Does your health insurance come with deductibles in the four figures? If so, you're probably eligible to establish a Health Savings Account (HSA). Used in combination with a High-Deductible Health Plan (HDHP), funds deposited in an HSA can go towards paying medical bills until the plan's deductible is met and your healthcare coverage kicks in.
HSAs were established in 2003 as part of the Medicare Prescription Drug, Improvement, and Modernization Act. These savings accounts have become an increasingly popular option for consumers seeking to manage their healthcare costs. They also work as a tax-advantaged savings tool as well.
- An HSA lets you set aside pre-tax income to cover healthcare costs that your insurance doesn't pay.
- You can open an HSA if you have a qualifying high-deductible health plan.
- For the 2022 tax year, the maximum contribution amounts are $3,650 for individuals and $7,300 for family coverage. For 2023, the maximum amounts are $3,850 for individuals and $7,750 for families.
- If you are 55 or older, you can add up to $1,000 more as a catch-up contribution.
- HSAs have no use-it-or-lose-it provision. Any funds still in the plan at the end of the year can be rolled over indefinitely.
Who Can Open a Health Savings Account?
According to the federal guidelines, you can open and contribute to an HSA if you:
- Are covered under a qualifying high-deductible health plan which meets the minimum deductible and the maximum out of pocket threshold for the year
- Are not covered by any other medical plan, such as a spouse's plan
- Are not enrolled in Medicare
- Are not enrolled in TRICARE or TRICARE for Life
- Are not claimed as a dependent on someone else's tax return
- Have not used Veterans Administration medical benefits in the past three months (exceptions apply to veterans enrolled in a high-deductible health plan who either have a service-connected disability or have only accessed disregarded coverage and preventive services in the past three months).
- Do not have any disqualifying alternative medical savings accounts, like a Flexible Spending Account or Health Reimbursement Account
What Qualifies as a High-Deductible Health Plan?
As its name implies, an HDHP is a healthcare plan that trades relatively low monthly premiums for relatively high deductibles. To qualify for an HSA that can be opened in combination with an HDHP, the HDHP must meet certain criteria.
The Internal Revenue Service (IRS) establishes guidelines ever year, adjusting the figures for inflation. Here are the qualifying criteria for tax years 2022 and 2023:
|2022 High-Deductible Health Plan Rules|
|Out-of-Pocket Maximum* (includes deductibles, co-payments, co-insurance)||$7,050||$14,100|
|2023 High-Deductible Health Plan Rules|
|Out-of-Pocket Maximum* (includes deductibles, co-payments, co-insurance)||$7,500||$15,000|
*Note that the out-of-pocket maximum is also designated by the plan. It can include deductibles, co-payments, and co-insurance. It does not include insurance premiums. The out-of-pocket maximum will usually not include out-of-network services.
How Does a Health Savings Account Work?
Contributions to an HSA are tax-deductible. For employer-sponsored plans, the contributions are deducted from paychecks. If you're self-employed, the deductions can be taken when your annual taxes are prepared.
Withdrawals from an HSA are tax-free provided the money is used to pay for qualified medical expenses. These expenses can include payments for dental and vision care, which some medical health insurance plans do not cover.
Most HSAs issue a debit card that can be used to pay for prescription medications and other eligible expenses. If you wait for a bill to come in the mail, you can make a payment over the phone using your debit card.
No Use-It-or-Lose-It Worries
Any money that is in your account at the end of the year remains in your account to pay for future qualified medical expenses. End-of-year balances are carried over indefinitely.
The account and its funds belong to you, and you retain ownership even if you change health insurance plans, change jobs, or retire. While it's in the account, the money grows tax-free.
How Much Can I Contribute to a HSA?
The IRS sets limits that determine the combined amount that you, your employer, and any other person can contribute to your HSA each year:
- For 2022,the maximum contribution amounts are $3,650 for individual coverage and $7,300 for family coverage.
- For 2023, the maximum amounts are $3,850 for individuals and $7,750 for family coverage.
- You can add up to $1,000 more as a "catch-up" contribution if you are age 55 or older.
