years beginning on or after January 1, 2020, the maximum election has increased from $2,700 to $2,750.


The “Use-It-or-Lose-It” provisions of the 2.5 month Grace Period or the $500 Carryover remain unchanged.


For Commuter Benefits Programs, the monthly limit has increased from $265 to $270 for both mass transit and employment-related parking expenses for months on or after January 2020.


Dependent Care Assistance Program limits of $5,000 for taxpayers filing as Married Filing Jointly, and $2,500 for all other tax filers remain unchanged.


Please reach out to us with any questions on your plan.


Expanded Preventive Care for Chronic Conditions Covered Under HDHPs and HSAs

In response to the June 24 Executive Order, the Treasury and the IRS, in consultation with HHS, have determined, via Notice 2019-45, that certain low cost medical services received and items purchased, including prescription drugs, for chronic conditions should be classified as preventive care for those with that chronic condition.

While the notice is effective immediately, we anticipate it to impact plans upon renewal. We will update the blog as we learn more.

IRS Announces 2020 HSA Limits

The IRS has announced the 2020 HSA limits with the publishing of Revenue Procedure 2019-25, posted in its entirety below.

Deductibles must be at least $1,400 for a single, or $2,800 for family coverage while contributions are limited to $3,550 for a single and $7,100 for family coverage. These represent $50 increases in deductible and contribution limits for singles, and $100 increases for families.

Rev. Proc. 2019-25


This revenue procedure provides the 2020 inflation adjusted amounts for Health Savings Accounts (HSAs) as determined under § 223 of the Internal Revenue Code.


Annual contribution limitation. For calendar year 2020, the annual limitation on deductions under § 223(b)(2)(A) for an individual with self-only coverage under a high deductible health plan is $3,550. For calendar year 2020, the annual limitation on deductions under § 223(b)(2)(B) for an individual with family coverage under a high deductible health plan is $7,100.

High deductible health plan. For calendar year 2020, a “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,400 for self-only coverage or $2,800 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,900 for self-only coverage or $13,800 for family coverage.


This revenue procedure is effective for calendar year 2020.

MTA Fares to increase on 4/21

Effective April 21st, the MTA will be raising fares for riders.

Weekly Metrocards will increase to $33 from $32

Monthly Unlimited Metrocards will increase to $127 from $121

As a reminder, if there aren’t enough funds on the card to cover the transaction, the card will decline the purchase.

Anyone currently contributing just enough to cover their MTA expenses should plan ahead and submit the form linked here.

Once your employees have updated their elections and payroll has been adjusted to match, the forms can be submitted to Admin Support for timely processing.

2019 Limits to Know

The ACA Remains in Place After Being Struck Down by Federal Court


  1. A federal judge ruled that the entire ACA is invalid due to the elimination of the individual mandate penalty.
  2. This ruling is expected to be appealed and will likely be taken up by the Supreme Court.
  3. The ACA will remain in place pending appeal.


On Dec. 14, 2018, a federal judge ruled in Texas v. United States that the entire Affordable Care Act (ACA) is invalid due to the elimination of the individual mandate penalty in 2019. The decision was not stayed, but the White House announced that the ACA will remain in place pending appeal.

This lawsuit was filed by 20 states as a result of the 2017 tax reform law that eliminates the individual mandate penalty. In 2012, the U.S. Supreme Court upheld the ACA on the basis that the individual mandate is a valid tax. With the penalty’s elimination, the court in this case ruled that the ACA is no longer valid under the U.S. Constitution.


This ruling is expected to be appealed and will likely be taken up by the Supreme Court. As a result, a final decision is not expected to be made until that time. The federal judge’s ruling left many questions as to the current state of the ACA; however, the White House announced that the ACA will remain in place pending appeal.


The ACA imposes an “individual mandate” beginning in 2014, which requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. In 2011, a number of lawsuits were filed challenging the constitutionality of this individual mandate provision.

In 2012, the U.S. Supreme Court upheld the constitutionality of the ACA in its entirety, ruling that Congress acted within its constitutional authority when enacting the individual mandate. The Court agreed that, while Congress could not use its power to regulate commerce between states to require individuals to buy health insurance, it could impose a tax penalty using its tax powerfor individuals who refuse to buy health insurance.

However, a 2017 tax reform bill, called the Tax Cuts and Jobs Act, reduced the ACA’s individual mandate penalty to zero, effective beginning in 2019. As a result, beginning in 2019, individuals will no longer be penalized for failing to obtain acceptable health insurance coverage.

Texas v. United States

Following the tax reform law’s enactment, 20 Republican-controlled states filed a lawsuit again challenging the ACA’s constitutionality. The plaintiffs, first, argued that the individual mandate can no longer be considered a valid tax, since there will no longer be any revenue generated by the provision.

In addition, in its 2012 ruling, the Supreme Court indicated (and both parties agreed) that the individual mandate is an essential element of the ACA, and that the remainder of the law could not stand without it. As a result, the plaintiffs argued that the elimination of the individual mandate penalty rendered the remainder of the ACA unconstitutional.

The U.S. Justice Department chose not to fully defend the ACA in court and, instead, 16 Democratic-controlled states intervened to defend the law.

Federal Court Ruling

In his ruling, Judge Reed O’Connor ultimately agreed with the plaintiffs, determining that the individual mandate can no longer be considered a valid exercise of Congressional tax power. According to the court, “[u]nder the law as it now stands, the individual mandate no longer ‘triggers a tax’ beginning in 2019.” As a result, the court ruled that “the individual mandate, unmoored from a tax, is unconstitutional.”

