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An HSA is a specific type of savings account that you can open IF you have an HSA-qualified high-deductible health insurance policy, and which allows you to save and pay for medical expenses with pre-tax dollars.


HSA plans do not have copays for services.  Some preventive services are covered 100% without applying to the deductible, if correct and preventive claim codes are submitted.  All other services apply to the deductible and you pay the full ‘allowed’ amounts.  If you use an HSA plan, you should shop around for Rx’s and other medical services, because prices vary widely. 

You can try or for help. 

Also, create an account on your health plan’s member website to see their cost estimator tools.  


The premiums that are paid are not deposited into your HSA.  You would use regular funds to make HSA contributions and you can deduct those contributions from your gross income. Your employer may deduct your HSA contributions for you from your paycheck, but whether you also save payroll taxes (FICA Medicare and SS) depends on whether your employer also has a Section 125 plan for HSA contributions.


Keep in mind that you can only use HSA funds to reimburse yourself for expenses you incur AFTER the account is opened.  So even if you were already on the HSA plan, you must have the HSA account open to reimburse yourself for expenses later.  You don’t have to have all the funds in the account at the time you incur the expense, however. 

I would suggest that you keep 2 files:

One titled ‘medical expenses reimbursed by HSA’

And one titled ‘medical expenses not reimbursed by HSA’

You can use the tracksheet attached to keep track of these expenses.  Let me know if you prefer it in Excel.


An HSA is not “use-it-or lose-it.” HSA’s are likened to IRA’s but for medical expenses.  You can only use money in the HSA account to pay for qualified medical expenses for you and your dependents, so you'd need to leave that money in the HSA account if you didn't use it for medical expenses.  If you withdrew it for other reasons, you'd pay income tax plus a 20% penalty.


The HSA account is part of your estate.  It is not a joint account, but you can order a debit card for your spouse as a co-signer.  If your spouse is also on an HSA plan (including yours,) they could open their own HSA account that would be theirs.  Unless you are over 55, you wouldn't increase the maximum allowed contribution by having 2 accounts - it would just be split between your 2 accounts.   


The maximum contributions for 2024 are $4150 for individuals and $8300 for families. For individuals over 55 there is an additional $1000 “catch-up” amount allowed. You can only make 1 catch-up contribution per account, so if your spouse is also eligible, s/he could open a separate account to be able to make their $1000 catch-up contribution. If you’re not on an HSA plan for the entire year, you must pro-rate your contribution (ask me.)

If you make HSA contributions, the deadline to do so is the day you file your taxes for that year, or April 15th, whichever is earlier.


You don't need to submit receipts to the HSA bank to use your HSA funds.  You can use the checkbook, debit card from the HSA bank, or you can use regular funds and write yourself a check from the HSA account at any time.  HSA funds are not 'use it or lose it', they are more like IRA funds in that they remain in the account until you take a distribution, and you can use the funds at any point in the future to reimburse yourself for expenses you incurred after the account was opened.  So if you had a bad year in 2024, and let's say you had $10,000 combined for gum surgery, dental expenses, and maternity or other eligible medical expenses, you can use future years' contributions to reimburse yourself if you didn't have enough in your HSA account in 2024. It's flexible that way.  Likewise, you can use 2024 contributions to pay for medical expenses you incurred in 2024 as long as you had the account open when the expenses were incurred.  You don't have to be on an HSA plan to use the HSA funds, you just have to be on an HSA plan to make the HSA contributions.  Once you are on Medicare, you can use HSA funds to pay for qualified medical expenses including Rx’s, dental costs and some premiums, but you cannot use it for Part B premiums.  If you take money out of the HSA when you are over 65 for non-qualified expenses, you’ll pay income tax on it, but no tax penalty of 20% like you would when you are under 65.


You are not eligible to open or make contributions into an HSA account if you have: other reimbursement for medical expenses such as a medical reimbursement plan thru your company, most VA coverage, Medicare, short-term or student coverage, or (usually) an FSA (Flexible Spending Account) thru your spouse’s employer.  You can still have an HSA-qualified health plan, and if you already have an HSA account you can use money in the account, but you can’t make more contributions.  If your plan does not call itself an “HSA qualified HDHP,” it is not an HSA plan, even if it has a high deductible, and you should not open an HSA account or make HSA contributions.


An excellent source of information:

And a video, if that helps:


 You can search the internet for HSA calculators, or tutorials, but I am also here to help you crunch the numbers.


Let me know if you have questions.  I'm used to discussing this with people at LEAST 3x because it takes at least that many exposures to the information to make a decision, so don't hesitate to call to discuss this again with me.

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