The 'invest, don't spend' strategy
Pay current medical bills out of pocket. Keep receipts. Let HSA grow tax-free for decades. Reimburse yourself decades later with no tax — there's no time limit on reimbursement. A $4,300/yr deposit at 7% for 30 years = $406K of tax-free medical money.
HSA vs. 401(k) hierarchy
Optimal: (1) 401(k) up to match, (2) HSA to max, (3) 401(k) to limit, (4) Roth IRA. HSA beats traditional 401(k) on tax efficiency because contributions ALSO avoid FICA (7.65%) when made through payroll.
When you can't contribute
Enrolled in Medicare (any part) ends HSA eligibility. Many high earners stop SS contributions at 65 but enroll in Medicare automatically — accidentally blocking HSA. Plan around it.
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Read the guideFAQ
Can spouses both contribute?
Family limit ($8,550) is per family, split as both spouses prefer. Each spouse 55+ can do their own $1,000 catch-up — but only in separate HSAs (catch-up doesn't combine).
What's an eligible expense?
Per IRS Pub 502 — doctors, dentists, prescriptions, mental health, fertility treatments, eyeglasses, OTC meds (post-CARES Act), Medicare premiums (not supplemental).
What about ETFs vs. cash?
Most HSA providers offer brokerage subaccounts. Keep 6 months expenses in cash; invest the rest in low-cost index funds. Fidelity and HealthEquity have the best investment options.
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