All about HSAs

HSA stands for health savings account. It's a personal bank account just for health care expenses. The money in your HSA rolls over from year to year (it's not a "use it or lose it" account). Your HSA also goes with you even when you change employers.

To open an HSA, you must have a type of medical insurance called a high-deductible health plan (HDHP). The Internal Revenue Service (IRS) defines a high-deductible health plan as any plan with a deductible of at least:

  • $1,350 for an individual
  • $2,700 for a family

With an HDHP, you usually pay less in premiums, and can use your HSA money to pay for medical expenses that apply toward your deductible and coinsurance.

Before you're 65, you can only use HSA dollars to pay for qualified medical expenses, as defined by the IRS. You also can save your HSA funds to cover health care costs when you're retired. And after you turn 65, the money is yours to use, penalty-free, for any purposes (learn more below).

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Read on for some frequently asked questions.

 How do I know if an HSA is right for me and my family?

An HSA could be a good choice if you want to think ahead and manage your health care and health care spending. To get the most value out of an HSA, you'll have to be aware of your health care costs so you know how much to deposit to your HSA, and you will need to actively manage your care. Common ways people use HSAs are to:

  • Plan and save for health care costs after they have retired to avoid using 401(k) or other retirement funds
  • Save for unexpected changes in health care costs at any time in their lives
  • Cover premiums if they've lost their job (COBRA) or have retired (along with some other specific situations)
  • Have more freedom in their health care spending on equipment, treatments and providers
  • Pay for the qualified medical expenses of a spouse or child, even one not covered on the HSA plan
 Who can open an HSA?

You can open an HSA if you:

  • Have a high-deductible health insurance plan that is HSA qualified by federal guidelines
  • Your high-deductible health plan is your only health plan (aside from a separate dental or vision plan)
  • Can't be claimed as a dependent on another person's tax return
  • Are not eligible for or enrolled in Medicare
  • Are not selecting a cost-sharing reduction plan that makes your deductible lower than the federally qualified amounts
 How does an HSA save me money on health care?

Using an HSA with your high-deductible health plan saves you money through reduced taxes and lower premiums. Also, when you tell providers you are paying out of your own pocket for care instead of filing an insurance claim, you often can arrange a cash discount.

Save money each year on taxes

The money you put into your HSA is tax-advantaged, meaning you can deposit money tax-free and take it out without paying taxes.

Plus, you can invest your HSA balance just like your individual retirement account (IRA). Your interest or investment gains will also be tax-free, though they can be spent only on qualified medical expenses.

Save money each month on premiums

High-deductible health plans that let you use an HSA cost less in monthly premiums. That is because you are sharing more of the cost, such as copays and deductibles.

While you can't use your HSA funds to pay for your monthly premiums, you can use the funds to pay for a number of qualified medical expenses that are not covered by your health plan, such as eye exams, eyeglasses and contact lenses, dental cleanings, fillings and even qualified medical expenses for a spouse or child.

 How do I get an HSA account?

If you bought your plan on the exchange, you can set up your HSA account with HealthEquity by signing in, going to My account and then the HSA options page. Select the HealthEquity option and choose to share your claims with HealthEquity if you would like to also see that information in your HealthEquity account. Or, you can choose to open an HSA account with the bank of your choice.

Managing your HSA through HealthEquity

Through our tie to HealthEquity, you can have your claims information automatically sent to HealthEquity to let you manage your account 24/7. You can also use online tools such as:

  • Document storage (for receipts)
  • Bill pay to providers
  • Deposits
  • Apps to manage your account from your smartphone
  • If you use HealthEquity, be sure to check your preferences by signing in to and going to My account.

Learn more about HealthEquity online or call 1 (866) 346-5800.

Managing your HSA through a bank of your choice

You can also set up an HSA with our referral partner, HSA Bank, for a discounted rate. And you always have the option to open an HSA with any IRS-qualified bank that you choose.

 How much money can I put into an HSA each year?

The IRS allows you to put only so much money into an HSA each calendar year.

For 2018, you can contribute up to:

  • $3,450 for an individual HSA
  • $6,900 for a family HSA

For 2019, you can contribute up to:

  • $3,500 for an individual HSA
  • $7,000 for a family HSA

For 2020, you can contribute up to:

  • $3,550 for an individual USA
  • $7,100 for a family HSA

For 2021, you can contribute up to:

  • $3,600 for an individual USA
  • $7,200 for a family HSA

Also, if the primary member of the high-deductible health plan is age 55 or older, you may deposit up to an additional $1,000.

 How do I put money into my HSA?

Each year, you decide how much to contribute to your HSA. Sometimes your employer may also kick in a contribution. You can put money into your HSA as easy as you make deposits into a bank account. For members with a HealthEquity HSA, you deposit money online or send checks to HealthEquity.

If you get your insurance through your employer, you can have payments deducted from your paycheck and deposited to your HSA account automatically.

