Is a Health Savings Account Right for You?

Transcript of Podcast Episode 395

Hello, this is Bill Rainaldi, with another edition of Security Mutual’s SML Planning Minute. In today’s episode: is a Health Savings Account right for you?

What would you say if someone told you about an investment vehicle where you get a tax deduction going in, the money in the account grows tax-free, and the withdrawals are tax-free when they come out? Such a product exists, but it’s not quite that simple.

An Individual Retirement Account or IRA doesn’t work that way. You get a deduction going in, but you pay income tax when you take the money out. A Roth IRA lets you take the money out tax-free (with certain qualifications), but you don’t get a deduction when you put the money in.

A Health Savings Account, or HSA, is one of very few financial vehicles considered “triple tax advantaged.”[1] You can get a deduction on monies going in, the money grows tax-free, and the money also comes out tax-free. But there are some major caveats to understand.

HSAs don’t work for everyone. Only certain people can contribute, and when you take the money out, there are some conditions that need to be met if you want to take full advantage of the tax incentives.

Here’s how an HSA works. To contribute, you need to be part of what the Internal Revenue Service or IRS calls a “High-Deductible Health Plan.” The IRS defines a high-deductible health plan as one that requires an annual deductible. A deductible is the amount one must pay out-of-pocket for healthcare before health insurance coverage will share in the costs.

In 2026, the minimum deductibles for a high deductible HSA health plan are set at $1,700 for coverage on yourself only, and $3,400 if the coverage includes your family.[2] Also, the out-of-pocket maximum cannot be higher than $8,500 for self-only coverage and $17,000 for family coverage.

There are more rules. To contribute to an HSA, you can’t be enrolled in another plan that is not considered HSA-eligible, nor can you be someone claimed as a dependent on someone else’s tax return. If you’re not sure whether your plan qualifies, you will need to ask either the benefits administrator where you work or the plan provider.

And for the record, Medicare does not count as a high-deductible medical plan. So, you can’t participate in an HSA if you’re covered by Medicare.

As with almost any tax-advantaged investment vehicle, there are contribution limits. For 2026, you can contribute up to $4,400 for yourself, or $8,750 if your high-deductible plan covers your family.[3] And much like a 401(k), your employer can match your HSA contribution. In fact, in 2024 approximately 84 percent of employees covered by a qualified HSA health plan also received a contribution from their employers.[4] Note that the limits above are overall limits that include both the employee and, if applicable, employer contributions.

Then there’s the issue of distributions from the account. Distributions can be tax-free, but with some significant restrictions. To be tax-free, the distributions must be used for what the IRS calls “qualified medical expenses.”

And what are qualified medical expenses? These might include hospital care, ambulance services, hearing aids, lab fees, dental and vision care, and other things. You can even use an HSA for health-care-related travel, massage therapy and substance abuse treatment.[5] [6] An HSA can be used for expenses both big and small.

If your distribution doesn’t meet the qualifications, any withdrawals after age 65 are considered fully taxable, like a traditional IRA or 401(k). Before age 65 there is also a 20 percent early withdrawal penalty. This means that, if necessary, you could treat an HSA as a secondary retirement plan. But of course, if you have qualified medical expenses that need to be paid, the taxation incentive would make them a better option.

When it comes time to withdraw money as needed, you can either pay the provider directly from the HSA account (many providers offer the use of a debit card tied to the account) or pay the provider yourself and get reimbursed from the account.[7]

Note that an HSA is different from a Flexible Spending Account or FSA. An FSA is another, albeit generally less popular, type of account designed to help with medical expenses. The employer generally owns an FSA, whereas the employee owns an HSA. But an FSA is also, in most cases, a “use it or lose it” type of account. At the end of the year (plus an optional grace period), you lose any money that’s left over in your FSA.[8] Also note that in most circumstances, you can have a general-purpose FSA or HSA, but not both.[9]

An HSA has no such restriction when it comes to how long it takes to use it. If you don’t spend the money, it rolls over within the account. It belongs to you forever, even if you switch jobs. Of course, these sums, invested over several decades, can amount to a significant amount of money by the time you use them. Compounding plays a role here just like most other investment vehicles, only this time it may all be potentially tax-free.

One final thought about HSAs. As we’ve mentioned before, the cost of health care for seniors can be staggering. According to Fidelity, a 65-year-old individual may need an after-tax total of $172,500 to cover the cost of health care expenses in retirement.[10] In the right circumstances, an HSA can be a tax-efficient way to fund some of those costs.

[1] Fidelity Learn. “What is an HSA, and how does it work?” Fidelity.com. https://www.fidelity.com/learning-center/smart-money/what-is-an-hsa.

[2] Fidelity Learn. “HSA contribution limits and eligibility rules for 2026 and 2027.” Fidelity.com. https://www.fidelity.com/learning-center/smart-money/hsa-contribution-limits.

[3] Id.

[4] Fidelity Learn. “What is an HSA, and how does it work?” Fidelity.com. https://www.fidelity.com/learning-center/smart-money/what-is-an-hsa.

[5] MetLife. “What Can I Use My HSA for in 2026?” MetLife.com. https://www.metlife.com/stories/benefits/hsa-qualified-expenses/.

[6] Miller, Kathryn. “What clients miss about HSAs — and how advisors can help.” Financial-Planning.com. https://www.financial-planning.com/news/what-clients-miss-about-hsas-and-how-advisors-can-help.

[7] Fidelity Learn. “Spending with your HSA.” Fidelity.com. https://www.fidelity.com/go/hsa/how-to-spend.

[8] Healthcare.gov. “Using a Flexible Spending Account (FSA).” Healthcare.gov. https://www.healthcare.gov/have-job-based-coverage/flexible-spending-accounts/.

[9] Fidelity Learn. “HSA contribution limits and eligibility rules for 2026 and 2027.” Fidelity.com. https://www.fidelity.com/learning-center/smart-money/hsa-contribution-limits.

[10] Fidelity Learn. “What is an HSA, and how does it work?” Fidelity.com. https://www.fidelity.com/learning-center/smart-money/what-is-an-hsa.

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