feel free to give us a call  512-643-4173


feel free to give us a call at 512-643-4173

Nick Soman
Nick Soman

Pros and Cons of Health Savings Accounts (HSAs)

October 26, 2023

Health Savings Accounts (HSAs) are a type of personal savings account that helps individuals save money for future medical or health care expenses, including many long term care expenses. HSAs have become increasingly popular as health insurance coverage costs rise, and people look for ways to reduce their healthcare expenses. This article will discuss the pros and cons of utilizing an HSA account to help readers understand whether it is the best option for them. 

Overview of HSA Accounts

HSAs are designed to help individuals save money on healthcare costs, including medical and dental costs, by combining a high-deductible health plan (HDHP) with a tax-advantaged savings account. HSAs are relatively new, having been created in 2003 as part of the Medicare Prescription Drug, Improvement and Modernization Act. Per IRS regulations, individuals must have an HDHP to qualify for an HSA account.

The fundamental characteristics of an HSA account include: 

  • Tax-free contributions.
  • Tax-free growth on investments.
  • Tax-free withdrawals for medical expenses.
  • Customizable contributions and distributions.

Unlike flexible spending accounts (FSAs), you can enroll in an HSA even if your employer doesn't offer HSAs. An FSA, like a health reimbursement arrangement or HRA (ICHRA or QSEHRA are the two types of HRA) is owned by your employer. Contributions to an FSA are tax-free, but an FSA also has a lower contribution limit than an HSA, reducing your potential savings.

What's the Relationship Between HSAs and Health Insurance Policies?

When an individual opens an HSA account, they must also have an eligible qualifying high-deductible health plan (HDHP). An HDHP has a high annual deductible that must be met before any insurance benefits kick in. The deductible is usually several thousand dollars, and most HDHPs do not cover any medical costs until the deductible is met. HSA funds can also be used to cover coinsurance or copayments. The idea behind combining an HSA with an HDHP is to encourage individuals to manage their health care costs more efficiently by only providing coverage for more expensive medical events. By providing individuals with a tax-advantaged account that they can use to pay for qualified medical expenses, they are incentivized to become more active in managing their health care costs. Additionally, because individuals with HDHPs must pay for most eligible medical expenses out-of-pocket until they meet their deductible, they are more likely to be cautious about unnecessary medical expenses. 

How are Banks Involved in HSAs? 

HSAs are typically managed by specialized banks that are responsible for ensuring that all funds in the account are used exclusively for qualified medical expenses. They also make it easier for individuals to manage their accounts by providing online account management tools and mobile apps for easy access to their accounts, or debit cards to enable easy HSA spending. When an individual opens an HSA account, they work with an HSA bank to set up the account and fund it with contributions. HSA banks are responsible for ensuring that all funds in the account are used exclusively for eligible qualified medical expenses.

Pros of Using HSA Accounts

  1. Tax Advantages One of the primary benefits of using an HSA account is the tax advantages. Contributions to the account are tax-deductible, meaning that individuals can take deductions from their taxable income by contributing pretax dollars to an HSA account. Additionally, any investment growth in the account is tax-free, and withdrawals made for qualified medical expenses are also tax-free. HSAs offer a triple tax benefit that can save individuals significant money in taxes each year. By reducing taxable income, HSAs can help individuals lower their tax bracket and keep more money in their pockets.
  2. Flexibility & Ownership Another benefit of using an HSA account is the flexibility it provides over traditional health insurance plans. Unlike traditional plans, which are tied to an employer, HSA accounts are portable, meaning they can be taken from one employer to another, even if the individual changes jobs. Additionally, the account is entirely owned by the individual, meaning they can control how and when to spend their HSA funds on medical or dental expenses. HSAs also provide ownership continuity, meaning that contributions to the account are not lost if they are not used. The funds in an HSA account can roll over from year to year, allowing individuals to build up significant savings to use for future medical expenses. 
  3. Investment Growth Potential One of the lesser-known benefits of using an HSA account is the investment growth potential. Besides taking deductions on taxable income, funds in an HSA account can be invested in a variety of assets, similar to retirement accounts. Unlike other tax-advantaged accounts, there is no required minimum distribution for HSA accounts, meaning individuals can continue to invest their HSA funds and let them grow over time. Additionally, any investment growth in the account is tax-free, meaning that individuals can save even more money on their federal income tax and state tax returns by investing their HSA funds.

Cons of Using HSA Accounts

  1. High-Deductible Requirements One of the biggest drawbacks of enrolling in an HSA account is the requirement to have a high-deductible health plan for insurance coverage. Note that HSAs are not Medicare-friendly: once you're enrolled in Medicare Part A and/or B and paying Medicare premium, you can no longer setup or contribute pre-tax dollars to an existing HSA. Similarly, the IRS does not allow TRICARE plan members to have HSAs, since TRICARE is not an HDHP. High deductible health plans typically have a high annual deductible, which can be several thousand dollars. This means that individuals with HDHPs may face higher out-of-pocket medical costs before their insurance benefits outside of preventive care kick in, cutting into the benefit of contributing pretax dollars. The high-deductible requirement for HDHPs also means that individuals may be less likely to seek medical care when they need it, as they may not be able to afford the out-of-pocket costs.
  2. Potential for Misuse Another potential drawback of using an HSA account is the risk of misuse. HSA funds can only be used for qualified medical expenses, and any non-qualified expenses will be subject to a penalty. This can lead to complications when trying to track expenditures for tax deductions, as individuals must keep meticulous records of all expenses, and it is highly recommended to work with a competent tax advisor. Additionally, individuals who use their HSA funds on non-qualified expenses may face significant penalties and may even be taxed on the funds used.
  3. Understanding & Maintenance Effort Finally, there is a potential for confusion and complexity when it comes to understanding and managing an HSA account. Many individuals are not familiar with how these accounts work and may not understand how to contribute effectively or maximize their tax benefits. Additionally, because HSA accounts are individually owned and managed, individuals must take an active role in managing their accounts and understanding the investment options available to them, or work with an experienced tax advisor. This can require a significant amount of time and effort and even money, which may be a barrier to entry for some individuals.


In summary, HSAs, like HRAs or FSAs, offer several significant benefits for individuals looking to manage their healthcare costs more efficiently. These accounts provide a tax-advantaged way to contribute to and save for future medical expenses while also offering investment growth potential. However, there are also risks and potential drawbacks to using an HSA account, including the high-deductible requirements, potential for misuse, and the effort required to manage and get the most out of these accounts.

No items found.