A Health Savings Account (HSA) is like a personal savings account, but it can only be used for qualified healthcare expenses. To be eligible, you must be enrolled in a High-Deductible Health Plan (HDHP). HSAs also have tax advantages, but there are some disadvantages to consider.

Key Takeaways

  • A Health Savings Account (HSA) can help people with high-deductible health insurance plans cover their out-of-pocket costs.
  • Contributions to HSAs generally aren't subject to federal income tax, and the earnings in the account grow tax-free.
  • Unspent money in an HSA rolls over at the end of the year, so it's available for future health expenses.
  • High-deductible health plans, which are a requirement for HSAs, aren't always the best option, especially for those who expect to have significant healthcare expenses in the future.

The Advantages of Health Savings Accounts

The following include the advantages Health Savings Accounts offer:

Many Expenses Qualify

Eligible expenses include a wide range of medical, dental, and mental health services. They are explained in detail in IRS Publication 502, Medical and Dental Expenses.

As a result of the Coronavirus Aid, Relief, and Economic Security (CARES) ACT, passed in 2020, over-the-counter medications and menstrual products are now qualified HSA expenses.

Others Can Contribute

Contributions can come from you, your employer, a relative, or anyone else who wants to add to your HSA. The IRS does, however, set limits. In tax year 2020, for example, the limit is $3,550 for individuals and $7,100 for families, plus an additional $1,000 "catch-up" contribution for anyone age 55 or older by the end of the tax year.  

Pre-Tax Contributions

Contributions are typically made with pretax dollars through payroll deductions at your employer. As a result, they are not included in your gross income and are not subject to federal income taxes. In most states, contributions are not subject to state income taxes.

Tax-Deductible After-Tax Contributions

If you make contributions with after-tax dollars, you can deduct them from your gross income on your tax return, reducing your tax bill for the year. For example, if you're an individual under the age of 55 your maximum allowed contribution in 2021 is $3,600 ($3,550 for 2020). If you only deposit $2,600 into your HSA through payroll deductions by the end of the year, you may choose to deposit an additional $1,000 in order to lower your tax liability. You generally have until the respective IRS tax filing deadline to make the contribution.

Tax-Free Withdrawals

Withdrawals from your HSA are not subject to federal (or in most cases, state) taxes if you use them for qualified medical expenses. However, HSAs can be used as investment accounts, allowing you to purchase stocks and other securities to potentially boost your returns. Please note, investing in stocks and other securities within your HSA is not recommended for everyone. It carries the risk of loss of principal, and should only be considered as part of a diversified, long-term wealth building strategy. It would be wise to seek the advice of a financial planning professional before taking such actions.

Tax-Free Earnings

Any interest or other earnings on the money in the account is tax free. Most HSA accounts earn a minimal amount of interest, less than 0.1%. 

Annual Rollover

If you have money left in your HSA at the end of the year, it rolls over to the next year. This offers more flexibility than Flexible Spending Accounts (FSAs), which can only be carried over in an amount up to $500 or 2.5 months into the following plan year.

Portability

The money in your HSA remains available for future qualified medical expenses even if you change health insurance plans, go to work for a different employer, or retire. Essentially, your HSA is a bank account in your name, where you decide how and when to use the funds.

HDHPs are required to set a minimum deductible and a maximum for out-of-pocket costs. In 2021, the minimum deductible is $1,400 for an individual and $2,800 for a family and $7,000 (individual) and $14,000 (family) for out-of-pocket costs.

Convenience

Most HSAs issue a debit card, so you can pay for prescription medications and other eligible expenses right away. If you wait for a medical bill to come in the mail, you can call the billing center and make a payment over the phone using your HSA debit card. You can alternatively reimburse yourself out of an HSA if you have paid a medical bill with an alternative form of payment.

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Pros And Cons Of A Health Savings Account

The Disadvantages of Health Savings Accounts

If you qualify for an HSA, here are some of the disadvantages to consider:

High-Deductible Requirement

A High-Deductible Health Plan, which you are required to have in order to qualify for an HSA, can put a greater financial burden on you than other types of health insurance. Even though you will pay less in premiums each month, 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. This is something to consider for anyone who knows they will have hefty medical bills in a particular plan year.

The deductibles for HDHPs are often significantly higher than the minimums required and can be as high as the maximum out-of-pocket costs allowed.

Pressure to Save

Some people may be reluctant to seek healthcare when they need it because they don't want to spend the money in their HSA account.

Taxes and Penalties

If you withdraw funds for non-qualified expenses before you turn 65, you'll owe income taxes on the money plus a 20% penalty. After age 65, you'll owe taxes but not the penalty.

Recordkeeping

You must keep receipts to prove that your withdrawals were used for qualified health expenses. This will be necessary if you are audited by the IRS.

Fees

Some HSAs charge a monthly maintenance fee or a per-transaction fee, which varies by institution. While typically not very high, the fees are almost certainly higher than any interest the account may earn and do cut into your bottom line. Sometimes these fees are waived if you maintain a certain minimum balance.

The Bottom Line

If you are enrolled in a high-deductible health plan, the tax advantages of an HSA and ability to roll over unspent money are appealing. But high-deductible health plans aren't always the best option, especially if you expect to have significant healthcare expenses.