Everything You Need to Know About Flexible Health Savings Accounts

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In March of last year, I broke my wrist while fencing with my son. Every month for 15 months, I received a bill for a medical cost related to the accident. Each time I opened the envelope, I felt grateful I could afford the costs, thanks in part to my flexible Health Savings Account (HSA).

I’m not the only person taking advantage of the HSA. According to benefits manager Benefitfocus, millennials are trying to save money on health care costs by opting for high-deductible health plans and using them in conjunction with flexible Health Savings Accounts. Benefitfocus reports that almost 40 percent of eligible millennials under the age of 26 participated in an HSA for the current year — up from less than 33 percent in 2016.

If the HSA isn’t in your financial toolbox yet, now is a good time to see if it belongs there.

What is an HSA?

The flexible Health Savings Account was introduced in 2003 as part of sweeping changes to Medicare prescription drug benefits.

It is a tax-advantaged account designed to help those with high-deductible health plans cover their out-of-pocket health costs.

The biggest perk of the HSA is the fact that you have the potential for truly tax-free savings. You receive a tax deduction for your contributions to the HSA today. Plus, when you withdraw the money later, you don’t have to pay taxes on it when you use the funds for qualified health care costs.

Another perk of the HSA is its flexibility. Unlike a more “traditional” Flexible Savings Account (FSA), all of the money in your HSA rolls over year-to-year. With the FSA, if you don’t use the money each year, you might lose some of what you’ve contributed. A recent rule change allows you to roll over up to $500 from your FSA. However, it’s still a relatively small amount when you consider you can amass thousands in your truly flexible Health Savings Account and keep all of it over subsequent years.

Your HSA can be accessed by debit card, allowing you to pay for qualified services and other costs immediately. It’s also possible to pay your health care costs out-of-pocket and then reimburse yourself from the HSA. Whether you pay with debit card or reimburse yourself, save your receipts for your tax records.

On top of all this, you can use your HSA as part of your retirement savings plan. After you reach age 65, it’s possible to withdraw money penalty-free for non-qualified expenses — just as you would with a traditional IRA.

Not just anyone can open an HSA, though.

How to qualify for an HSA

Before you decide to jump on the HSA bandwagon, it’s important to make sure you are eligible. There are no income limitations, but there are other conditions you have to meet:

You must enroll in a high-deductible health plan

First of all, you can only use an HSA if you are enrolled in a high-deductible health plan (HDHP). With an HDHP you pay a lower monthly premium, but your out-of-pocket costs are higher. The IRS determines what qualifies as an HDHP. For 2018, the HDHP minimum deductible is $1,350 for a self-only plan. A family plan needs to have a deductible of at least $2,700 to qualify as an HDHP.

On the ACA exchange, you can find silver- and bronze-level plans that qualify you for a flexible Health Savings Account. According to a Health Affairs policy brief published last year, about 25 percent of the plans on the ACA Marketplace qualified for HSAs.

There’s also a chance that your employer’s plan qualifies for an HSA. With the rise in health spending expected to outpace economic growth through 2025, it’s no surprise employers are looking to cut costs. In fact, between 2010 and 2016, deductibles increased 67 percent in the employer market.

If you choose an HDHP plan at work, your employer gets a cost break and you can increase your chances of qualifying for an HSA.

You can’t be under another health plan

If you want to enroll in an HSA, you can’t have other health coverage. This includes coverage from your spouse’s health plan and Medicare. However, you can qualify if your spouse has a non-HDHP plan, so long as it does not cover you. So if you want to open an HSA in this case, you’ll need to get separate HDHP coverage.

You can also still get an HSA if you have additional insurance coverage for accidents, disability, dental, vision, or long-term care. Exceptions for additional coverage also include workers’ compensation and coverage for specific illnesses or a fixed daily amount for hospitalization.

Someone can’t claim you as a dependent

If a parent (or someone else) claims you as a dependent on their tax forms, you can’t open an HSA. Talk to others to determine your dependent status before opening an HSA.

How to open an HSA

Before you open your HSA account, check with your employer to see if they offer an HSA.

Don’t confuse an HSA with an FSA, mentioned above — they are two different types of accounts.