Because the court determined that the individual mandate is no longer valid, it now had to determine whether the provision is “severable” from the remainder of the law (meaning whether other portions of the ACA can remain in place or whether the entire law is invalid without the individual mandate).

In determining whether the remainder of the law could stand without the individual mandate, the court pointed out that “Congress stated three separate times that the individual mandate is essential to the ACA … [and that] the absence of the individual mandate would ‘undercut’ its ‘regulation of the health insurance market.’ Thirteen different times, Congress explained how the individual mandate stood as the keystone of the ACA … [and,] ‘together with the other provisions’ [the individual mandate] allowed the ACA to function as Congress intended.” As a result, the court determined that the individual mandate could not be severed, making the ACA invalid in its entirety.

Impact of the Federal Court Ruling

Judge O’Conner’s ruling left many questions as to the current state of the ACA, because it did not order for anything to be done or stay the ruling pending appeal. However, this ruling is expected to be appealed, and the White House announced that the ACA will remain in place until a final decision is made. Many industry experts anticipate that the Supreme Court will likely take up the case, which means that a final decision will not be made until that time.

While these appeals are pending, all existing ACA provisions will continue to be applicable and enforced. Although the individual mandate penalty will be reduced to zero beginning in 2019, employers and individuals must continue to comply with all other applicable ACA requirements. This ruling does not impact the 2019 Exchange enrollment, the ACA’s employer shared responsibility (pay or play) penalties and related reporting requirements, or any other applicable ACA requirement.

The IRS has released Cost of Living Adjustments for 2019

Modest increases for FSA and Commuter Benefits
Healthcare FSA – $2,700 (up from $2,650 in 2018)
Qualified Transit – $265 per month (up from $260 in 2018)
Qualified Parking – $265 per month (up from $260 in 2018)
Dependent Care Assistance – $5,000 per couple, $2,500 for an individual (same as 2018)
For all employers with a Healthcare FSA maximum of $2,650, we will assume that they wish to increase the annual maximum to $2,700 for the 2019 plan year and will adjust the plans and documents accordingly. If, for any reason, the plan sponsor does not want to make such a change, simply email to let us know.
The full text of IRS Revenue Procedure 2018-57 can be read here.

Planning your election: Tips and tricks to guide how much money you should put in your HSA or FSA account.

The basic premise:

Tax-advantaged benefit accounts – like health savings accounts (HSAs) and flexible spending accounts (FSAs) – were created to help save and pay for healthcare in a tax-protected manner. Simply stated, every dollar you put into one of these accounts is worth more (up to 30% more!), because you don’t get taxed on the money you put in – and, your IRS-reportable income is decreased by however much you contribute. The phrase “free money” comes to mind for many.

The reality of the situation is this: Regardless of what health insurance plan you choose to participate in next year, you really should open and fund a tax-advantaged benefit account. It’s rarely a matter of should you enroll, but rather how much should you contribute to your account.

Planning and calculating your election:

While many election planner calculators exist to help you better understand your individual healthcare and financial situation, there are some important things you should understand and consider – because deciding how much money to put in isn’t always a perfect science:


  1. How much did you spend on healthcare last year? If last year was a normal healthcare year for your family, consider funding up to the lower of the two figures: (1) last year’s total spend, or (2) the IRS limit for the account. If you’re going to spend, get the maximum tax savings.
    • HSA 2019 IRS Limit:$3,500 for an individual and $7,000 for a family
    • FSA 2019 IRS Limit: $2,650
  1. To the best of your ability, predict the health expenses your family will incur next year and the costs of these expenses. Add up all your prescriptions, doctor visits, surgeries, orthodontia, and other anticipated costs. The sum of these costs can be a great minimum starting point for your election. At a minimum, contribute what you know you’ll spend for certain.
  2. What’s your deductible? If you’re not sure what you’ll spend, putting enough money in to cover your deductible is a great strategy. If you’re someone who typically reaches your deductible, you might as well reap the tax benefits of using your account to pay for your deductible.
  3. What will you do with extra funds?If you find yourself half-way through the plan year having used less money than planned, don’t worry.
    • For HSAs, unused funds roll over year to year, can be invested, and grow tax-free – turning the account into a long-term investment vehicle that helps you save for future healthcare expenses.
    • For FSAs, there are several great ways to leverage funds, like: Family planning, eye care, contact solution, acupuncture, sun block, and more.
  1. Arguably the hardest part of healthcare budgeting is planning for the unexpected. If you’re typically a high healthcare user, it will probably benefit you to increase your election by adding some ‘buffer funds’ on top of what you know you’ll spend. If you’re generally healthy and a relatively low healthcare user, you may consider forgoing additional wiggle room.

The bottom line

If there was a way to perfectly predict your healthcare spending, you wouldn’t be reading this. But, budgeting your healthcare finances can be downright challenging. The good news:


  • Tax-advantaged benefit accounts give you a little tax-protected help to save on healthcare expenses
  • Our election planning calculator helps you run different election/spending scenarios to help your decision making
  • For HSAs, the money in the account is yours, carry’s forward year to year, and any interest or other earnings on the account are tax free
  • For FSAs, if you over-fund the account, there are many everyday items you can purchase with your FSA. It’s better to over-fund then under-fund and miss the tax savings altogether.


Many people fail to realize the tax and retirement savings potential associated with tax-advantaged benefit accounts – do your homework, use these tips, predict your spending, and rest assured you’re doing your best to save for healthcare expenses.