The ABCs of 401(h) Plans For Humana Employees

Healthcare Provider Update: Humana is one of the largest health insurance companies in the United States, primarily offering a range of Medicare Advantage plans, individual and family health insurance, and group health plans for employers. As we look towards 2026, healthcare costs are expected to rise significantly, with many experts forecasting increases in health insurance premiums across various states. For Humana, the pressure stems from a confluence of factors including the anticipated expiration of enhanced federal premium subsidies under the Affordable Care Act (ACA) and rising medical costs. The Kaiser Family Foundation projects that without renewed subsidies, a staggering 92% of ACA policyholders could face premium hikes of over 75%, making 2026 one of the most challenging years for consumers navigating their healthcare finances. Factors like escalating hospital and drug costs, aggressive rate increases by insurers, and overall economic conditions contribute to this inflationary trend. Click here to learn more

'Employees of Humana companies who are about to retire should understand the benefits of 401(h) plans as it is a good way to reduce the tax liability and to secure the medical costs for themselves and their families thus ensuring a better approach to the healthcare in retirement.'

It is important for Humana retirees to understand the structure of 401(h) plans because the moneys that can be contributed and the time that can be saved on medical expenses will help to decrease the impact of the increasing healthcare costs and will help to establish a solid financial situation for the retirees and their families.'

In this article we will discuss:

1. The effects of the rising medical costs on health insurance premiums in 2023.
2. Basic information about 401(h) eligible retiree medical benefit accounts for Humana companies' employees.
3. The pros and cons of using 401(h) plans for healthcare and retirement purposes.

The average increase in premium that health insurance plans have requested for 2023 is 10%; some plans have asked for an increase of between 5 and 14 percent. However, this year, 72 providers submitted their plans, and only four of them show a reduction in the prices. This is because the cost of health care is rising.

In their submissions for 2023, many insurers expect that the cost of health care will rise by 4 – 8 percent. The behavior of the costs reflects the prices that the plans pay for hospitals, doctors, and drug makers because of the inflation and the prices that the plans expect the patients to incur in the following year. The Humana company employees who are eligible for 401(k) plans should learn how to optimize it to the maximum extent. Here is a summary of the most important information about these plans:

Summary of Discussion:

Retirees of Humana should know that it is a retiree medical benefit account that is established within a defined benefit pension plan to pay benefits for illness, accident, and hospitalization for retired employees, their spouses, and their dependents. It is essential to comprehend that Sections 401(h)(1)-(6) of the Internal Revenue Code must be met in order for payments to be made.

Education

Internal Revenue Code section 213(d) defines medical expense as amounts paid for medical care (1). This includes costs related to:
I. Transportation mainly for and necessary to medical care, qualified long term care services or insurance (including Medicare Part B premiums and qualified long term care insurance premiums).

It is important for retired Humana employees to know that the language of the plan document determines the schedule of distributions, the scope of coverage, and who is eligible for the plan. A 401(h) account cannot have discrimination in coverage, contribution, and benefit in favor of officers, shareholders, supervisory employees, or highly compensated employees. A 401(h) contribution is not permitted to exceed the total cost of providing the benefits, which must be amortized over the duration of prospective service.

In compliance with Section 1.401-14(c) of Treasury Regulation 1.401, a qualified 401(h) account must provide:
Pension benefits must take precedence over retiree medical benefits. The 401(h) medical benefits of the retirees must be placed in a separate account in the pension trust.

Except for key personnel, the account for the benefits of the employee, or the employee’s spouse or dependents, must be held in a separate account. Furthermore, this account can only be used to pay for the employee’s medical benefits. The contributions from the employer to the account must be reasonable and quantifiable.

Contributions to 401(h) accounts made during or after the tax year must be used to pay for medical plan benefits. These contributions are non-transferable and cannot be used for any other purpose. Furthermore, the plan must provide that any balance remaining in the 401(h) account must be reversed to the employer at the time of liquidation of the plan’s obligations for the retiree medical benefits.

Humana retirees should be aware that the subordination requirement is incomplete until the plan demonstrates that the total contributions for retiree medical benefits do not exceed 25 percent of total contributions. The 25% includes the actual contribution to the life insurance part of the plan (but excludes the contribution to fund past service credits).

This restriction is meant to ensure that medical contributions are subordinate to pension contributions. It is also important for Humana retirees to know that plan sponsors with overfunded, terminating defined benefit plans are allowed to make tax-free contributions (known as) to the related 401(h) accounts. Furthermore, there are restrictions that need to be taken into account, namely the amount transferred is not considered as a taxable reversion. The provision expires on December 31, 2025, or the asset transfer occasioned by December 31, 2025.

