Health Savings Accounts: FAQs About HSAs

What is a health savings account?

Health savings accounts (HSAs) are tax-advantaged savings and investment accounts available to those with eligible high-deductible health plans.¹ Contributions to HSAs are tax-deductible.² Capital gains, dividends, and interest accumulate tax-free.³ And you pay no tax on withdrawals for qualified medical expenses, such as doctor visits, prescription medications, eye exams, and dental care (see IRS Publication 502 for a complete list of qualified expenses).

If you use HSA funds on nonmedical expenses before age 65, you pay not only ordinary income tax but also a 20% penalty; however, if you use HSA funds for nonmedical expenses after age 65, you pay only ordinary income tax. In other words, you’d take no worse a tax hit than you would with an individual retirement account.

Why do they exist?

HSAs were created in 2003 to provide a tax break to those with high-deductible health plans as employers shifted more health care costs to employees. The Employee Benefit Research Institute estimates enrollment in HSA-eligible health plans in 2018 to be between 23 and 36.8 million policyholders and their dependents.⁴

Who can open an HSA?

You are eligible to enroll in an HSA if:

• You are enrolled in an eligible high-deductible health plan.
• You aren’t covered by a non-high-deductible health plan (through a spouse, for example).
• You aren’t enrolled in Medicare.
• You can’t be claimed as a dependent on someone else’s tax return.

How do I contribute?

If your employer offers a high-deductible health plan, they may also offer an HSA through a third-party provider (some employers even make annual contributions to their employees’ HSA accounts). You can also open an account on your own through a qualified HSA provider, such as a bank or an insurance company.

In 2021, contribution limits—for both the employee plus employer portions—are $3,600 for individuals and $7,200 for families (plus an additional $1,000 in catch-up contributions for those age 55 and older). Contributions can be made any time between January 1 of a given year and the tax-filing deadline for that same year, usually April 15 of the following year. 

Can I invest HSA balances?

Funds in an HSA account can be invested, although the investment choices will vary depending on the HSA administrator. Note that many plans require a minimum balance—say, $1,000 or $2,000—before you can begin investing the funds.

As a practical matter, it’s a good idea to keep one to three years’ worth of potential out-of-pocket health care expenses in cash or a cash investment (such as a savings account or money market fund) to avoid selling riskier investments in a down market.

What if I change jobs?

Your HSA is portable—if you change jobs, you can take it with you. Also, if you die with money still in your account, you can leave it to your spouse (free of estate taxes) or other heirs (subject to estate taxes).

¹The IRS defines a high-deductible health plan as requiring a minimum annual deductible of $1,400 for an individual plan, and $2,800 for a family plan (see IRS Publication 969 for a complete list of requirements).

²While HSA contributions are exempt from federal income tax, they are not exempt from state taxes in California and New Jersey.

³State taxes may vary.

⁴Paul Fronstin, “Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2018: Statistics from the EBRI HSA Database,” Employee Benefit Research Institute, 12/5/2019.