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If you're one of the 20 million or so Americans with a flexible spending account for health care, watch for some changes next year. NPR's Julie Rovner explains how these accounts work and what's at stake for those who have them.

JULIE ROVNER: Flexible spending programs have been growing in popularity in recent years, particularly as the cost of health care has risen. The idea is fairly simple, says Kelly Traw of the benefits consulting firm Mercer. Workers have a portion of each paycheck withheld, before taxes, and deposited into the FSA. Then they draw that money down during the year to pay for whatever health expenses their health insurance doesn't cover.

Ms. KELLY TRAW (Mercer): So, for example, some very common items are things like eyeglasses, kids' orthodontia, those types of expenses that aren't necessarily covered by the medical benefit plan but certainly are a medical expense that folks often incur.

ROVNER: Of course every dollar that goes into an FSA is a dollar that person doesn't pay taxes on, so it costs the government money, something in the neighborhood of about $4 billion a year. So earlier this year, when lawmakers were trying to find ways to finance the new health law, they decided to make flexible spending accounts, well, a little less flexible, to get some of that money back. The first change comes this January 1st, says Traw.

Ms. TRAW: No longer will employees be able to use their health FSAs for medicines or drugs that are not prescribed by their physicians. So there'll be a limit on the over-the-counter type medications that folks can use their health FSA's to reimburse.

ROVNER: In other words, you won't be able to use your FSA to buy aspirin or Tylenol, or, for that matter, drugs that you used to need a prescription for but don't anymore, things like the popular allergy drug Claritin or the heartburn remedy Prilosec.

Now, there's a loophole. The law says you need a prescription for it to be reimbursable from your FSA. But there's nothing to stop a doctor from writing a prescription for even an over-the-counter drug.

Ms. TRAW: So if it was an item that you can obtain a prescription for, and you get that prescription, then you can indeed use a health FSA to reimburse that.

ROVNER: A lot of people think that loophole may lead to a lot of extra trips to the doctor. Dennis Triplett heads a coalition of employers who tried to stop the changes to the accounts.

Mr. DENNIS TRIPLETT (Employers Council on Flexible Compensation): It makes no sense - the whole notion of overburdening, you know, doctors to write prescriptions for aspirin or Claritin or something, just again is so wasteful.

ROVNER: Triplett's day job is at a bank that administers FSAs and other tax-preferred accounts.

Also lining up in opposition to the changes are the people who sell over-the-counter drugs. The National Association of Chain Drug Stores is asking for a two-year delay in the new restrictions. It's worried about problems with computer systems being able to distinguish between drugs sold with and without prescriptions. Chris Krese is a senior vice president with the group.

Mr. CHRIS KRESE (National Association of Chain Drugs Stores): Maintaining access to products that keep people healthy and that make people feel better, those are very wise short term investments, because often they can prevent higher cost long term alternatives.

ROVNER: And of course Congress is getting into the act. At least three separate bills have been introduced that would repeal the changes to the flexible spending account provisions.�

But if you're one of those workers who has to decide in the next few weeks how much to put in your account for next year, you might be wise not to plan for the cost of those over-the-counter medications. Just to be safe. One thing that isn't changing - if you don't use up all the money in your FSA at the end of the year, you still lose it.�

Julie Rovner, NPR News, Washington.

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