How Does An HSA Work?

Health savings accounts are tax-advantages personal accounts. Continue reading to find out more details regarding how they work.

A health savings account (HSA) resembles a 401(k) for health care. HSAs are tax-advantaged accounts that amass interest and can acquire investment returns. The funds can be utilized to pay for qualified clinical costs today or can be put aside for future costs.

So how does an HSA work? It works with a health plan that has a high deductible. You can set aside cash in your HSA account before taxes and utilize the funds to pay for qualified health care costs. HSAs can likewise help you save up for retirement, when you can utilize the funds to pay for general everyday costs without any penalty. As compared to other health spending accounts, HSAs give you more ways to save money on taxes and health care costs, now and in the future.

A health savings account (HSA) could be exactly what was ordered by your doctor. Utilized carefully, this inventive way to deal with health inclusion may give significant benefits that could keep both your personal and financial life healthy.

What is a health savings account?

A health savings account is a tax-advantaged personal savings account that works together with an HSA-qualified high-deductible health insurance policy (HDHP) to give both an investment and health coverage.

The savings account gives the funds you use to pay clinical costs that are not paid by your HDHP, or — if you do not have to utilize it — is an interest-bearing savings that develops over the long-term. Meanwhile, the HDHP, is your safety net if you need coverage for significant clinical costs that surpass the amount of your deductible. Furthermore, as long as your HDHP is not grandfathered, it is likewise needed to cover certain preventive care at no expense for you, whether or not you have met your deductible.

This sounds too good to be true. Right? Keep in mind that you are paying a lower premium for your insurance coverage since a high-deductible plan does not cover anything besides preventive care before the deductible. On the off chance that you need to see the doctor for anything else, you will cover the whole bill (decreased as per the negotiated rates your health plan has with the doctor) on the off chance that you have not met your deductible yet.

How does an HSA work?

A HSA is only accessible with high deductible health plans. These plans typically have lower month to month premiums. You do not pay any taxes on the money you put into an HSA. For instance, suppose you put the maximum sum ($3,400 for an individual, $6,750 for a family) in your HSA every year and you are in the 28% tax section. An HSA would save you $952 in taxes, or $1,890 for a family.

You likewise will not pay taxes when you remove cash from your HSA to pay for qualified health-related costs. This incorporates health care expenses your health plan does not cover. For instance, you can utilize HSA dollars to take care of health care costs until you reach your plan’s deductible. You would then be able to utilize HSA funds to pay coinsurance or co-pays until you meet your out-of-pocket limit. You can even use a cost calculator to analyze and compare the expense of a conventional health insurance plan with a high-deductible health plan and HSA.

Contributions to your HSA

Opening a HSA permits you to pay lower federal income taxes by making deposits without tax into your account every year. Most states — except California and New Jersey — likewise offer tax breaks on funds deposited in these accounts (a few states have no income tax, so HSA contributions would just influence federal taxes in those states).

Contributions can be made by the individual who owns the account, by an employer, or by any other person who wants to contribute on behalf of the account proprietor. At the point when individuals contribute their own funds to an HSA, they do not need to pay income tax on those funds. The cash is either payroll deducted pre-tax (which implies that it is free from income tax and FICA taxes), or deducted from your income tax on your tax return (you can deduct your contributions regardless of whether you take the standard deduction and do not itemize). Also, if an employer contributes, the cash is not taxed as the employee’s income.

You cannot add or contribute to an HSA when you are enrolled in Medicare — regardless of whether you continue to work and have HDHP coverage from an employer, along withMedicare. However, you can still keep on withdrawing tax-free funds from your HSA after you are enrolled in Medicare, as long as you utilize the cash to cover out-of-pocket clinical costs, including Medicare premiums.

The 2021 contribution limit is $3,600 in the event that you have individual coverage under your HDHP, and $7,200 if your HDHP likewise covers at least one other family member. In the event that you have HDHP coverage in 2021 (regardless of whether it is only in December), you have until April 15, 2022 to contribute to your HSA for 2021 (keep in mind that the deadlines were extended for 2019 and 2020 contributions, because of COVID; regularly, it is April 15 of the next year, or the tax filing deadline if somewhat different). For 2022, the limit of the contribution is $3,650 if your HDHP covers only yourself, and $7,300 if you have family HDHP coverage.

