Health Savings Accounts: Both Scary and Useful

As we approach the new year, we can think about actions we can take to help with next year’s taxes as well as better support our retirement prospects. Most companies’ open enrollment season for benefits just concluded; you may have seen in your summary of employee options a Health Savings Account (HSA).

What is an HSA? Not only is it a tax-deductible account you can use to save money into to cover medical expenses tax-free; it’s also a tax-deductible account you can save money into for retirement. In a nutshell, you can contribute money into one and take a tax deduction for that tax year, you can invest those dollars and let them build tax-deferred, and then, in retirement, you can draw them out tax-free. There really isn’t another type of account like it.

For the here and now—if you are a somewhat heavy user of medical services, and you have the nice low and consistent co-pays, it’s unlikely that you will pay enough in co-pays to be able to take advantage of the medical tax deduction because of the high threshold that deduction uses (7.5% of your AGI). By switching to a High Deductible Health Plan and using an HSA, you can fund the HSA with tax-deductible dollars then pay for those services from that account tax-free. Once you’ve met your insurance deductible, your insurance kicks in and pays for any additional services you might need throughout the year. Is it really that simple? Of course not, but very often it does make much more financial sense than the co-pay process. A little more work at first—yup. A little more money in your pocket overall—more than likely. You can even complete a once-in-a-lifetime rollover from your IRA into your HSA to frontload your account.

Another strategy is to use an HSA in anticipation of big medical events. Let’s say you are a young healthy person but you know you’re going to want to start a family (we’ve already talked about how expensive giving birth is and you can count on spending many times more than that that if you need help to get pregnant), or perhaps you’ve been having a hip / knee / shoulder / reproductive / nasal / digestive / etc. issue that you know you’ll need to deal with at some point. These are big-ticket medical expenses where most insurance policies require a significant contribution from the participant. You could fund an HSA every year, with the contributions rolling from one year to the next and building along the way because you’ve invested them in a conservative allocation. Then, when your planned for event finally happens, you use the balance in one fell swoop when the bills come in.

For retirement—want to get the most out of this type of account? Fully fund an HSA and let the dollars roll until you need them for those hearing aids and dental care in retirement (which aren’t usually covered by Medicare). Sure you could contribute to your company retirement plan or an IRA and take the tax deduction now but then you’ll pay taxes when you take the money out, something you won’t do with an HSA. You could also use a Roth IRA but you won’t get a tax deduction now like you do with an HSA. This strategy requires a little more budgetary attention since you’ll want to cover your current medical expenses out of pocket to make the most of the strategy but that’s not out of the realm of possibility with a little prep work.

Want to make the most out of this strategy? Fund your company retirement plan up to the maximum you need to get the match, fully fund your HSA, and then throw additional dollars into your Roth or post-tax investment account—three legs of your retirement stool all set and ready to help you later in life.

Of course, there is a catch to all of this. In order to use a Health Savings Account, your health care plan must be a high-deductible one, not one of those co-pay plans, and that’s not always the right type of an account for everyone, which is why I bring this up now. In order to do our taxes, many of us take a peek at what we spent on medical costs for last year. Take an hour one day and do the math as we approach year-end, so you are ready for your next open enrollment. Which is better for you—using a High Deductible Health Plan and an HSA or using a co-pay-based plan? While there are pros and cons to each, make sure that you are making the decision based on the numbers and not the emotions. Some people find the idea of a high deductible plan to be a little scary and I get it. Tackle those fears by looking at the numbers and building a plan. There is no insurance fairy godparent looking out for you so it’s up to all of us to make a well-informed choice.