Things are changing and evolving in the healthcare insurance world.

Health Savings Accounts (HSAs) are tax-sheltered accounts dedicated to medical expenses, which can be accessed by check or debit cards for medical bills and insurance costs. Any balance at the end of the year carries over in your name.

In addition to HSAs, there are Flexible Spending Accounts (FSAs) of pre-taxed money deducted from your paycheck for insurance premiums and un-reimbursed medical expenses. Employers may contribute to FSAs.

Health Reimbursement Accounts (HRAs) are similar, but fully employer-sponsored.

These types of accounts were given congressional approval in January, according to Ty Tabor, sales and marketing director for KPS Health Plans.

Tabor lists other changes. There is a continuation of cost shifting from employers to employees, which has become more prevalent as healthcare costs rise to where employers cannot afford the same level of coverage.

Tabor mentions the popularity of higher deductibles to keep insurance premiums down. Finally, he names the move toward health maintenance and disease management as one of the major changes in healthcare coverage.

Tabor says insurance carriers must be creative to meet the needs of consumers. KPS offers a wide range of plans through employers and local Chamber of Commerce.

Chris Jarvis, communications manager for Premera Blue Cross, says a new suite of products, called Premera Dimensions, fit right in with the new medical accounts. They allow for greater flexibility for the consumer, who may choose to bundle, or mix and match, including selection of a specific network of providers. People can find what fits them best, he says, allowing the rigid rules of the past to go by the wayside.

These consumer-directed health plans will give people more of a feel for how much healthcare costs, as they are brought into making informed decisions, including financial ones.

Diana Elser, director of market research and analysis for Group Health sees a “sticker-shock” phenomenon coming, as consumers realize the cost of seeking the latest in pharmaceuticals and technology being advertised directly to the public.

As long as patients are separated from the cost of services, they will continue to demand more. “We all want the best and latest, especially if we don’t have to pay for it.” Elser says insurance was never intended to cover all expenses, but to create pools to spread the risk. As the higher risk and poor were removed from those pools, the demands on insurance increased, and before long, she believes, government will have to “sort it all out.”

She believes the HSAs aren’t accessible to the poor, but only to those who can afford to “buy their way out.”

Furthermore, the availability of healthcare is different between urban and rural areas. Whatever future fix occurs must recognize that location is a factor in cost.

“Group Health’s strength is and always has been that we offer a system,” says Elser. With doctors on salary, there is no financial incentive to send a patient for excessive tests. Physicians have access to research readily available without having to do the background work themselves. They have access to specialists for consultation.

Although Group Health does not offer complete choice, it has contracts with various hospitals, and offers services in the majority of counties in the state.

“One of the slickest things Group Health has,” says Elser, is its online support. A patient may see, via the Internet, his or her medical records, make an appointment, receive test results and email non-urgent questions to the doctor. Group Health’s 24-hour consulting nurses likewise have access to the patient’s file before giving advice.