In case you are 55 years old or more, you can contribute an extra $1,000 every year (this is officially called an “additional contribution” and frequently alluded to as a catch-up contribution). This sum is not filed; it remains consistent at $1,000 each year. What’s more is that if two spouses are each more than 55 years old, they each need their own HSA to have the option to make a catch-up contribution for each spouse. HSAs are independently owned, as opposed to jointly owned (they are similar to IRAs in this manner). So, despite the fact that a couple may have family HDHP coverage and make the full family HSA contribution to one HSA every year, the HSA is actually in the name of only one spouse. So the catch-up contribution for that life partner can be made to the existing HSA (bringing the 2021 maximum contribution amount to a sum of $8,200 for the couple). Yet, the other companion should likewise open an HSA to deposit the other $1,000 catch-up contribution. This is clarified in the IRS Publication 969.

As of the 2018 tax year, the IRS abbreviated the primary 1040 and moved things that used to be on the main form onto a progression of schedules. So while you will still be using Form 8889 to report your HSA contributions and withdrawals, the HSA contribution deduction (in case you are qualified for it) on Form 1040 would now appear on Schedule 1. However, nothing changes regarding qualification for the actual deduction. Assuming that you make after-tax HSA contributions (ie, not through a payroll deduction, since those are now pre-tax), you will get to deduct them on your 1040 and avoid paying income taxes on the sum you contributed.

Withdrawals from your HSA

The cash you deposit into your HSA is yours to withdraw whenever you have to pay for clinical costs that are not covered by your high-deductible health insurance policy or reimbursed by any other person (so if you have a dental policy that pays part of your dental expenses, for instance, you can just utilize your HSA funds to pay the portion of your dental bill that you need to pay out-of-pocket). HSAs are viewed as a component of consumer-driven health care (CDHC), implying that you control the plan, deciding how to spend and invest those dollars.

Costs may incorporate deductibles, copayments, coinsurance, vision and dental care, and other cash based clinical expenses. Furthermore, the range of qualified services is expansive. You can utilize your HSA to pay for acupuncture, chiropractor services, or even conventional Chinese medicine (all that you can use it for is illustrated in the IRS Publication 502). From 2011 through 2019, people could not utilize tax-advantaged cash from a HSA for over-the-counter medications that were not recommended by a doctor. In any case, that changed in 2020 because of the CARES Act, which additionally changed the guidelines to permit HSA funds to be used to buy menstrual products.

You can withdraw the funds at the time you cause the clinical cost, or anytime later on, as long as you had effectively settled the HSA when the cost was brought about. You need to keep careful records in any case, however if you are planning to wait for ten years to repay yourself for a clinical cost, the onus is on you to prove that you had the cost and paid for it out-of-pocket, with non-HSA funds, and saved the receipts.

How does an HSA work for employers?

With an HSA you can make tax-deductible contributions every year to pay for current and future health care costs. In the event that your employer offers an HSA, it commonly works just like a customary 401(k). Your contribution is removed from your paycheck on a pre-tax premise. Your employer may likewise kick in a contribution. In the event that you have an HSA on your own, you still get the tax break; you simply claim the contribution as an “above the line” deduction on your tax return, and your taxable income will be decreased by the amount of your contribution.

Employers and employees can add to an HSA, and there are a few advantages of utilizing an HSA for each party that contributes to the HSA.

  • For employees: Employee contributions to an HSA are paid before tax, permitting them to pay their out-of-pocket expenses with pre-tax dollars. An HSA is linked to a specific individual, not their job. Cash in an employees’ account that has not been used, can roll over year to year, potentially growing over time, and can earn tax-free interest.
  • For employers: All employer contributions to employee HSAs can be used as an income tax deduction for your small business. Employers also will not have to cover payroll taxes on the pre-tax contributions of employees. The lower premiums of an HSA-compatible HDHP for employees may imply reduced cost-sharing for the employer.

If you are an employer, and are setting up a health savings account for your small business employees, keep in mind that it is a pretty direct process. Here is a quick rundown of the required steps.

  • Determine plan eligibility and contributions. The first thing you need to do is, find out if your employees have HSAs through eligible high deductible health plans. They could either be provided by the business or bought individually. Then, figure out the amount that the employees will contribute to their HSAs, along with whether your business will contribute to their accounts.
  • Create a Section 125 plan. A section 125 cafeteria plan permits employees and employers to contribute tax-free dollars to the HSA. The plan can be made available to employees, spouses, and dependents. Moreover, these plans can be set up by either your business or a payroll service.
  • Manage contributions and tax documentation. After implementing the Section 125 plan, employees can send HSA payments to their custodian or bank-administered account. As an employer, you will be needed to send your payments to employees’ accounts (if you choose to contribute to their HSAs). Your business will also be needed to provide the necessary tax documents, including W-2s, to your employees at the end of the tax year.