The Positives of 401(h) Plans

Deductible:

Employers can claim deduction on their tax returns up to a certain limit. There is no provision for the arrangement to be made for contributions that are beyond the total benefits cost.
Benefit is tax-free for retirees.

The funds are taxed on the way out, and the distributions are tax-free if they are made for the purposes of medical expenses.
The amount that can be contributed annually to the plan by employers is not restricted and can be anything from zero to 25%. They are not required to contribute, but they have the option to do so.

Humana employees who are interested in the possibility of maximizing their retirement benefits may be interested in knowing that contributions made to 401(h) accounts can be used to pay for qualified medical expenses that include spouses and children, and dependents. This enables retirees to go beyond the healthcare needs of the 401(h) plan and use the funds to support the medical costs of their relatives and friends. As we explained above, 401(h) plans are tax-compliant and flexible, and when used correctly, they can help retirees design a sound healthcare strategy that includes their families.

The Drawbacks to 401(h) Accounts

The plan itself is complicated and comes with expensive setup and management fees. Because it is not an IRS-approved plan, it operates with more time, administration, and supervision needed.
Employers have to keep the account open until all the retirees have used up their medical account benefits.
Actuaries are often needed to manage and supervise the account, but they can be hard to find.

The conclusion of the Pharmaceutical and Biotechnology Association (BPIA) indicated that its members raised the prices of arthritis and cancer medicines and other prescriptions by 5.6% at the beginning of this year. This means that a Humana retiree with a 401(k) may be in a better position (h). Furthermore, a large number of pension plan sponsors may be inclined to fund retiree medical costs through 401(h) accounts. Humana employees who are considering this plan are entitled to employer and/or employee contributions, as well as transfers of excess pension benefits, if permitted by the plan terms.

The contributions are deductible, the earnings are taxed on the accrual basis, and the withdrawals are tax-free for 401(h) accounts. Those Humana retirees who are not very sure how their 401(h) works may benefit from seeking professional financial advice. We at The Retirement Group will help you get a free cash flow analysis and talk to a consultant who will help you identify which decision is most appropriate for you.

Anybody, whether male or female, can be compared to a chef in the kitchen. The chef has the responsibility of preparing meals for his guests and therefore has to make sure that everyone gets the food that they want. The chef also knows that the enjoyment of the meal is not only limited to the consumer’s plate but also the company’s plate as well. In this analogy, the chef represents the Humana employees who are about to retire while the meal represents their retirement benefits. Just as the chef takes into account the diverse tastes and preferences of the guests, Humana employees must consider the overall needs of their retirement.

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Like a buffet, the 401(h) plan is a menu of choices that can help the financial health of the employee and his or her dependents. With each course as a different aspect of their retirement plan, from pension benefits to medical expenses, the chef prepares the meal to ensure everyone gets something out of it. In the same manner, Humana employees can choose the various components of the 401(h) plan to develop a full retirement plan that will benefit not only their financial situation but also that of their families. In the same manner that the chef’s attention to detail will improve the overall experience of the meal, the proper application of a 401(h) plan can positively affect the career of a Humana employee and his or her family

Sources: 

1. Health Affairs. 'Health Insurance Premiums: Average Family Premium Hits $23,968 in 2023.'  Health Affairs , 2023,  healthaffairs.org/doi/10.1377/hlthaff.2023.00996 .

2. MissionSquare Retirement. '401(h) Retiree Health Account.'  MissionSquare Retirement ,  missionsq.org/products-and-services/401%28h%29-retiree-health-accounts.html .

3. Groom Law Group. 'IRS Rules that Payment of 401(h) Account Benefits to Pension-Eligible Active Participants Won't Jeopardize Plan Qualification.'  Groom Law Group , 2023,  groom.com/resources/irs-rules-that-payment-of-401h-account-benefits-to-pension-eligible-active-participants-wont-jeopardize-plan-qualification .

4. American Society of Pension Professionals & Actuaries. 'Retiree Health Accounts Under Section 401(h).'  ASPPA , 2019,  asppa-net.org/news/2019/4/retiree-health-accounts-under-section-401h .

5. Emparion. 'Pros and Cons of 401(h) Accounts Plans.'  Emparion , 2023,  emparion.com/pros-and-cons-of-401h-accounts-plans .