Beyond Basics: HSAs as a Tool for Wealth and Health Management

Dan Pascone |

Health Savings Accounts (HSAs) offer a beautiful trio of financial benefits often overlooked by high-earners.

Referred to as the "triple tax advantage,” HSA contributions can:

  1. Lower your taxable income. Contributions to an HSA are made with pre-tax dollars, which means they can be deducted from your gross income. This taxable income reduction leads to immediate savings, which can be a real saving grace for high earners on the margins of higher tax brackets.
  2. Grow tax-free. The funds in an HSA grow tax-free– any interest, dividends, or capital gains accumulated within the account aren’t subject to tax as they accrue. This can be especially powerful for high earners who invest their contributions in the higher-yielding options available within HSA accounts.
  3. Be withdrawn tax-free for qualified medical expenses. Withdrawals from an HSA for qualified medical expenses are not taxed. This includes a wide range of costs such as deductibles, copayments, prescriptions, and other medical expenses not typically covered by health insurance. This benefit means that you can pay for those pesky out-of-pocket medical costs using pre-tax dollars, providing a significant cost advantage over using post-tax income.

Additionally, HSAs are not subject to the "use-it-or-lose-it" rules that apply to Flexible Spending Accounts (FSAs). Any unspent money in an HSA rolls over year after year, allowing account holders to build a substantial medical emergency fund over time. 

This feature makes HSAs an excellent tool for long-term healthcare planning.

What Actually Is an “HSA”?

The intertwining worlds of taxes and health insurance come with too many acronyms for comfort for the average person who simply wants health coverage.

A common confusion is the difference between a Health Savings Account (HSA) and purchasing health insurance through the marketplace.

An HSA isn’t a health insurance policy; it's a savings account designed to help individuals save for future medical expenses on a tax-advantaged basis. 

However, you must be enrolled in a high-deductible health plan (HDHP) to qualify for an HSA. Combining an HDHP with an HSA aims to create a more cost-effective approach to healthcare, promoting saving and cost awareness among consumers. This structure benefits individuals who are generally healthy and those looking for ways to save tax-efficiently for future medical expenses.

Funds in an HSA roll over year after year. You own and control the money in your HSA, which can even be invested, allowing potential growth over time. 

These funds can be used at any age for qualified medical expenses without penalty. 

After age 65, funds can also be used for non-medical expenses without penalty, although they will be taxed as income.

A High Deductible Health Plan (HDHP) is a type of health insurance plan that typically features higher deductibles and lower premiums than other types. 

The deductible is the amount you pay out-of-pocket for medical expenses before your insurance coverage begins to pay.

The rationale behind requiring an HDHP for HSA eligibility is to encourage consumers to become more conscious of healthcare spending due to the high deductible requirement. 

The theory is that consumers will make more informed and cautious decisions about accessing health services by paying more upfront costs. 

The HSA complements this by allowing individuals to save for these higher out-of-pocket costs using pre-tax dollars, which can then be used tax-free for qualified medical expenses, providing a little financial buffer for out-of-pocket costs. 

For a plan to qualify as an HDHP, it must meet specific deductible thresholds set by the Internal Revenue Service (IRS). For example, in 2023, the minimum deductible for an HDHP was $1,500 for individual coverage and $3,000 for family coverage.

Besides having a minimum deductible, HDHPs also have a maximum limit on yearly out-of-pocket expenses. These limits include deductibles, copayments, and other amounts but do not include premiums. For 2023, these limits were $7,500 for individual coverage and $15,000 for family coverage.

HDHPs typically cover preventive care services such as annual physicals, vaccinations, and screenings without the deductible being met.

So, that’s HSAs and HDHPs in a nutshell. 

Health coverage benefits aside, HSAs can be a potent triple-threat tax strategy for high earners. 

#1: Tax-Deductible Contributions

The tax-deductible nature of HSA contributions provides an effective way for high earners to manage their taxable income, ensuring that they are saving for future medical expenses and strategically reducing their immediate tax liability. 

This benefit is why HSAs are valued as a financial planning tool.

Contributions to an HSA can be made with pre-tax dollars, which means the money is taken out of your paycheck before income taxes are applied. 

As a result, your total taxable income for the year is reduced by your contribution amount. By reducing your taxable income, you effectively lower the income tax you owe for that year. Reducing taxable income can lead to substantial tax savings for high earners, who are often in higher tax brackets (potentially paying a higher percentage of their income in taxes). 

The higher your tax bracket, the more significant the savings from making pre-tax or tax-deductible contributions.

This is done through payroll deductions if your employer offers an HSA.

You can still benefit from tax advantages if you contribute to an HSA on your own, not through an employer’s payroll system. These contributions are still tax-deductible on your federal income tax return, which means you can deduct the amount of your contribution from your gross income when you file your taxes. 

This deduction is available whether you itemize deductions or not.

There are annual limits to how much you can contribute to an HSA. For example, in 2023, individuals can contribute up to $3,850, and families can contribute up to $7,750. Individuals aged 55 and older can also make an additional $1,000 catch-up contribution.

#2: Tax-Free Growth

The tax-free growth feature of Health Savings Accounts (HSAs) is one of their most appealing financial benefits, particularly for long-term financial planning. 

When you contribute funds to an HSA, any growth those funds experience—whether through interest, dividends, or capital gains— occurs without taxes imposed on any gains. 

