Everything You Need to Know About Flexible Health Savings Accounts

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flexible health savings account

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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 8 lenders of 2020!
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 3.20% APR (with Auto Pay) to 6.99% APR (with Auto Pay). Variable rate loan rates range from 1.99% APR (with Auto Pay) to 6.89% 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 December 13, 2019, 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 12/13/2019. 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 our student 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 SoFi.

SoFi Disclosures

  1. Student loan Refinance: Fixed rates from 3.46% APR (with AutoPay) to 7.61% APR (without AutoPay). Variable rates currently from 2.31% APR (with AutoPay) to 7.61% (without 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 2.31% APR assumes current 1 month LIBOR rate of 2.31% plus 0.75% margin minus 0.25% for AutoPay. If approved for a loan, the fixed or variable interest rate offered will depend on your credit history and the term of the loan 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.

3 Important Disclosures for Figure.

Figure Disclosures

Figure’s Student Refinance Loan is a private loan. If you refinance federal loans, you forfeit certain flexible repayment options associated with those loans. If you expect to incur financial hardship that would impact your ability to repay, you should consider federal consolidation alternatives.

4 Important Disclosures for College Ave.

College Ave Disclosures

College Ave Student Loans products are made available through either Firstrust Bank, member FDIC or M.Y. Safra Bank, FSB, member FDIC. All loans are subject to individual approval and adherence to underwriting guidelines. Program restrictions, other terms, and conditions apply.

1College Ave Refi Education loans are not currently available to residents of Maine.

2All rates shown include autopay discount. The 0.25% auto-pay interest rate reduction applies as long as a valid bank account is designated for required monthly payments. Variable rates may increase after consummation.

3$5,000 is the minimum requirement to refinance. The maximum loan amount is $300,000 for those with medical, dental, pharmacy or veterinary doctorate degrees, and $150,000 for all other undergraduate or graduate degrees.

4This informational repayment example uses typical loan terms for a refi borrower with a Full Principal & Interest Repayment and a 10-year repayment term, has a $40,000 loan and a 5.5% Annual Percentage Rate (“APR”): 120 monthly payments of $434.11 while in the repayment period, for a total amount of payments of $52,092.61. Loans will never have a full principal and interest monthly payment of less than $50. Your actual rates and repayment terms may vary.

Information advertised valid as of 1/1/2020. Variable interest rates may increase after consummation.

5 Important Disclosures for Laurel Road.

Laurel Road Disclosures

Laurel Road is a brand of KeyBank National Association offering online lending products in all 50 U.S. states, Washington, D.C., and Puerto Rico. Mortgage lending is not offered in Puerto Rico. All loans are provided by KeyBank National Association.
As used throughout these Terms & Conditions, the term “Lender” refers to KeyBank National Association and its affiliates, agents, guaranty insurers, investors, assigns, and successors in interest.

This term represents the actual cost of financing to the borrower over the life of the loan expressed as a yearly rate.


There are no origination fees or prepayment penalties associated with the loan. Lender may assess a late fee if any part of a payment is not received within 15 days of the payment due date. Any late fee assessed shall not exceed 5% of the late payment or $28, whichever is less. A borrower may be charged $20 for any payment (including a check or an electronic payment) that is returned unpaid due to non-sufficient funds (NSF) or a closed account.


For bachelor’s degrees and higher, up to 100% of outstanding private and federal student loans (minimum $5,000) are eligible for refinancing. If you are refinancing greater than $300,000 in student loan debt, Lender may refinance the loans into 2 or more new loans.
For eligible Associates degrees in the healthcare field (see Eligibility & Eligible Loans section below), Lender will refinance up to $50,000 in loans for non-ParentPlus refinance loans. Note, parents who are refinancing loans taken out on behalf of a child who has obtained an associates degrees in an eligible healthcare field are not subject to the $50,000 loan maximum, refer to https://www.laurelroad.com/refinance-student-loans/refinance-parent-plus-loans/ for more information about refinancing ParentPlus loans.


Borrower, and Co-signer if applicable, must be a U.S. Citizen or Permanent Resident with a valid I-551 card (which must show a minimum of 10 years between “Resident Since” date and “Card Expires” date or has no expiration date); state that they are of at least borrowing age in the state of residence at the time of application; and meet Lender underwriting criteria (including, for example, employment, debt-to-income, disposable income, and credit history requirements).

Graduates may refinance any unsubsidized or subsidized Federal or private student loan that was used exclusively for qualified higher education expenses (as defined in 26 USC Section 221) at an accredited U.S. undergraduate or graduate school. Any federal loans refinanced with Lender are private loans and do not have the same repayment options that federal loan program offers such as Income Based Repayment or Income Contingent Repayment.

All loans must be in grace or repayment status and cannot be in default. Borrower must have graduated or be enrolled in good standing in the final term preceding graduation from an accredited Title IV U.S. school and must be employed, or have an eligible offer of employment. Parents looking to refinance loans taken out on behalf of a child should refer to https://www.laurelroad.com/refinance-student-loans/refinance-parent-plus-loans/ for applicable terms and conditions.