Some employers offer the flexible Health Savings Account as a benefit. They can deduct your contributions from your paycheck. Some employers even match contributions you make to your employer-sponsored HSA. This can be a way to build your account using free money, similar to how you manage a 401(k).

If your employer offers HSAs, your human resources representative or plan administrator can help you fill out the paperwork to enroll.

You can also open an HSA account with your bank — many financial institutions offer them. You need to bring proof of active enrollment in a qualifying HDHP. You’ll also need identifying documents, your address, Social Security number, and date of birth, just as you would open any other financial account.

My primary banking institution holds my HSA. This makes it easy for me to transfer my contributions from my checking account into the HSA. I can also manage my HSA with ease.

Even if you hold your HSA at a bank instead of using an employer-sponsored account, it might be possible to use automatic deposits from your paycheck to fund your HSA. Check with human resources.

No matter where you keep your HSA, the money held in it is yours. If you leave an employer with an HSA, it can stay with your old company. If you want to move the money, though, check for information about rolling your account into an HSA opened at your bank or your new employer.

HSA contribution limits

While there aren’t any income limitations to using an HSA and getting the tax benefits, there are contribution limits. If you have an individual HDHP, you can contribute up to $3,450 a year in 2018. Someone with family coverage can contribute up to $6,900 a year.

Your contribution reduces your income, saving you money on your tax bill.

Using your flexible Health Savings Account

Once you fund your account, you can access the money anytime for qualified expenses. It’s even possible to invest some of the money in your HSA.

Because an HDHP often comes with a lower premium than other types of policies, you might be able to bank the savings. If your old health plan required a premium of $500 per month, but your new high-deductible plan only costs $325 a month, that’s a discount of $175. You can put that money into your HSA, saving it for future use.

Over time, if you free up more money in your budget, you can increase what you set aside each month — as long as your total contributions for the year don’t exceed the limit imposed by the IRS.

Qualified health care expenses

You can use a debit card to access your HSA, pay for your costs on your own and reimburse yourself later, or withdraw cash and use it to make qualified purchases at any time. Some of the eligible costs include:

  • Doctor visit co-pays
  • Doctor and specialist visits
  • Vision exams
  • Glasses and contacts
  • Dental exams and other dental care costs
  • Prescription medicines
  • Physical therapy
  • Hearing aids and their batteries
  • Nursing services
  • Fertility treatment

You can find a complete list of qualifying expenses with the help of Publication 502, Medical and Dental Expenses, from the IRS.

It’s important to pay attention to how you spend your HSA money and to keep good records. If you withdraw the money for non-qualified expenses, you will pay income taxes on the money. Plus, the IRS will also charge you a penalty amounting to 20 percent of the amount drawn.

You can escape the penalty once you reach age 65. However, you will still pay taxes on the amount withdrawn if you don’t use it for health care costs.

Invest some of your HSA money

Many people don’t realize that an HSA isn’t just a savings account. It’s also an investment account. Once your account balance reaches $2,000, you are eligible to invest some of the funds. Your earnings will be tax-free.

Not every account offers investment choices. Those accounts that do have this option often focus on index mutual funds and ETFs to help reduce the overall risk.

It’s important to remember that with any investment there is a risk of loss. If you choose to put a portion of your HSA into investments, you could lose those funds.

Use your HSA as part of your long-term retirement plan

While you can access your HSA money now, it’s also possible to include the account in your retirement planning. Instead of tapping your flexible Health Savings Account to pay for your out-of-pocket costs today, you can let the money grow (as long as you can afford to cover your health expenses without the HSA funds).

Consider maxing out your contributions to your HSA each year (and get the tax deduction). Once your account is eligible, start investing in funds that can help your account grow. Over time, your HSA has the potential to become a retirement health care account. Later, during retirement, you can use the funds to cover your health costs — and never pay taxes on the money.

Fidelity expects a couple to spend about $245,000 on health care during retirementWhen you consider that, building up your HSA as part of your overall retirement plan doesn’t seem like a bad idea.

Is the HSA right for everyone?

At first glance, an HSA seems like a no-brainer. However, even with all the advantages, HSAs aren’t necessarily right for everyone. The main issue is the requirement to enroll in a high-deductible health plan.

