Got an HSA? Here’s What You Need to Know

An HSA or Health Savings Account is where you could put away money to help pay for qualified medical expenses, such as prescriptions and doctor visits.

You need to meet these requirements to be able to fund an HSA:

1. Your health insurance plan has to be considered a High Deductible Healthcare Plan (HDHP). Your employer or insurance company will be able to tell you if you’ve got an HDHP. For more information on what qualifies as HDHP, visit Healthcare.gov.
2. You have no other health coverage except what is permitted under IRS rules (see "Other health coverage")
3. You’re not covered by Medicare.
4. You’re not listed as a dependent on someone else’s tax return.

In this article, we'll go over the basics of an HSA, so that you can decide if it's right for you. Keep in mind: We're talking only about HSAs here, not HRAs (Health Reimbursement Arrangements) or FSAs (Flexible Spending Accounts) which work a little differently.

The basics of HSAs 

While money in an HSA earns interest, it’s different from your typical savings account and it’s also different from a catch-all emergency fund. Here are some key highlights:

1. You don’t pay federal taxes on money in your HSA (as long as the money is used to pay for qualified medical expenses), though you may pay state taxes (depending on your state).
2. You can only use HSA funds for qualified medical expenses; otherwise you'll have to pay federal taxes.
3. There are limits to how much you can deposit into your HSA each year.
4. The money doesn’t expire, and you’re not required to make withdrawals.

Isn’t an HSA just an emergency fund with a different name?

We get it, health expenses can sometimes be emergency expenses. But there are a few differences between having money in an account “for emergencies” and having an HSA that’s meant only for medical expenses and that has its own IRS category.

The HSA includes tax benefits other savings accounts may not

If you’re contributing money to your HSA, you won’t pay federal taxes on the interest, unlike the interest you earn with a traditional savings account or a certificate of deposit.

Depending on how it’s funded, there could be an additional benefit: If the money you contribute to an HSA is taken out of your paycheck before taxes, this could lower your taxable income. If you fund an HSA using after-tax dollars, you may be able to deduct these contributions on your tax returns, but it’s a good idea to double-check with a tax professional to see if this applies.

HSAs could help you bolster your savings for when you’re older

Having different buckets for different expenses is a tenet of budgeting and long-term financial planning.

Because you can only use the money tax-free for qualified medical expenses, when you contribute money to an HSA, you’re creating a pool of funds for this specific type of expense.

What can you spend your HSA money on?

The IRS outlines what is considered a qualified medical expense. (see IRS Publication 969: Health Savings Accounts). Your insurer will also be able to guide you about what you can use the money for. In general, eligible expenses include the medical bills you pay before reaching your deductible, co-pays, co-insurance and some over-the-counter medicines.

Good to know: Under the 2020 CARES Act, in response to COVID-19, some rules about how you can use HSA funds have changed. Contact your HSA servicer, health insurer and/or human resources department for further information. You can also visit the IRS website here.

How do you add money to a Health Savings Account?

HSAs work a lot like typical savings accounts – you deposit money and it earns interest.

There are two ways to fund your HSA:

• If your HDHP is through work, your company can withdraw money from your paycheck – before taxes – and deposit it in your HSA.
• In some cases, you may be covered by an HDHP that qualifies for an HSA, but need to set up your account though a financial institution, such as a brokerage or bank. If that’s the case, you can deposit the funds directly with that institution.

How much can you contribute to an HSA?

In 2022, you’ll be able to deposit up to $3,650 ($3,850 for 2023) to your HSA if the policy is just for you. If the policy covers your family, you’ll be able to deposit up to $7,300 ($7,750 for 2023). And if you're 55 or older, you could make "catch-up" contributions of up to $1,000.

Employers sometimes contribute to HSAs, which can increase your savings.

What are the other benefits of an HSA? 

For one, the money is always yours. If you change jobs, if you change insurers or if you retire, it doesn’t change things: The money you’ve contributed travels with you.

Another benefit is that there’s no deadline to use the money. You’re not required to use the money in your HSA by a certain date or age.

Can you use your HSA to pay for insurance premiums?

Generally speaking, HSA funds may not be used to pay premiums. But there are a few exceptions - for example:

• If you’re unemployed and receiving unemployment benefits, you may be able to use the money to pay for your health insurance
• If you’ve left your job but are keeping your company’s healthcare through COBRA (the legislation that may let you keep a former employer’s health coverage for a set amount of time).

See IRS Publication 969's "Distributions from an HSA" for more details.

How long can you add money to your HSA?

As long as you’re covered by an HDHP, you can add money to your HSA. If you’re covered by a partner’s plan, you can contribute to your HSA as long as their plan is also a HDHP.

What happens to your HSA if you no longer have an HDHP?

If you switch to a health care plan that is not an HDHP, you get to keep the money you’ve saved in your HSA. You can also continue to spend the money on qualified medical expenses. The only real change is that you won’t be able to add money to your HSA if your new plan is not an HDHP.

What happens if you use your HSA funds for something else?

If you're under 65, your withdrawals will be taxed as income, and you can get socked with an additional 20% tax if you use the money for something that’s not on the IRS’s list of approved medical uses.

Over 65? You won’t have to pay the additional 20% tax, but your withdrawals could be taxed as income if you use the money for something that’s not a qualified medical expense.