For Associates Degrees: Only associates degrees earned in one of the following are eligible for refinancing: Cardiovascular Technologist (CVT); Dental Hygiene; Diagnostic Medical Sonography; EMT/Paramedics; Nuclear Technician; Nursing; Occupational Therapy Assistant; Pharmacy Technician; Physical Therapy Assistant; Radiation Therapy; Radiologic/MRI Technologist; Respiratory Therapy; or Surgical Technologist. To refinance an Associates degree, a borrower must also either be currently enrolled and in the final term of an associate degree program at a Title IV eligible school with an offer of employment in the same field in which they will receive an eligible associate degree OR have graduated from a school that is Title IV eligible with an eligible associate and have been employed, for a minimum of 12 months, in the same field of study of the associate degree earned.


The interest rate you are offered will depend on your credit profile, income, and total debt payments as well as your choice of fixed or variable and choice of term. For applicants who are currently medical or dental residents, your rate offer may also vary depending on whether you have secured employment for after residency.


The repayment of any refinanced student loan will commence (1) immediately after disbursement by us, or (2) after any grace or in-school deferment period, existing prior to refinancing and/or consolidation with us, has expired.


After loan disbursement, if a borrower documents a qualifying economic hardship, we may agree in our discretion to allow for full or partial forbearance of payments for one or more 3-month time periods (not to exceed 12 months in the aggregate during the term of your loan), provided that we receive acceptable documentation (including updating documentation) of the nature and expected duration of the borrower’s economic hardship.

We may agree under certain circumstances to allow a borrower to make $100/month payments for a period of time immediately after loan disbursement if the borrower is employed full-time as an intern, resident, or similar postgraduate trainee at the time of loan disbursement. These payments may not be enough to cover all of the interest that accrues on the loan. Unpaid accrued interest will be added to your loan and monthly payments of principal and interest will begin when the post-graduate training program ends.

We may agree under certain circumstances to allow postponement (deferral) of monthly payments of principal and interest for a period of time immediately following loan disbursement (not to exceed 6 months after the borrower’s graduation with an eligible degree), if the borrower is an eligible student in the borrower’s final term at the time of loan disbursement or graduated less than 6 months before loan disbursement, and has accepted an offer of (or has already begun) full-time employment.

If Lender agrees (in its sole discretion) to postpone or reduce any monthly payment(s) for a period of time, interest on the loan will continue to accrue for each day principal is owed. Although the borrower might not be required to make payments during such a period, the borrower may continue to make payments during such a period. Making payments, or paying some of the interest, will reduce the total amount that will be required to be paid over the life of the loan. Interest not paid during any period when Lender has agreed to postpone or reduce any monthly payment will be added to the principal balance through capitalization (compounding) at the end of such a period, one month before the borrower is required to resume making regular monthly payments.


This information is current as of November 8, 2019 and is subject to change.

6 Important Disclosures for Splash Financial.

Splash Financial Disclosures

Terms and Conditions apply. Splash reserves the right to modify or discontinue products and benefits at any time without notice. Rates and terms are also subject to change at any time without notice. Offers are subject to credit approval. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet applicable underwriting requirements. Not all borrowers receive the lowest rate. Lowest rates are reserved for the highest qualified borrowers.

7 Important Disclosures for CommonBond.

CommonBond Disclosures

Offered terms are subject to change. Loans are offered by CommonBond Lending, LLC (NMLS # 1175900). If you are approved for a loan, the interest rate offered will depend on your credit profile, your application, the loan term selected and will be within the ranges of rates shown. All Annual Percentage Rates (APRs) displayed assume borrowers enroll in auto pay and account for the 0.25% reduction in interest rate. All variable rates are based on a 1-month LIBOR assumption of 1.76% effective November 10, 2019.

8 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.

Subject to floor rate and may require the automatic payments be made from a checking or savings account with the lender. The rate reduction will be removed and the rate will be increased by 0.25% upon any cancellation or failed collection attempt of the automatic payment and will be suspended during any period of deferment or forbearance. As a result, during the forbearance or suspension period, and/or if the automatic payment is canceled, any increase will take the form of higher payments. The lowest advertised variable APR is only available for loan terms of  5 years and is reserved for applicants with FICO scores of at least 810.

As of 12/019/2019 student loan refinancing rates range from 1.90% to 8.59% Variable APR with AutoPay and 3.49% to 7.75% Fixed APR with AutoPay.

1.99% – 6.89%1Undergrad
& Graduate

Visit Earnest

2.31% – 7.36%2Undergrad
& Graduate

Visit SoFi

2.06% – 6.81%3Undergrad
& Graduate

Visit Figure

2.62% – 6.12%4Undergrad
& Graduate

Visit College Ave

1.99% – 6.65%5Undergrad
& Graduate

Visit Laurel Road

1.99% – 7.06%6Undergrad
& Graduate

Visit Splash

1.85% – 6.13%7Undergrad
& Graduate

Visit CommonBond

1.90% – 8.59%8Undergrad
& Graduate

Visit Lendkey

Our team at Student Loan Hero works hard to find and recommend products and services that we believe are of high quality. We sometimes earn a sales commission or advertising fee when recommending various products and services to you. Similar to when you are being sold any product or service, be sure to read the fine print to help you understand what you are buying. Be sure to consult with a licensed professional if you have any concerns. Student Loan Hero is not a lender or investment advisor. We are not involved in the loan approval or investment process, nor do we make credit or investment related decisions. The rates and terms listed on our website are estimates and are subject to change at any time.

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