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Additionally, some have feared that MSAs could be used by the very wealthiest -- who can pay out of pocket for even the most expensive care -- simply as a tax shelter.

Partly in response to these criticisms, the HIPAA law capped the number of allowable MSAs at 750,000 and limited them to self-employed individuals or employers with less than 50 workers. It also imposed minimum deductible requirements and restrictions on amounts that could be contributed to accounts.

Since that time, less than 100,000 MSA accounts have been formed. Scandlen says the restrictions have inhibited the growth of MSAs unnecessarily. He also disputes the notion that such accounts are only for the wealthy and healthy, citing research by the Rand Corporation showing that MSAs have broad appeal across income groups.

Now, there is reason to believe that the vision of MSAs may not have faded entirely. One patients' bill of rights proposal, sponsored by Republicans in the House of Representatives, contains a provision that would remove the restrictions currently imposed on MSAs. And during his campaign, President George W. Bush expressed support for medical savings accounts.

Scandlen also says that some businesses confronting high employee healthcare costs are beginning to develop MSA-like products for their workers -- even if they are not being called medical savings accounts.

"The same notion is taking on different forms," Scandlen says. "When HIPAA first passed, most [employers] were moving toward managed care. In the past five years, that attitude has changed dramatically. Now large employers are thinking that some kind of cash account for employees to pay directly for services makes sense."

Still, he acknowledges that only 20-25 insurance companies are offering MSA products -- most of them small companies that still offer indemnity-style insurance. "Until the big guys get in, I don't see a lot of growth," he says.

So while they are not the hot ticket they were five years ago, MSAs should probably be kept in sight -- if only out of the corner of one's eyes.

Are they good for you?

"They are good for the wealthy, and they are relatively good for the healthy as long as they remain lucky and don't get sick and can accumulate enough to cover their deductibles," Nichols tells WebMD. "There are some cases where people who have a chronic illness but have relatively low expenses can benefit because the premium is lower and the contribution is tax deductible."


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