When Robert Payne, 61, needed back surgery last year, he said he wasn't worried about how to pay for it. Payne, a self-employed architect in Richmond, pulled $5,500 -- the amount of his health insurance deductible for such procedures -- from a savings account he uses exclusively for medical expenses. His insurance covered the rest.

Payne had a medical savings account (MSA), the predecessor to the health savings accounts (HSAs) created by federal law in December. Payne and his wife, Jebbie, 62, switched to an HSA in January, sold on the do-it-yourself philosophy that undergirds both types of health insurance vehicles. The more than $30,000 they had accumulated in their MSA over seven years transferred to their new HSA plan.

That plan, like all HSAs, has a high deductible (at least $1,050 a year for individuals; $2,100 for families), a low premium and a mechanism for saving for the future. And along with other HSAs, it's carrying some policymakers' hopes this season that such plans will help curb rising health care costs.

Since the plans haven't been around long, few people report enough experience to vouch for their usefulness, though more businesses and insurers are expected to offer them in coming years. The launch of "open season" for federal employees -- when government workers choose their health plans for 2005 -- is also expected boost enrollment in HSA plans.

Some early HSA adopters, like Payne, have had largely good experiences.

HSA proponents say consumers who have to pay in full for their own medical expenses -- at least until they've met a large deductible -- will make responsible decisions on how and when they seek care. That means some may wait until Monday morning to have a doctor look at their sore throat instead of making a more expensive emergency room visit on Saturday night. But opponents say the plan could backfire by encouraging consumers to forgo needed medical care because they want to save money.

Some consumers who've already signed up for the plans point out other shortcomings. Patty Delony, a Chicago business and financial writer, signed up for an HSA plan in September. The 56-year-old quickly made her first deposit -- $750 (the prorated maximum amount she was allowed to deposit since she joined near the end of the year) -- and began paying her $277 monthly insurance premium. But two weeks later, the debit card linked to her HSA account was stolen.

The theft prompted a dispute between Delony and the bank that administers her HSA account over a $600 charge for a cell phone that had been made with the stolen card. Late last week the bank agreed to credit her account, but Delony is still waiting for a replacement card. Despite these frustrations, Delony said she plans to keep her HSA, though she may find another bank to host her account.

"Like most self-employed people, I'm always struggling to find health insurance," Delony said. "This is the first time [a health plan] made financial sense."

A California father of seven found another benefit in HSAs: flexibility. Wayne Modugno, a self-employed construction manager, set up an HSA linked to his family's existing preferred provider network (PPO) health insurance plan. Modugno, 49, said they use the account to pay for a variety of medical needs, including doctor's office visits, dental care, prescriptions and over-the-counter medications. They put about $5,000 into the plan this year and pay a $790 monthly premium.

"It's a fairly long list of things that [an HSA account] can be used for," said Modugno. "It's easy to keep track of . . . Before, it was really hard to keep your records straight."

Modugno said no one in his family has chronic health conditions. This year, the family used much of their HSA savings on braces for three of the children and a hernia operation for their 1-year-old.

"Health insurance is very, very expensive," said Modugno. "This is just another benefit that we're taking advantage of to ease some of our tax burdens to carry the deductibles for health care."

The Paynes pay about $321 a month for health insurance through Indiana-based Medical Savings Health Plan.

HSAs offer some features that make them more attractive than MSAs to older adults. People over 55 are allowed to invest $500 more annually in their HSAs than younger adults, helping them build a larger safety net for unexpected health problems or a nest egg for retirement. The additional amount they're permitted to invest will grow by $100 a year through 2009. MSAs, like the one Payne had before switching, did not offer such a "catch up" provision.

Payne and his wife deposited $3,862 into their HSA this year. He said that the coverage -- and the savings component -- are ideal for them. When they reach age 65, the fund can be used for nonmedical purchases without penalty, though they would have to pay income taxes on such expenses.

Still, Payne said, it's comforting to have the money there.

The HSA plan "allows me to put away a considerable amount of money for those emergencies," Payne said. "We've built up a pretty good reserve."

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