The Key Benefits of Health Savings Accounts

HSA Plans—A Tax-Advantaged Way to Save for Future Health Care Expenses

A medical bill for laboratory services

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Health savings accounts (HSAs) are tax-deductible savings plans that allow you to put aside pre-tax dollars for future health care expenses. Pre-tax dollars are subtracted from the top of your pay before withholding for taxes is calculated, so you don't pay tax on this portion of your income. Distributions from the HSA can be tax-free as well. 

"A health savings account is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur," according to the IRS. "You must be an eligible individual to qualify for an HSA." 

Qualifying Rules

Eligibility requires that you must be enrolled in a high-deductible health insurance plan. You can't be covered by another type of health insurance plan such as an HMO or a PPO-type plan.

The high-deductible plan must meet certain requirements. The annual deductible limit for 2019 is $1,350 for self-only coverage, or $2,700 for family coverage—the deductible must be at least this much. Maximum out of pocket expense limits are $6,750 for self-only coverage and $13,500 for family coverage.

There are no income limitations to qualify for a health savings account. Individual retirement accounts (IRAs) require that a person must have earned income, but there's no such requirement for HSAs.

How Contributions Are Treated 

Contributions to an HSA are tax deductible on your Form 1040 tax return as an adjustment to income. You don't have to take them as an itemized deduction for medical expenses, which can have limited tax impact because itemized medical deductions are limited to expenses paid in excess of 7.5 percent of your adjusted gross income as of the 2018 tax year. This threshold is scheduled to increase to 10 percent in 2019. The health savings account doesn't have a similar limitation.

According to the IRS, "Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income." Of course, if you're not paying taxes on your own contributions, you can't also claim a deduction for them.

Contributions for a particular tax year are due by the same day as the filing deadline for your tax return, which is usually April 15 unless this date falls on a weekend or holiday. In that case, the deadline is the next business day. You can contribute savings for tax year 2018 from January 1, 2018 until April 15, 2019.

There's a cap on how much you can contribute and save each year, however. This amount can increase annually, although it doesn't necessarily do so. Contribution limits are $3,500 for self-only HSAs in 2019, or $7,000 for family HSAs. Contributions made by your employer count toward these thresholds.

Those who are age 50 or older can contribute an additional $1,000. This "catch up" contribution isn't indexed for inflation, so it's the same amount from year to year. It can be made at any time during the year.

Unfortunately, no HSA contributions or tax deductions are permitted if you're enrolled in Medicare.

Earnings Are Tax-Exempt 

Earnings, such as interest and dividends from the money contributed to an HSA, are tax-exempt at the federal level. Interest or other investment income earned on the contributions are not included on your tax return.

Withdrawing From Your HSA 

Withdrawals from an HSA are tax-free as long you use the money to pay for qualified medical expenses. "Qualified" expenses are detailed in IRS Publication 502, Medical and Dental Expenses, and they include most medical costs, from birth control pills to guide dogs to surgery.

Some State Rules Are Different

Not all states mirror federal rules for taxation of HSAs. As of 2019, neither New Jersey nor California allow deductions for HSA contributions. They also tax earnings and capital gains within HSAs. Tennessee and New Hampshire tax earnings and gains as well over a certain annual amount.

Using an HSA As a Tax-Planning Tool 

HSAs achieve tax savings in other ways as well. They accumulate earnings and income without being subject to forfeiture the way flexible spending accounts are if they're not used.

Money held inside an HSA can be withdrawn at any time for medical expenses, so an HSA can be used to accumulate tax-free income for use later in life. You can build tax-free savings for future medical expenses as you age.

HSAs offer people with few medical expenses a tax deduction upfront in the year that contributions are made. 

Where and How to Claim the Deduction

Financial institutions report HSA contributions using Form 5498-SA, which is sent to both the taxpayer and to the IRS. You can then report your tax-deductible HSA contributions on Form 8889, with the total contributions reported on Form 1040.