Depending on your health needs, an HDHP might not be the best choice for you. If you have young dependents requiring a lot of doctor visits, you could easily spend a lot in out-of-pocket costs and be unable to set aside money in your HSA.

Similarly, a high-deductible plan might not be best if you have a chronic condition that requires regular treatment or expensive medications.

Run the numbers

Before choosing a plan, estimate what your likely health care needs will be.

For years, an HDHP worked for me. I rarely reach my deductible, I almost never go to the doctor beyond my annual checkup, and I have only one recurring prescription that costs me nothing. Until I broke my wrist, I didn’t have major medical costs. Those years of saving on premiums benefitted me.

But if I’d had larger health care needs, the story would have been different.

Say you have a condition that requires four checkups throughout the year, with each specialist visit costing $250. On top of that, you need a prescription that costs $300 a month.

What if you have a “regular” plan that costs $500 per month, with a $30 specialist copay and a $15 prescription copay? In this case, with your insurance premiums, monthly drug copay, and the quarterly visits, your total spent comes to $6,300 for the year (see chart below).

flexible health savings account

But what about the HDHP? You only pay $325 per month, but you have a $2,600 deductible. After that, you’re responsible for 20 percent of your health care costs.

After seven months, when you’ve had two specialist visits and seven filled prescriptions, you’ll just barely be hitting your deductible. For the remainder of the year, you only pay 20 percent for your services, which will include two more specialist visits left ($100) and five months’ worth of prescriptions ($300).

When you include your premiums for the year, your total with the HDHP comes out to $6,900. Because of your recurring health care needs, choosing the higher-deductible plan sets you back an extra $600 a year.

Ask for more options

Check your health care choices during your employer’s open enrollment. Look for a plan that fits your budget and your needs.

If your employer doesn’t offer an HDHP option, but you think it’s right for you, talk to your human resources representative about adding that choice. Additionally, if your employer offers an HDHP and you want to take advantage of the lower premiums, find out if there is an HSA. Encourage your employer to offer an HSA if they offer HDHPs.

Health care prices are likely to keep rising. Consider your budget, and research health plans. If you qualify, and if the numbers make sense for your situation, an HSA might be one way for you to manage your long-term health costs.

Interested in refinancing student loans?

Here are the top 6 lenders of 2018!
LenderVariable APREligible Degrees 
Check out the testimonials and our in-depth reviews!
1 Important Disclosures for Earnest.

Earnest Disclosures

To qualify, you must be a U.S. citizen or possess a 10-year (non-conditional) Permanent Resident Card, reside in a state Earnest lends in, and satisfy our minimum eligibility criteria. You may find more information on loan eligibility here: https://www.earnest.com/eligibility. Not all applicants will be approved for a loan, and not all applicants will qualify for the lowest rate. Approval and interest rate depend on the review of a complete application.

Earnest fixed rate loan rates range from 3.89% APR (with Auto Pay) to 5.87% APR (with Auto Pay). Variable rate loan rates range from 2.47% APR (with Auto Pay) to 5.87% APR (with Auto Pay). For variable rate loans, although the interest rate will vary after you are approved, the interest rate will never exceed 8.95% for loan terms 10 years or less. For loan terms of 10 years to 15 years, the interest rate will never exceed 9.95%. For loan terms over 15 years, the interest rate will never exceed 11.95% (the maximum rates for these loans). Earnest variable interest rate loans are based on a publicly available index, the one month London Interbank Offered Rate (LIBOR). Your rate will be calculated each month by adding a margin between 1.82% and 5.50% to the one month LIBOR. The rate will not increase more than once per month. Earnest rate ranges are current as of Month/Day/Year, and are subject to change based on market conditions and borrower eligibility.

Auto Pay discount: If you make monthly principal and interest payments by an automatic, monthly deduction from a savings or checking account, your rate will be reduced by one quarter of one percent (0.25%) for so long as you continue to make automatic, electronic monthly payments. This benefit is suspended during periods of deferment and forbearance.

