Health Savings Accounts: More Time, Less Money

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"For the most part, the consumer has no visibility into what medical services or pharmaceuticals cost and no clear process on how to 'negotiate' a better deal," says Zimmerman, who uses an HSA.

When Zimmerman called a lab company prior to recent blood work, she says she got nowhere trying to obtain cost information. "Prescriptions are typically mail-order only; another huge insult to the consumer, who is reduced to an account number and a plan designation," Zimmerman says.

The Ugly

Another frequent complaint HSA customers have is the extensive runaround you often encounter when using your HSA. Earlier this year, Norman Wu, who runs Qliance, a primary-care medical practice in Seattle, went on a wild goose chase after his wife had a physical in his office. His colleagues recommended that she get a bone-density scan, a mammogram, and a carotid ultrasound. Since Wu's office did not offer those tests, his wife was referred to outside providers.

But none of the specialists was able to tell the Wus how much they would pay if they ran the medical costs through their insurance company to take advantage of a contracted rate. "They'd say, 'You have to call our business office.' The business office would say, 'You should call your insurance company.' The insurance company would say, 'It depends. Is the physician billing it as a facility or a group?' How would [my wife] know?" Wu says. "She had no idea what they were even talking about!"

But perhaps the scariest thing about HSAs is the market risk. HSAs work like a 401(k), which means you invest the proceeds in a mutual fund or other savings vehicle. Most HSA plans offer four to eight investment options, including stock funds, says Alexander Domaszewicz, principal at Mercer Health and Benefits in Newport Beach, Calif.

And those, of course, are down almost 38% for the year, according to fund-tracker Morningstar (MORN). With nearly $4 billion invested in health savings accounts, diminished account balances must sicken some investors, although the majority of HSA assets—as much as 95% in some plans—are stashed in money market or stable-value funds. "The average person is still feeling their way around how they spend and save money" in HSAs, Domaszewicz says.

Billet, the well-versed benefits consultant, has three-quarters of his HSA invested in stock funds. "I haven't looked at my account yet, but I can assume it is down a lot," he says. "Thankfully, I won't need to use it for at least 10 years," so there's a chance it will recover.

Domaszewicz, meanwhile, invested the maximum contribution of $5,650 for his family in an HSA last year. It was worth about $4,000 when he last checked in early October. "Luckily, I'm just 40," he says. "I've got a ways to go before I need that money."

Young is a Personal Business editor for BusinessWeek .