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Your Guide to Health Savings Accounts

More and more employers are starting to offer health savings accounts in lieu of a standard health plan. Unfortunately, employees seem to know little about health savings accounts and why they may be better than going with the standard plan.

A health savings account is the retirement account for your health. It has a lot of great features, that when taken advantage of, will really put you in a good position in retirement.

What is a Health Savings Account

A health savings account or HSA is a retirement or savings account built to pay for your future health costs. Like an IRA account, the idea is to put money away into the HSA and let it grow before taking it back out.

The health savings account is the trifecta of tax savings. Money that goes into an HSA is pre-tax money, like a 401k. This money can either come directly out of your paycheck so it skips taxes, or you can contribute the money on your own a deduct it on your taxes. Once the money is in the account, it becomes invested through investment options that you select. The money will continue to grow tax-free and can taken out tax-free. A health savings account is the only type of account that has this type of tax savings.

Unlike a flexible spending account, or FSA, an HSA never expires. An FSA must be used by the end of the year or the contributions will be lost. Not only will an HSA rollover from year-to-year but if you left your employer, you will take the health savings account with you.

Unlike most retirement plans, you can withdraw from a health savings account at any time. There is no penalty or taxes if you withdraw the money earlier than retirement.

An HSA must have a high-deductible health plan with it. You cannot open an HSA without one, and not all high-deductible health plans will allow a health savings account.

How Health Insurance Works

A high deductible health plan means the amount of money you must pay out for health care services is higher than the standard plan. The upside, the higher the deductible in the plan, the lower the monthly premium tends to be. It becomes a tradeoff, paying more when you do have a health care expenses versus paying more every month. This can be bad because you can get hit with a bigger bill once it becomes time to pay for health care. On the other hand, money spent on a monthly premium is simply money gone.

Health plans can structure deductibles in a couple of ways. If you are an individual, you will have to meet the individual deductible before the insurance steps in and helps to pay. If you are a family, and you are paying to cover that family, the insurance can have individual or aggregate deductibles. The individual deductible means each person in the family has their own deductible that they must meet. The aggregate deductible means anyone in the family can meet the deductible for the entire family. Under this method, you could spend the deductible money on yourself and then not have to pay a deductible when your spouse has health care expenses.

After the deductible we get coinsurance. The insurance company is not going to pickup the total cost once a deductible has been paid. They will pay for apart of it. The part that they do pay for is called coinsurance. Coinsurance is usually stated as a percentage, and it is the percentage that you will pay once the deductible has been paid.

For example, if your deductible is $1,000 and your coinsurance is 20%, you will pay $1,100 of a $1,500 health bill. You take your total bill, minus the $1,000 deductible, and you are left with $500. Of that $500, you will pay 20%, or $100 of it. This brings your total bill to $1,100. Once you have hit your deductible for the year, you won’t have to pay it again until next year. It does not restart for every health bill, it restarts every year. Once it has been used, health care expenses become cheaper for you for the rest of the year.

If you have already used your deductible for the year and you are debating on getting a medical procedure done in December or January, it would be cheaper to have it done in December.

The next feature of a health care plan that you must know is the out-of-pocket limit. The out-of-pocket limit is the maximum amount you can spend on healthcare in a given year, not including monthly premiums.

Once you have reached your out-of-pocket limit, the health care company will take over 100% of the expenses.

You had a procedure that costs $20,000, you have a $1,300 deductible, 20% coinsurance, and out-of-pocket maximum of $4,400. The most you would pay for this procedure is $4,400 plus any monthly premium charges.

You first subtract the deductible from the total amount because that must be paid first. $20,000 minus $1,300 gives you $18,700 left in charges. With the remaining charges, you figure out the amount you would pay with the coinsurance. 20% of $18,700 is $3,740. Your total charges are $1,300 plus $3,740 for a total bill of $5,040. This amount is more than your out-of-pocket maximum, so the total amount you would pay is $4,400. The insurance company would cover the remaining $640. Any more health care expenses for the rest of the year would also be covered in full by the health care provider.

Getting the Most Out of Your HSA

The first step of maximizing your HSA account is the need to find a quality custodian to hold the account. Your employer will have their own custodian that they use to manage the health savings account, but you are not limited to that custodian. Any money that is added to the account from your paycheck will need to go into the account your employer setup but any money that you add can be sent to your own custodian.

Each custodian comes with their own fee structure, which includes annual fees and setup fees, along with their own investment options. Investment options can be limited to a few certain funds or very wide and self-directed. If you do not like the custodian provided by your employer, don’t use that one, find your own and make your own contributions.

A quality, up-to-date breakdown of the top HSA custodians can be found at 20 Something Finance.