These deposits are made on a pre-tax basis. That means they may not be counted as part of your gross earnings. Basically, you have less income, so you pay lower taxes. You also don't pay taxes on the money you take out of your HSA to pay for medical expenses.

 How do I spend money from my HSA?

Your HSA comes with a debit card, just like other bank accounts, or you can request checks. Use the card or the checks to pay for qualified medical expenses at the time of purchase. You can also reimburse yourself—that is, pay out of pocket, then pay yourself from your HSA. As long as you spend your HSA funds only on qualified medical expenses, you won't pay income tax on that money.

While you can't open an HSA in a child's name, you can use money from your HSA to pay for medical expenses if you or your spouse claims that child as a dependent on a tax return.

Spend only on qualified medical expenses

The IRS decides which expenses are considered HSA-qualified medical expenses, but the list includes:

  • Office visit copayments
  • Your deductible
  • Prescription drugs
  • Lab tests
  • Many treatments that may not be covered by your insurance, such as buying contact lenses, glasses, dental care and even things your health plan may not cover, like LASIK and orthodontics

In general, your premiums, nonprescription medicine and some other expenses do not count as HSA-qualified medical expenses.

Note: If you spend HSA money on nonqualified medical expenses, you'll have to pay income tax on that amount. Plus, if you're under 65, you also pay a penalty to the IRS. So, it's important to check the qualified medical expense list when making decisions about how to use your HSA money. You can see a list in IRS Publication 502.

 How do I get the best use of my HSA?

Make tax free contributions to your account, and put in the maximum amount you can if possible

The earlier you open an HSA and begin contributing, the better. Your savings will accumulate quickly and grow interest for tomorrow's medical expenses.

Spend wisely from your account

While the money is there for your use if needed, save it for the future if you can. An HSA is not just an account for today's medical expenses. It is also a tool to help you in your retirement.

Find out how much it costs to go to your doctor

Understanding how much health care costs before you go is important. Asking your doctor or researching what it costs for services helps you plan how much to save.

Budget for yearly health care costs

Make an annual health care budget. What were your costs last year? Make an estimated budget for what you think you will spend and make pre-tax contributions to cover that estimated amount at least.

Ask the experts

We partner with HealthEquity, who is an expert in all your HSA needs. The 24/7 customer service department can help you get the answers you need, when you need them. If you have a HealthEquity account you can contact Member Support at 1-866-960-8055.

Understand the rules

Know the annual limits, understand what you can and can't do and refer to the list of qualified medical expenses. IRS Publication 969 contains all the nuts and bolts of what you can and cannot do with an HSA account. The Complete HSA Guidebook fills in many of the gaps.

 What happens to the money in my HSA if I don't spend it all in a year?

Money you deposit into the HSA is yours and stays in your account until you spend it. Use your HSA to save money while you're healthy and don't need medical care. Your money will grow tax-free and be there to help you pay for future medical expenses.

The funds will become available to you for nonmedical expenses in retirement (after age 65) without having to pay a penalty, but you will have to pay income taxes on for any nonqualified medical expenses.

 What happens to my HSA if I'm no longer enrolled in a high-deductible health plan?

While you need to be enrolled in a qualified high-deductible health plan in order to start or contribute to an HSA, you can use funds from your HSA for qualified medical expenses whenever you want—even if you're no longer enrolled in a high-deductible health plan.

While you can't open or contribute to an HSA if you're eligible for Medicare, you can still use funds from your HSA when you transition to Medicare.

 How do I make sure my HSA contributions get into my tax return?

At the end of the year, you'll get a report in the mail from the bank that holds your HSA. Use this report to help prepare your tax return.

 Flexible spending account (FSA). How is that different from an HSA?

FSAs and HSAs both let people save pre-tax money to pay for qualified medical expenses. The biggest differences between the two are that:

  • An FSA is established through an employer.
  • An FSA can be used with health insurance, but you don't have to have health coverage to have and use an FSA.
  • An FSA is limited to $2,750 (for 2021) per year per employer. Spouses also can put up to $2,750 in an FSA with their employers.

Other differences are:

  • An FSA usually has money added into it through pre-tax deductions from your paycheck. However, your employer can also contribute to your FSA.
  • Money from an FSA can pay deductibles, copays and coinsurance, as well as qualified medical expenses that are not covered by health insurance. It can cover qualified care of your dependents and spouse. It can also cover over-the-counter medications if a doctor prescribes them.
  • You lose any money in your FSA that you do not use by the end of the year. Your employer can either allow for a grace period of up to two and a half extra months to use the money in your FSA or it can let you carry over up to $500 per year to use in the following year (or it can offer neither option).
  • You put money into an FSA through a deduction from each of your paychecks during the year. However, you can use the full annual contribution immediately at the beginning of the year (or after you make your first contribution). If you use the full amount and then quit, are fired or are laid off before to the end of the year, you do not have to pay the FSA money back to your employer.