Remember that employees and employers should hold fast to yearly HSA contribution limits. The 2021 HSA contribution limits are higher than the 2020 sums. For self-only coverage, people can contribute $50 more in 2021 than they could in 2020. For family coverage, the 2021 limit is $100 higher than the 2020 cap. Generally, offering an HSA can be a reasonable method to enhance the health insurance plans of your employees while additionally giving tax benefits to your business.

How does HSA reimbursement work?

One of the advantages of a HSA is that you will have the option to compensate yourself for the cash that you utilized out-of-pocket – regardless of whether you utilized all of your funds in your account. You can repay yourself at any time, which means you will have the option to gather more tax-free funds in your HSA and utilize the HSA to refund yourself of a certified cost. For instance, while walking into work, your mind is stuck on an important meeting, you stumble on the sidewalk, fall down, land yourself in the ER and end up with a $3,500 bill. You think about your HSA and it dawns upon you that you do not have $3,500 in it.

To pay for this medical event, you can utilize the cash you have in your HSA, and pay the remainder of the bill out-of-pocket, with cash you have already paid taxes on. When you do this, make sure to always keep the receipts of the transactions, if you ever get examined by the IRS. Over time, you can build your HSA back up by proceeding with your contributions. When your account comes to $3,500, you can reimburse yourself with tax-free HSA funds for the cash that you used to pay out-of-pocket. This is where keeping the receipts is significant in light of the fact that you can easily attach that to your reimbursement.

How do I set up a health savings account?

Enrollees can choose from an extensive list of banks, credit unions, and brokerage firms that offer accounts for saving and developing HSA funds. Enrollment in HSA-qualified HDHPs had taken off to 21.8 million individuals by 2017, up from 10 million individuals in 2010 (since 2017 more than 3/4 had HDHP coverage given by a large employer). As per information from America’s Health Insurance Plans (AHIP), enrollment has been developing at a pace of about 15% each year since 2011. AHIP’s information demonstrates that 8 million people were enrolled in HSAs in 2009 and only 3.2 million in 2006 (note that HSAs first opened up in 2004). Not all of those enrollees contribute funds to an HSA, yet they are qualified to do so if they want.

Numerous organizations, large and small, offer these HDHP approaches to their employees, however you can likewise buy them all alone through the exchange in your state or directly from a health insurance carrier. For individuals who purchase their own insurance, HDHPs are accessible in practically every region in the US. In case you are shopping on or a state-run marketplace, the HSA-qualified plans will be assigned with a symbol or a little notice. You will have the option to utilize a search filter to limit the plan choices to only show HSA-eligible plans.

What are the advantages of having an HSA?

The following list highlights some of the advantages of having a Health Savings Accounts.

Many Expenses Qualify

Eligible costs include a vast range of medical, dental, and mental health services. They are mentioned in detail in IRS Publication 502, Medical and Dental Expenses. Because of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed in 2020, over-the-counter medications and menstrual products are now qualified HSA costs.

Others Can Contribute

You, your employer, a family member, or anyone else who wants to add to your HSA, can contribute towards your HSA account. However, the IRS does set limits. For 2021, the limit is $3,600 for individuals and $7,200 for families ($3,550 and $7,100, respectively, for 2020). Moreover, an additional $1,000 “catch-up” contribution is also present for anyone who is 55 years old or more by the end of the tax year.

Pre-Tax Contributions

Contributions are usually made with pretax dollars through payroll deductions at your employer. Consequently, they are not part of your gross income and are not subject to federal income taxes. In most states, contributions are not subject to state income taxes.

Tax-Deductible After-Tax Contributions

If you make contributions with after-tax dollars, you can deduct them from your gross income on your tax return, reducing your tax bill for the year. For instance, if you are an individual under the age of 55, your maximum allowed contribution in 2021 is $3,600 ($3,550 for 2020). By the end of the year, if you only deposit $2,600 into your HSA through payroll deductions, you might have to choose to deposit an extra $1,000 to lower your tax liability. You typically have until the respective IRS tax filing deadline to contribute.

Tax-Free Withdrawals

Withdrawals from your HSA are not subject to federal (or in most cases, state) taxes if you use them for eligible medical costs. Nevertheless, HSAs can be used as investment accounts, permitting you to buy stocks and other securities to potentially boost your returns. Keep in mind that investing in stocks and other securities within your HSA is not suggested for everyone. Investing in stocks comes with the risk of loss of principal, and should only be thought of as part of a diversified, long-term wealth-building strategy. It would be a smart idea to seek the advice of a financial planning professional before taking a huge step.