Unlike traditional investment accounts, where gains can be taxed as capital gains or dividends each year, the HSA allows these gains to compound without being reduced by taxes.

This feature is beneficial if you invest your HSA funds in the stock market or mutual funds, which can offer higher returns than traditional savings accounts. 

For individuals who don't frequently face significant medical expenses, the HSA can function similarly to a retirement account. The longer funds grow and compound tax-free, the more substantial the account balance can become. 

#3: Tax-Free Withdrawals for Qualified Medical Expenses

HSAs are an excellent option for saving toward future health-related expenses in retirement when individuals are more likely to incur higher healthcare costs.

However, unlike a Roth, 401(k), or traditional IRA– all of which are taxed at some point (either before or after), HSA funds are made with pre-tax dollars and never taxed if used on qualifying expenses.

The strategic benefit comes into play with the ability to make tax-free withdrawals for qualified medical expenses at any time. 

In short, your pre-tax money and its gains will never be taxed in an HSA, putting together a growing stockpile of funds for many of the qualified expenses that are an inevitable part of life. 

The money in an HSA is taxed differently based on the type of withdrawal you make:

  1. For Qualified Medical Expenses: Withdrawals from an HSA for qualified medical expenses are tax-free. This is one of the primary benefits of an HSA. Use the funds for expenses that meet the IRS definition of "qualified medical expenses," including most medical, dental, and vision care. You will not pay any taxes on these withdrawals.
  2. For Non-Qualified Expenses: If you withdraw funds from your HSA for non-medical purposes before age 65, those withdrawals are subject to income tax and a 20% penalty. This discourages the use of HSA funds for non-healthcare-related expenses before retirement.
  3. After Age 65: Once you turn 65, you can withdraw funds from your HSA for any purpose without facing the 20% penalty. However, if the withdrawal is not for qualified medical expenses, it will be treated like regular income and taxed accordingly.

HSA FAQs: Beyond the Triple Advantage

HSAs are a unique offering often underutilized by high-earners for various reasons. Like most IRS tax-advantaged plans, they have their nuances. 

Here are a few common questions I get about HSAs beyond the basics.

  1. Can HSA funds be used to pay health insurance premiums?

Generally, you cannot use HSA funds to pay for health insurance premiums, except under specific circumstances such as COBRA continuation coverage, health insurance while receiving unemployment benefits, or Medicare premiums.

  1. Can HSA contributions be invested in real estate?

HSAs typically allow investments in stocks and mutual funds, but direct real estate investment is not permitted. The range of investment options depends on the HSA custodian.

  1. What happens to my HSA if I switch from high-deductible to standard health insurance plans?

You can keep your HSA and use the funds but can no longer make new contributions if you enroll in another qualifying high-deductible health plan.

  1. Can HSA funds be used to pay for medical expenses incurred in another country?

Yes, HSA funds can be used for qualified medical expenses incurred internationally, as long as the services qualify under IRS rules if performed in the United States. Be sure to look deeper into this to ensure you’re qualified. 

  1. What are the tax implications if I accidentally use HSA funds for a non-qualified expense?

Non-qualified withdrawals are subject to taxes and a 20% penalty if made before age 65. You must include the amount in your gross income and pay the penalty unless you repay the withdrawal to the HSA.

  1. Can HSA funds be used to pay for the medical expenses of a family member not covered under my high-deductible health plan?

Yes, you can use your HSA funds to pay for qualified medical expenses of any family member who qualifies as a dependent on your tax return, regardless of whether your HDHP covers them.

  1. How does divorce affect my HSA?

In a divorce, an HSA can be divided between the spouses as agreed upon in the divorce decree or settlement. The division itself does not trigger taxes or penalties.

Final Thoughts: HSAs and Next Steps

With their unique tax benefits and flexibility, HSAs offer a compelling option for high earners looking to maximize their tax efficiencies and prepare for future healthcare costs.

If you're interested in exploring the advantages of a Health Savings Account (HSA) after reading this article, here are some actionable steps you can take to get started:

First, evaluate your health insurance and make sure your current health plan qualifies as a High-Deductible Health Plan (HDHP), which is necessary to be eligible for an HSA. If you're not already enrolled in an HDHP, consider whether switching plans during the next open enrollment period could benefit your financial strategy.

Compare the fees, investment options, and additional benefits of various financial institutions that offer HSA accounts. A financial planner can be an invaluable asset in finding the perfect plans distinguishing how an HSA can be integrated with other tax-friendly accounts. Schedule a free financial analysis to explore your options and customize a strategy that best meets your needs.

Familiarize yourself with the most annual contribution limits for HSAs (adjusted yearly for inflation) and plan how much you want to contribute based on your healthcare spending and financial goals.

Start tracking your anticipated healthcare expenses, including any regular medications, anticipated surgeries, or ongoing medical treatments. This planning can help you decide how much to contribute annually and whether to use your HSA funds immediately or invest them for future growth.

Lastly, stay informed and in the loop. Health and tax laws can change, potentially impacting HSAs. 

We cover all relevant updates to HSAs and other developments in the tax world, distilling insights specifically for high-earners in our newsletter, Making Cents of Your Money

Keep up to date with any changes that might affect your account or health insurance plan to make sure you make the most of the tax-advantaged accounts at your disposal.