Health care costs have skyrocketed over the last few decades. Fortunately, health savings accounts (HSAs) allow qualifying individuals to pay for certain medical expenses with pretax dollars. Here is what you need to know to put an HSA to work for you. 

Healthy Growth

Over the last decade, many people have jumped on the HSA bandwagon. HSA assets exceeded $51 billion as of June 30, 2018, according to a recent survey conducted by HSA investment provider Devenir. That's an increase of 20.4% compared to the previous year.

In addition, the total number of HSAs grew to 23.4 million as of June 30, 2018, up 11.2% compared to a year earlier. Devenir projects the number of HSA accounts to increase to 29 million by the end of 2020 with assets approaching $75 billion.

The Basics

With HSAs, individuals must take more responsibility for their health care costs, instead of relying on an employer or the government. The upside is that HSAs offer some tax benefits.

Under the Affordable Care Act (ACA), health insurance plans are categorized as Bronze, Silver, Gold or Platinum. Bronze plans — which have the highest deductibles and least generous coverage — are the most affordable. Platinum plans have no deductibles and cover much more, but they're also significantly more expensive.

In many cases, the ACA has led to premium increases, even for those with less generous plans. However, these less generous plans also might make you eligible to open and contribute to a tax-advantaged HSA.    

For the 2018 tax year, you could make a tax-deductible HSA contribution of up to $3,450 if you have qualifying self-only coverage or up to $6,900 if you have qualifying family coverage (anything other than self-only coverage). For 2019, the maximum contributions are $3,500 and $7,000, respectively. If you're age 55 or older as of year end, the maximum contribution increases by $1,000.

To be eligible to contribute to an HSA, you must have a qualifying high deductible health insurance policy and no other general health coverage. For 2018, a high deductible health plan was defined as one with a deductible of at least $1,350 for self-only coverage or $2,700 for family coverage. For 2019, the minimum deductibles are the same. 

For 2018, qualifying policies must have had out-of-pocket maximums of no more than $6,650 for self-only coverage or $13,300 for family coverage. For 2019, the out-of-pocket maximums are $6,750 and $13,500, respectively.

Important note: For HSA eligibility purposes, high deductible health insurance premiums don't count as out-of-pocket medical costs. 

Deductible Contributions

If you're eligible to make an HSA contribution for the tax year in question, the deadline is April 15 of the following year (adjusted for weekends and holidays) to open an account and make a tax-deductible contribution for the previous year.

So, there's still time for an eligible individual to open an account and make a deductible contribution for 2018. The deadline for making 2018 contributions is April 15, 2019.

The write-off for HSA contributions is an "above-the-line" deduction. That means you can claim it even if you don't itemize.

In addition, the HSA contribution privilege isn't tied to your income level. Even billionaires can make deductible HSA contributions if they have qualifying high deductible health insurance coverage and meet the other eligibility requirements. 

Important note: Sole proprietors, partners, LLC members, and S corporation shareholder-employees are generally allowed to claim separate above-the-line deductions for their health insurance premiums, including premiums for high deductible health plans that make you eligible for HSA contributions.

HSAs in the Real World

To show the tax perks of HSAs, consider the following example: Albert and Angie are a married couple in their 30s. They're both self-employed, and both have separate HSA-compatible individual health insurance policies for all of 2019. Both policies have $2,000 deductibles.

For 2019, Albert and Angie can each contribute $3,500 to their respective HSAs and claim a total of $7,000 of write-offs on their 2019 joint return. If they're in the 32% federal income tax bracket, this strategy cuts their 2019 tax bill by $2,240 (32% × $7,000). Over 10 years, they'll save $22,400 in taxes, assuming they contribute $7,000 each year and remain in the 32% bracket.

Tax Treatment of Distributions

HSA distributions used to pay qualified medical expenses of the HSA owner, spouse and dependents are federal-income-tax-free. However, you can build up a balance in the account if contributions plus earnings exceed withdrawals for medical expenses. Any earnings are free from federal income tax unless you withdraw them for something other than qualified medical expenses.

So, if you're in very good health and take minimal or no distributions, you can use an HSA to build up a substantial medical expense reserve over the years, while earning tax-free income along the way. Unlike flexible spending accounts (FSAs), undistributed balances in HSAs are not forfeited at year end. They can accumulate in value, year after year. Thus, an HSA can function like an IRA if you stay healthy.

Even if you empty the account every year to pay medical expenses, the HSA arrangement allows you to pay those expenses with pretax dollars. But there are some important caveats to bear in mind:

• HSA funds can't be used for tax-free reimbursements of medical expenses that were incurred before you opened the account.

• If money is taken out of an HSA for any reason other than to cover qualified medical expenses, it will trigger a 20% penalty tax, unless you're eligible for Medicare.

If you still have an HSA balance after reaching Medicare eligibility age (generally age 65), you can drain the account for any reason without a tax penalty. If you don't use the withdrawal to cover qualified medical expenses, you'll owe federal income tax and possibly state income tax. But the 20% tax penalty that generally applies to withdrawals not used for medical expenses won't apply. There's no tax penalty on withdrawals after disability or death. 

Alternatively, you can use your HSA balance to pay uninsured medical expenses incurred after reaching Medicare eligibility age. If your HSA still has a balance when you die, your surviving spouse can take over the account tax-free and treat it as his or her own HSA, if he or she is named as the account beneficiary. In other cases, the date-of-death HSA balance must generally be included in taxable income on that date by the person who inherits the account.

For More Information

HSAs can provide a smart tax-saving opportunity for individuals with qualifying high deductible health plans. Contact us to help you set up an HSA or decide how much to contribute for 2019. And, remember, there's still time to make a deductible contribution for your 2018 tax year, if you're eligible.