It’s Open Enrollment Season. Have You Taken a Good Look at an HSA?

In one of the biggest changes to employee benefits in decades, high-deductible healthcare plans are appearing on more and more benefits menus, and these plans are experiencing dramatic growth in enrollment as a result. Twenty-eight percent of workers were covered by a HDHP in 2021, according to data from the Peterson Center on Healthcare/Kaiser Family Foundation; in 2014, 21% of workers were covered by an HDHP.

For some employees, the decision to participate in an HDHP is a choice; it appears alongside a traditional healthcare insurance plan option. But for some, the HDHP is their sole health-insurance option.

Yet despite their rapid uptake—or perhaps more aptly, because of it—there’s widespread confusion about how HDHPs work and how best to use the health savings accounts that are typically offered in conjunction with them. More-affluent employees, in particular, are forgoing valuable tax benefits by not steering their HSA balances toward long-term investments. And even employees who are using a “spend as they go” approach to their HSAs should consider using the accounts to take advantage of the tax breaks.

If you've forgone the HDHP/HSA combo in the past, use open enrollment season for employee benefits to revisit it.

What Is an HSA, and How Does It Work?

Employees covered by qualifying HDHPs are also allowed to contribute to an HSA. The parameters for what constitutes an HDHP are a moving target. For 2024, plans with annual deductibles of at least $1,600 for individuals and $3,200 for families are classified as high-deductible. There’s also a cap on allowable out-of-pocket expenses for people insured under HDHPs. The out-of-pocket maximum for HDHP plans is $8,050 for single coverage and $16,100 for family coverage.

Three tax breaks serve as an incentive to contribute to a health savings account and make the HSA the most tax-friendly savings wrapper in the tax code.

1. HSA contributions consist of pretax dollars (or they’re deductible, for people who aren’t using payroll deductions to fund their HSAs).
2. Any interest or investment gains earned on the account are tax-free.
3. Withdrawals for qualified medical expenses are also tax-free.

Companies may also contribute to the HSA on behalf of their employees.

HSA Annual Contribution Limits

Annual contribution limits for HSAs are going up in 2024; next year, people with single coverage will be able to contribute as much as $4,150 to an HSA, and people with family coverage can steer $8,300 to their HSAs. People older than 55 can make an additional “catchup” contribution of $1,000 annually.

Note that HSAs are different from flexible spending arrangements. While a use-it-or-lose-it policy (with a little wiggle room) applies to FSA balances, amounts in an HSA roll over from year to year; unused amounts in an HSA can build up and may be invested in long-term assets.

HSA Benefits

The ability to roll over an HSA balance from one year to the next—as well as these accounts’ prodigious tax breaks—points to the fact that there’s more than one way to use them. The obvious use is to spend from the HSA to cover out-of-pocket costs as they’re incurred. Because the contributions are pretax and qualified withdrawals are tax-free, it’s far better to stake at least as much in the HSA as you expect to incur in out-of-pocket expenses each year. Unfortunately, the data suggest that many HSA contributors are not putting in enough to cover their out-of-pocket health expenses.

The other way to use an HSA is to contribute to the account, but use non-HSA assets to cover actual healthcare costs; that enables the money in the HSA to be invested in long-term investments and stretches out the tax benefits that the HSA wrapper affords. Using a basic example that compares investing in an HSA up to the annual limit versus investing the same amount in a taxable account, and earning an annualized 4% return over 30 years, the HSA investor would be $100,000 ahead of the taxable investor. That makes an annual HSA investment up to the limit pretty close to (but not entirely) a no-brainer for higher-income folks who are maxing out other tax-sheltered options like IRAs and 401(k)s.

HSA Safety Valves

Despite the potential for tax savings and improved take-home returns, only a fraction of HSA assets are invested. Many HSA owners obviously don’t have the financial wherewithal to both spend out of pocket for healthcare while also reserving their HSAs for long-term investments. And even HSA owners who do have the liquid aftertax assets to cover healthcare costs out of pocket may choose to spend from their HSAs instead, in an effort to keep healthcare expenses from throwing them off their budgets. Finally, there’s the reality that it’s early days for HSAs, and many of these accounts are larded with costs, both for the “spenders” and the “savers” who use them.

Yet there are ways to work around those impediments. People who would like to use their HSA as a long-term investment vehicle, but aren’t sure if they can swing it long term, can pay for their healthcare expenditures from their aftertax pockets as they are able. If they need funds at a later date for another, non-healthcare-related purpose, they can tap the HSA, provided they’ve saved the receipts for the healthcare expenditures they covered with non-HSA funds.

It’s also worth noting that if you don’t like your employer-based HSA, you can set up another HSA alongside of it and periodically (or annually) transfer funds from the employer-based HSA into your own, hand-selected HSA. That’s a way to take advantage of the tax benefits and the convenience of having your HSA contributions extracted directly from your paycheck, while also maximizing your investment opportunities.

A previous version of this article was published on Oct. 20, 2022.