Unfortunately, it takes more than just finding the right custodian to maximize a health savings account.

Once you have a custodian, either provided by your employer or one you found yourself, you need to fund it. The contribution limits for your health savings account depends on the type of healthcare plan that you are on at your work. If you are on a single plan, where it just covers you, your 2019 contribution limit is $3,500. If, however, you’re on the family plan at work, your 2019 contribution limit is $7,000. These contribution limits are not aggregated with any other limits. So, if you invest in an IRA or Roth IRA, it doesn’t limit how much you can put into an HSA.

The idea behind a health savings account is to make these contributions, have them grow over the years, and then to cash them out in retirement. If you have a funded HSA, you can save your medical receipts over the years and submit them in retirement to get all the money back. This allows your contributions and earnings to get exponential growth over the years.

You cannot save or cash in any medical receipts from before you had a health savings account. This will also require you to pay out-of-pocket for your medical expenses up until that point. Again, you will have to pay your deductible and coinsurance, up the maximum out-of-pocket expense.

Being able to take advantage of the compounding of returns in an HSA is another great reason to have an emergency fund. If you do not have an emergency fund or find yourself tight on cash, it is still okay to use your health savings account immediately.

Once you are no longer have a high deductible health plan or you move onto Medicare, you can no longer contribute to an HSA. You can still use, move, and get the money out of your health savings account, but you will no longer be able to contribute.

How to Compare Company Health Plans

A lot of employers are now offering high deductible plans with health savings accounts. Overall, if they can pass higher health care costs onto the employee, it will be cheaper for the employer. When looking through these benefits, sometimes the employer can really make the high deductible plan attractive.
Here is a comparison of the traditional plan and the high deductible plan offered by the client’s employer. The first thing you should start with is the annual premium, how much is going to come out of your paycheck to pay for your health plan. No matter what happens, this is a sunk cost that must be paid. It doesn’t not could towards the out-of-pocket limit. High deductible plans should always be cheaper in this aspect. In this case, they went from $204 a paycheck ($408 a month) to $60 a paycheck ($120 a month). Right off the bat, that is a savings of $3,456.

With a high deductible health plan, you are expected to lose money in the deductible portion. In this case, the deductible increased by $1,800. Not a huge deal, but it is more money that will need to be spent out of pocket before insurance kicks in. When comparing all this information, make sure you compare the single to single plan and the family to family plan.

The coinsurance and out-of-pocket maximum are the same in both plans. This is not always the case, but like I said, some employers really gear the high deductible plan to be a no-brainer.

To further sweeten the deal, the employer is going to contribute $1,000 annually into the health savings account. This benefit is not received through the traditional plan.

Once you have all your numbers figured out, it is best to run a few scenarios to make sure which plan is better. We like to know which plan comes out on top in the best-case scenario, worst-case scenario, and somewhere in between.

The best-case scenario would be $0 in medical expenses. In this case, the only money you are spending will be the annual premium amount. Clearly the high deductible plan is going to win here. Not only is the premium a lot cheaper, but they also kick in $1,000 annually into the plan.

The worst-case scenario would be $50,000. This is enough money that the annual out-of-pocket limit has been breached. For the traditional plan, the total cost would simply be the out-of-pocket limit plus the annual premium amount. In this case, $10,896 would be the total cost. For a high-deductible plan the total cost is $6,440. This is the out-of-pocket limit, plus the annual premium, minus the employer contribution.

We through in a few other scenarios just to make sure we have the right plan in place. As you can see, no matter what happens, good or bad, the high-deductible plan comes out on top. Now, this isn’t always the case. Some employers are not as generous with their high deductible plans as this one.

Here is a good example of a plan that wasn’t built as strong. The traditional plan didn’t cost as much so the savings in the high deductible plan wasn’t as predominate. There was some relief in that the deductible limit wasn’t a giant increase and the employer did fund the HSA annually. The interesting thing to note with this plan is the addition of the coinsurance when you switch to the high-deductible plan.

Looking at our scenarios, we can still see savings across the board, making the high deductible plan the way to go.


Check with your employer benefits and see if you are eligible for a high deductible plan with a health savings account. Most employers skew the benefits of having the high deductible plan so it is typically the better choice, but you can run a quick comparison to make sure.

Health savings accounts are the only accounts that allow for triple tax savings. The contributions go in pre-tax, either through your employer or personally and with a tax deduction. The contributions and earnings will grow tax-free. Any distributions for qualified medical expenses also come out tax-free.

To really take advantage of the HSA benefits, you want to fund the accounts up to the yearly limits, and then invest those contributions and let them grow. Save all your medical receipts over the years and once you get into retirement, cash in those receipts for reimbursements.

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