How Can I Use HSA Money?
The money in your HSA can be used to pay for qualified medical expenses incurred by you, your spouse, and your dependents. The IRS establishes what is and what is not a qualified medical expense, detailed in IRS Publication 502, Medical and Dental Expenses.
Qualified expenses include nearly any medical cost you may incur, including payments for diagnostics, cures, mitigations, treatments, and prescribed preventative medications.
One of the great benefits of the HSA is that it can be used to make payments that count toward your deductible.
Moreover, the HSA is a tax shelter, meaning you won’t pay income taxes on the money you contribute. This saves you the taxable amount while allowing you to put those funds towards medical expenses that you would probably have otherwise paid with after-tax dollars.
Filling Gaps in Health Plans
Remember that you can also use the account for expenses that aren't covered by your health insurance plan. For example, if your medical plan doesn't cover dental or vision care, HSA funds can still be used for those bills.
There are a few things that an HSA cannot be used for. You can't use it to pay insurance premiums. Other ineligible expenses include over-the-counter items like toothpaste, toiletries, and cosmetics, as well as most cosmetic surgeries. A vacation to a healthier climate would also not qualify.
Starting on Jan. 1, 2020, and due to the passage of the CARES Act, more items are HSA eligible and reimbursable, including menstrual care products, over-the-counter drugs without a prescription, and smoking cessation drugs (nicotine patches and gum). Cigna provides a complete list of covered and not covered items.
If you're 64 or younger and withdraw funds for a non-qualified expense, you'll owe income taxes on the money, plus a 20% penalty. If you're 65 or over or are disabled, you'll still owe taxes on the amount but will be spared the penalty.
So, frankly, after age 65, you can essentially withdraw HSA funds for anything.
How Can I Set Up a HSA?
You first need to enroll for an HDHP. If you take that step through your employer's human resources department, it should be able to advise you on creating your HSA. Most employer-sponsored HDHPs have an associated HSA provider for you to work with.
If an HSA does not come with your HDHP, you can set up the account on your own. Banks, credit unions, and brokerages all offer HSAs. Each HSA provider can create its own terms. HSAs through a brokerage even allow you to invest your contributions in stocks, bonds, or funds. Bank HSAs will usually offer an optimal interest rate.
Once you select a provider, the enrollment process is fairly straightforward: You will be required to complete an application with information on your HDHP. Once your account is approved you can fund the account and begin using it for qualified expenses.
HSAs As Savings/Investing Tools
An HSA can be used as a tax-sheltered investment vehicle. For savvy investors, they create an opportunity to accumulate capital gains that can be withdrawn tax-free for medical expenses.
Most HSA account holders will want to be somewhat conservative in investing this money since it is intended for necessary medical costs. This can limit the types of investments an account holder may want to make with their HSA contributions to mostly low-risk products like highly-rated bonds.
The type of account opened will dictate the type of investments that may be available. Plans provided through banks usually offer only high-yield savings deposits. Brokerages offer much more. Some of the top HSA investment platforms include Vanguard, HSA Bank/TD Ameritrade, Lively, Optum Bank, and HealthSavings Administrators.
Who Benefits Most From a HSA?
High-deductible health plans make the most sense for people who are relatively healthy with minimal expectations for their annual healthcare needs. HDHPs offer lower premiums in return for higher deductibles that would need to be paid if an emergency arises.
This is what makes the combination of an HDHP and HSA very beneficial. Plan owners can potentially save indefinitely through an HSA for emergencies that may require a high deductible payment.
HSAs and HDHPs can also appeal to high-income earners as well as people nearing retirement age. High earners choosing an HDHP can use an HSA to save up to $7,300 per year in a tax-sheltered account.
The HSA as a Retirement Savings Vehicle
For both high-income earners and those approaching retirement, the HSA can be a worthwhile vehicle for building a medical emergency fund while also saving in a type of alternative retirement vehicle.
On the other hand, keep in mind that if you incur substantial health costs for standard medical care, the high-deductible health plan required to open an HSA might not be the right choice for you. Even though you will pay less in premiums with the HDHP, it could be difficult—even with money in an HSA—to come up with the cash to meet the deductible for a costly medical procedure.