The information provided on this page is updated as of 08/21/18. Earnest reserves the right to change, pause, or terminate product offerings at any time without notice. Earnest loans are originated by Earnest Operations LLC. California Finance Lender License 6054788. NMLS # 1204917. Earnest Operations LLC is located at 302 2nd Street, Suite 401N, San Francisco, CA 94107. Terms and Conditions apply. Visit https://www.earnest.com/terms-of-service, email us at hello@earnest.com, or call 888-601-2801 for more information on ourstudent loan refinance product.

© 2018 Earnest LLC. All rights reserved. Earnest LLC and its subsidiaries, including Earnest Operations LLC, are not sponsored by or agencies of the United States of America.


2 Important Disclosures for Laurel Road.

Laurel Road Disclosures

Savings example: average savings calculated based on single loans refinanced from 9/2013 to 12/2017 where borrowers’ previous rates were disclosed. Assumes same loan terms for previous and refinanced loans, and payments made to maturity with no prepayments. Actual savings for individual loans vary based on loan balance, interest rates, and other factors.

Application detail: 5 minutes indicates typical time it takes to complete application with applicant information readily available. It does not include time taken to provide underwriting decision or funding of the loan.

Instant rates mean a delivery of personalized rates for those individuals who provide sufficient information to return a rate. For instant rates a soft credit pull will be conducted, which will not affect your credit score. To proceed with an application, a hard credit pull will be required, which may affect your credit score.

Total savings calculated by aggregating individual average savings across total borrower population from 9/2013 to 12/2017. Individual average savings calculation based on single loans refinanced from 9/2013 to 12/2017 where borrowers’ previous rates were provided. Assumes same loan terms for previous and refinanced loans, and payments made to maturity with no prepayments. Actual savings for individual loans vary based on loan balance, interest rates, and other factors.


3 Important Disclosures for SoFi.

SoFi Disclosures

  1. Student loan Refinance:Fixed rates from 3.899% APR to 7.804% APR (with AutoPay). Variable rates from 2.470% APR to 6.990% APR (with AutoPay). Interest rates on variable rate loans are capped at either 8.95% or 9.95% depending on term of loan. See APR examples and terms. Lowest variable rate of 2.470% APR assumes the current index rate derived from the 1-month LIBOR of 2.08% plus 0.64% margin minus 0.25% ACH discount. Not all borrowers receive the lowest rate. If approved for a loan, the fixed or variable interest rate offered will depend on your creditworthiness, and the term of the loan and other factors, and will be within the ranges of rates listed above. For the SoFi variable rate loan, the 1-month LIBOR index will adjust monthly and the loan payment will be re-amortized and may change monthly. APRs for variable rate loans may increase after origination if the LIBOR index increases. The SoFi 0.25% AutoPay interest rate reduction requires you to agree to make monthly principal and interest payments by an automatic monthly deduction from a savings or checking account. The benefit will discontinue and be lost for periods in which you do not pay by automatic deduction from a savings or checking account. *To check the rates and terms you qualify for, SoFi conducts a soft credit inquiry. Unlike hard credit inquiries, soft credit inquiries (or soft credit pulls) do not impact your credit score. Soft credit inquiries allow SoFi to show you what rates and terms SoFi can offer you up front. After seeing your rates, if you choose a product and continue your application, we will request your full credit report from one or more consumer reporting agencies, which is considered a hard credit inquiry. Hard credit inquiries (or hard credit pulls) are required for SoFi to be able to issue you a loan. In addition to requiring your explicit permission, these credit pulls may impact your credit score.
  2. Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet SoFi’s underwriting requirements. Not all borrowers receive the lowest rate. To qualify for the lowest rate, you must have a responsible financial history and meet other conditions. If approved, your actual rate will be within the range of rates listed above and will depend on a variety of factors, including term of loan, a responsible financial history, years of experience, income and other factors. Rates and Terms are subject to change at anytime without notice and are subject to state restrictions. SoFi refinance loans are private loans and do not have the same repayment options that the federal loan program offers such as Income Based Repayment or Income Contingent Repayment or PAYE. Licensed by the Department of Business Oversight under the California Financing Law License No. 6054612. SoFi loans are originated by SoFi Lending Corp., NMLS # 1121636. (www.nmlsconsumeraccess.org)