Tax-Free Earnings

Any interest or other earnings on the cash in the account is tax-free. Most HSA accounts earn a minimal amount of interest, which is usually less than 0.1%.

Annual Rollover

If you have cash left in your HSA by the end of the year, it rolls over to the next year. This offers more adaptability and flexibility than a Flexible Spending Accounts (FSAs), which usually can only be carried over in an amount up to $550 or 2.5 months into the following plan year.


The cash in your HSA stays available for future qualified clinical costs regardless of whether you change health insurance plans, go to work for a different employer, or resign. Basically, your HSA is a bank account in your name, where you choose how and when to utilize the funds. HDHPs are needed to set a minimum deductible and a maximum for out-of-pocket expenses. In 2021, the minimum deductible is $1,400 for an individual and $2,800 for a family and $7,000 (individual) and $14,000 (family) for out-of-pocket expenses.


Most HSAs issue a debit card, so you can pay for prescription drugs and other qualified costs immediately. If you wait for a medical bill to come in the mail, you can get in touch with the billing center and make a payment over the phone through your HSA debit card. Moreover, you can alternatively reimburse yourself out of an HSA if you have covered a medical bill with an alternative form of payment.

What is the downside of an HSA?

In case you are eligible for an HSA, here are some of the disadvantages you need to keep in mind:

High-Deductible Requirement

A High-Deductible Health Plan, which you are required to have in order to meet all requirements for an HSA, can put a more prominent financial weight on you than other kinds of health insurance. Despite the fact that you will pay less in premiums every month, it very well may be difficult — even with cash in an HSA — to come up with the money to meet the deductible for an expensive medical operation. This is an interesting point for any individual who realizes they will have heavy clinical expenses in a specific plan year. The deductibles for HDHPs are regularly significantly higher than the minimums required and can be as high as the maximum out-of-pocket expenses permitted.

Pressure to Save

Some people may be hesitant to seek healthcare when they need it since they do not want to spend the money in their HSA account.

Taxes and Penalties

If you withdraw funds for non-qualified costs before you turn 65 years old, you will owe income taxes on the cash, along with a 20% penalty. After you hit 65, you will owe taxes but not the penalty.


It is important to keep receipts to provide evidence that your withdrawals were used for eligible health costs. This will be important if you are going to be audited by the IRS.


Some HSAs charge a monthly maintenance fee or a per-transaction fee, which can change from one institution to another. While usually not very high, the fees are almost certainly greater than any interest the account may earn. Sometimes these charges are waived if you maintain a certain minimum balance.


Health insurance organizations and employers will usually suggest a bank that insureds can use to set up an HSA whenever they are enrolled in an HDHP. However, enrollees are allowed to choose any HSA custodian they like. In case you are enrolled in an HSA through your employer, you will probably have to use the HSA custodian that your employer chooses, to have your pre-tax contributions payroll deducted and to get any contributions that your employer makes on your behalf. Be that as it may, when the funds are in your account, you are allowed to move them to another HSA custodian if you decide to do so.

In case you are enrolled in a high-deductible health plan, the tax benefits of an HSA and the ability to turn over unspent cash are engaging. Be that as it may, high-deductible health plans are not generally the most ideal choice, particularly in the event that you think you would have huge healthcare costs. A long list of banks, credit unions, and brokerage firms offer accounts for saving and developing HSA funds over the long term. Therefore, look around before you select an HSA custodian. The saving accounts incorporate a bewildering exhibit of choices. Moreover, businesses offer endless stocks, bonds, and funds to invest into with low trading charges, while others may have restricted options, are more costly, and have covered up expenses.

Sandra Johnson

Sandra Johnson

Sandra Johnson was a few years out of school and took a job as a life insurance agent in California, selling coverage door-to-door for Prudential. The experience taught her about the technical components of insurance and its benefits for individuals and society, as well as the misunderstandings people often have about insurance. She has over ten years’ experience in the insurance industry, having worked as both a Broker and Underwriter, assisting clients across a broad range of industries. At Insurance Noon, Sarah diligently gathers all the required information and curates up pieces to provide meaningful insurance solutions. Her personal value proposition is to demonstrate a genuine interest in always adding value for clients.Her determined approach to guiding clients has turned her into a platinum adviser to multiple insurers.

Insurance Noon is the world's leading source of insurance related content on the web, focusing on industry news, buying guides, reviews, and much more.