Can I Get an HSA If I Have a Low-Deductible Plan?
No. Only people who have high-deductible health insurance plans are eligible to open a Health Savings Account. Some employers offer a similar plan called a flexible spending account (FSA). That is, employees can choose to divert up to a certain annual limit, tax-free, into an account that can be used to pay medical expenses that the company health plan doesn't cover. The FSA is also a "tax-favored plan" but it is relatively limited in its usefulness. For one thing, the money in your account doesn't roll over from year to year. You use it or lose it.
What Are the Benefits of a Health Savings Account?
The Health Savings Account was created to help people pay for expenses, expected or unexpected, that aren't covered by their high-deductible health insurance plans. That's no small benefit if you or someone in your family requires expensive health treatment.
Moreover, the money you pay into the account is tax-sheltered. It works somewhat like a 401(k) plan or IRA. The money accumulates from year to year without taxes being owed on it.
If you don't use all of the money in your account, it can turn into a retirement nest egg.
What Are the Downsides of a Health Savings Account?
The money deducted from your paycheck and paid into a Health Savings Account can only be used for medical expenses. If you take the money out for any other reason, no matter how necessary, you'll owe income taxes plus a 20% penalty. (Unless you're over age 65. In that case, there's no penalty.)
The Bottom Line
If you have a high-deductible health insurance plan, having a Health Savings Account can give you some peace of mind regarding unexpected (and uncovered) medical expenses.
Better yet, any money in your account that you don't have to use will continue to accumulate tax-free over time. In the long run, your HSA can turn into a separate stream of retirement income.
Internal Revenue Service. "Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans," Pages 3-4.
U.S. Congress. "H.R.1 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003."
Internal Revenue Service. "Rev. Proc. 2021-25," Page 1.
Internal Revenue Service. "Rev. Proc. 2022-24," Page 1.
Internal Revenue Service. "Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans," Page 6.
U.S. Office of Personnel Management (OPM). "Healthcare & Insurance."
WageWorks. "Can I Have an HSA if I Have VA Benefits?"
Purdue University. "Health Savings Account Eligibility Expanded for Veterans."
Internal Revenue Service. "Rev. Proc. 2021-25," Page 2.
Internal Revenue Service. "Rev. Proc. 2022-24," Page 2.
U.S. Centers for Medicare & Medicaid Services, Healthcare.gov. "High Deductible Health Plan (HDHP)."
Internal Revenue Service. "Publication 969 (2021), Health Savings Accounts and Other Tax-Favored Health Plans."
Internal Revenue Service. "Publication 502: Medical and Dental Expenses," Pages 2-17.
Internal Revenue Service. "Publication 502: Medical and Dental Expenses."
Internal Revenue Service. "Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans," Pages 8-9.
Internal Revenue Service. "Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans," Page 16.
Health Savings vs. Flexible Spending Account: What's the Difference?
Flexible Spending Account (FSA): Uses, Benefits, and Amounts
Health Savings Account (HSA): How HSAs Work, Contribution Rules
Health Reimbursement Arrangement (HRA): What It Is, How It Works
What Is a VEBA—Voluntary Employees' Beneficiary Association Plan?
Medical Savings Account (MSA)
Health Reimbursement Arrangement (HRA) vs. Health Savings Account (HSA)
What Are the Pros and Cons of a Health Savings Account (HSA)?
How Flexible Spending Accounts Work
Does Money in a Flexible Spending Account (FSA) Roll Over?
Who Can Use Your Flexible Spending Account (FSA)?
Can an FSA Be Used for a Gym Membership?
How Grace Periods for Flexible Spending Accounts (FSAs) Work
Do Flexible Spending Accounts (FSAs) Expire?
20 Ways to Use Up Your Flexible Spending Account
Health Savings Account (HSA) Rules and Limits
Best Health Savings Account (HSA) Providers
Why You Should Consider an HSA Even If You're Not Rich
Transferring IRA Money to an HSA