4 Important Disclosures for LendKey.

LendKey Disclosures

Refinancing via LendKey.com is only available for applicants with qualified private education loans from an eligible institution. Loans that were used for exam preparation classes, including, but not limited to, loans for LSAT, MCAT, GMAT, and GRE preparation, are not eligible for refinancing with a lender via LendKey.com. If you currently have any of these exam preparation loans, you should not include them in an application to refinance your student loans on this website. Applicants must be either U.S. citizens or Permanent Residents in an eligible state to qualify for a loan. Certain membership requirements (including the opening of a share account and any applicable association fees in connection with membership) may apply in the event that an applicant wishes to accept a loan offer from a credit union lender. Lenders participating on LendKey.com reserve the right to modify or discontinue the products, terms, and benefits offered on this website at any time without notice. LendKey Technologies, Inc. is not affiliated with, nor does it endorse, any educational institution.


5 Important Disclosures for CommonBond.

CommonBond Disclosures

  1. Offered terms are subject to change. Loans are offered by CommonBond Lending, LLC (NMLS # 1175900). The following table displays the estimated monthly payment, total interest, and Annual Percentage Rates (APR) for a $10,000 loan. The Annual Percentage Rate (APR) shown for each in-school loan product reflects the accruing interest, the effect of one-time capitalization of interest at the end of a deferment period, a 2% origination fee, and the applicable Repayment Plan. All loans are eligible for a 0.25% reduction in interest rate by agreeing to automatic payment withdrawals once in repayment, which is reflected in the interest rates and APRs displayed. Variable rates may increase after consummation. All variable rates are based on a 1-month LIBOR assumption of 2.08% effective July 25, 2018.

6 Important Disclosures for Citizens Bank.

Citizens Bank Disclosures

  1. Education Refinance Loan Rate DisclosureVariable rate, based on the one-month London Interbank Offered Rate (“LIBOR”) published in The Wall Street Journal on the twenty-fifth day, or the next business day, of the preceding calendar month. As of October 1, 2018, the one-month LIBOR rate is 2.22%. Variable interest rates range from 2.72%-8.32% (2.72%-8.32% APR) and will fluctuate over the term of the borrower’s loan with changes in the LIBOR rate, and will vary based on applicable terms, level of degree earned and presence of a cosigner. Fixed interest rates range from 3.75%-8.69% (3.75%-8.69% APR) based on applicable terms, level of degree earned and presence of a cosigner. Lowest rates shown require application with a cosigner, are for eligible, creditworthy applicants with a graduate level degree, require a 5-year repayment term and include our Loyalty discount and Automatic Payment discounts of 0.25 percentage points each, as outlined in the Loyalty and Automatic Payment Discount disclosures. The maximum variable rate on the Education Refinance Loan is the greater of 21.00% or Prime Rate plus 9.00%. Subject to additional terms and conditions, and rates are subject to change at any time without notice. Such changes will only apply to applications taken after the effective date of change. Please note: Due to federal regulations, Citizens Bank is required to provide every potential borrower with disclosure information before they apply for a private student loan. The borrower will be presented with an Application Disclosure and an Approval Disclosure within the application process before they accept the terms and conditions of their loan.
  2. Federal Loan vs. Private Loan Benefits: Some federal student loans include unique benefits that the borrower may not receive with a private student loan, some of which we do not offer with the Education Refinance Loan. Borrowers should carefully review their current benefits, especially if they work in public service, are in the military, are currently on or considering income based repayment options or are concerned about a steady source of future income and would want to lower their payments at some time in the future. When the borrower refinances, they waive any current and potential future benefits of their federal loans and replace those with the benefits of the Education Refinance Loan. For more information about federal student loan benefits and federal loan consolidation, visit http://studentaid.ed.gov/. We also have several resources available to help the borrower make a decision at http://www.citizensbank.com/EdRefinance, including Should I Refinance My Student Loans? and our FAQs. Should I Refinance My Student Loans? includes a comparison of federal and private student loan benefits that we encourage the borrower to review.
  3. Citizens Bank Education Refinance Loan Eligibility: Eligible applicants may not be currently enrolled. Applicants with an Associate’s degree or with no degree must have made at least 12 qualifying payments after leaving school. Qualifying payments are the most recent on time and consecutive payments of principal and interest on the loans being refinanced. Primary borrowers must be a U.S. citizen, permanent resident or resident alien with a valid U.S. Social Security Number residing in the United States. Resident aliens must apply with a cosigner who is a U.S. citizen or permanent resident. The cosigner (if applicable) must be a U.S. citizen or permanent resident with a valid U.S. Social Security Number residing in the United States. For applicants who have not attained the age of majority in their state of residence, a cosigner will be required. Citizens Bank reserves the right to modify eligibility criteria at anytime. Interest rate ranges subject to change. Education Refinance Loans are subject to credit qualification, completion of a loan application/consumer credit agreement, verification of application information, certification of borrower’s student loan amount(s) and highest degree earned.
  4. Loyalty Discount Disclosure: The borrower will be eligible for a 0.25 percentage point interest rate reduction on their loan if the borrower or their co-signer (if applicable) has a qualifying account in existence with us at the time the borrower and their co-signer (if applicable) have submitted a completed application authorizing us to review their credit request for the loan. The following are qualifying accounts: any checking account, savings account, money market account, certificate of deposit, automobile loan, home equity loan, home equity line of credit, mortgage, credit card account, or other student loans owned by Citizens Bank, N.A. Please note, our checking and savings account options are only available in the following states: CT, DE, MA, MI, NH, NJ, NY, OH, PA, RI, and VT and some products may have an associated cost. This discount will be reflected in the interest rate disclosed in the Loan Approval Disclosure that will be provided to the borrower once the loan is approved. Limit of one Loyalty Discount per loan and discount will not be applied to prior loans. The Loyalty Discount will remain in effect for the life of the loan.
  5. Automatic Payment Discount Disclosure: Borrowers will be eligible to receive a 0.25 percentage point interest rate reduction on their student loans owned by Citizens Bank, N.A. during such time as payments are required to be made and our loan servicer is authorized to automatically deduct payments each month from any bank account the borrower designates. Discount is not available when payments are not due, such as during forbearance. If our loan servicer is unable to successfully withdraw the automatic deductions from the designated account three or more times within any 12-month period, the borrower will no longer be eligible for this discount.
  6. Co-signer Release: Borrowers may apply for co-signer release after making 36 consecutive on-time payments of principal and interest. For the purpose of the application for co-signer release, on-time payments are defined as payments received within 15 days of the due date. Interest only payments do not qualify. The borrower must meet certain credit and eligibility guidelines when applying for the co-signer release. Borrowers must complete an application for release and provide income verification documents as part of the review. Borrowers who use deferment or forbearance will need to make 36 consecutive on-time payments after reentering repayment to qualify for release. The borrower applying for co-signer release must be a U.S. citizen or permanent resident. If an application for co-signer release is denied, the borrower may not reapply for co-signer release until at least one year from the date the application for co-signer release was received. Terms and conditions apply.
  7. Estimated average savings amount is based on 14,659 Education Refinance Loan customers who saved on loans between August 1, 2017 and July 31, 2018. The calculation is derived by averaging monthly savings across Education Refinance Loan customers whose payment amounts decreased after refinancing, calculated by taking the monthly payment prior to refinancing minus the monthly payment after refinancing. We excluded monthly savings from customers that exceeded $4,375 and were lower than $20 to minimize risk of data error skewing the savings amounts. Savings will vary based on interest rates, balances and remaining repayment term of loans to be refinanced. Borrower’s overall repayment amount may be higher than the loans they are refinancing even if monthly payments are lower.

2.47% – 6.99%3Undergrad
& Graduate
Visit SoFi
2.47% – 5.87%1Undergrad
& Graduate
Visit Earnest
2.47% – 8.03%4Undergrad
& Graduate
Visit Lendkey
2.95% – 6.37%2Undergrad
& Graduate
Visit Laurel Road
2.48% – 6.25%5Undergrad
& Graduate
Visit CommonBond
2.72% – 8.32%6Undergrad
& Graduate
Visit Citizens
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