Your Top HSA Questions Answered

Drive adoption and confidence in HSAs with in-depth answers to common questions.


We know that your clients and employees come to you with a number of questions about HSAs, how they work, and how to get the most benefit out of them. We’ve compiled the top HSA questions we receive and provided easy-to-understand answers. You can share this document with your clients and employees and use it to help support HSA education and adoption. We’ve also provided links to additional resources so you can dig deeper and learn more.

HSA basics

What is an HSA?

A Health Savings Account (HSA) is a tax-advantaged, personal savings account used to save and pay for eligible healthcare expenses. It is:

  • A dedicated bank account for qualified healthcare expenses
  • Designed to pair with High Deductible Health Plans (“HDHP”)
  • Triple tax advantaged and enables account holders to save, spend, and invest their HSA money tax-free.
  • Federally established in 2003 and here to stay

Funds in an HSA never expire and are fully owned by the account holder, not the employer. HSAs are not tied to a specific health insurance provider and can be paired with any qualifying health plan.

Each year the IRS establishes annual HSA contribution limits. In 2023 they are:

  • $3,850 for individual coverage
  • $7,750 for family coverage

For 2024 they are:

  • $4,150 for individual coverage
  • $8,300 for family coverage

Those 55 years or older are eligible to contribute an extra $1,000 annual catch-up contribution.

Learn more in our comprehensive HSA Guide.

Who is eligible to open an HSA?

To qualify for an HSA, an individual must meet the following criteria:

  • They are covered by a qualifying High-Deductible Health Plan (HDHP) and the HDHP is their only health insurance coverage. Meaning, they don’t have supplemental coverage from a spouse or other family member (dental and vision is fine).
  • The account owner or their spouse doesn’t have a General Purpose FSA (Flexible Spending Account). They are allowed to have a Limited Purpose FSA for dental and vision, or a Dependent Care FSA.
  • No one else can claim them as a dependent on their tax return.
  • They are 18 or older and not enrolled in Medicare (Part A and Part B) or Medicaid.

Eligibility is not a requirement for usage. HSA funds never expire and the account holder can always use the funds for qualified, out-of-pocket medical expenses.

Read more about HSA eligibility requirements.

What is a High Deductible Health Plan and how does it work with an HSA?

A High Deductible Health Plan (HDHP) is a health insurance plan defined by lower premiums and a higher deductible. HDHPs offer affordable health insurance coverage while offering savings opportunities when paired with an HSA. Preventative care by in-network providers is 100% covered, regardless of whether employees have met their deductible. HDHPs are also the only health insurance option that can be paired with a Health Savings Account (HSA). An HSA can help pay for the high-deductible or to save money for future medical costs.

The minimum deductible and out-of-pocket maximum for an HDHP is set each year by the IRS.

2023 minimum deductible:

  • $1,500 for individual plans
  • $3,000 for family coverage

2023 out-of-pocket maximum:

  • $7,500 for individual plants
  • $15,000 for family plans

To learn more, consult our HDHP Guide.

How is an HSA different from an FSA?

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are both tax-advantaged accounts that enable employees to save money on qualified, out-of-pocket medical expenses.

An FSA is an employer owned account that pays for short-term expenses and account holders must use the funds they contributed by the end of their plan year. FSAs work with a wide variety of health plans, but are typically only available through employers that offer employer-sponsored health plans. The account holder does not need to enroll in their employer sponsored plan to be eligible to sign up for the FSA.

HSAs are individually owned and funds never expire, so account holders can use them for short-term expenses, or long-term savings, like retirement. Account holders also have the ability to invest HSA funds so they grow tax free. HSAs can be opened by anyone over the age of 18 with a qualifying high deductible health plan.

View our infographic for more details about the differences between HSAs and FSAs.

HSA benefits

What are the benefits of an HSA for account holders?

HSAs offer account holders multiple benefits. They include:

  • Pre-tax contributions through employer payroll or tax-deductible contributions otherwise, growth, and withdrawals for qualified expenses
  • Funds contributed are tax-deductible, which means reduced income taxes (now or later)
  • Saves up to 35% on out-of-pocket costs for eligible expenses, including federal, payroll, and state taxes. The 35% example includes 24% federal tax savings, 7.65% payroll tax savings, and 3.35% state tax savings. Payroll tax savings are only available on deposits made through your employer’s payroll. State tax savings are not available in states without income taxes or in California or New Jersey.
  • Serves as a healthcare safety net for the account holder and their family—anyone can contribute funds and funds can be spent on select others, including tax dependents, spouse, or domestic partner. Contribution limits still apply, no matter where the funds are coming from. Funds contributed to another person’s HSA are typically not tax-deductible.
  • Funds can be invested, if the HSA provider allows, and grow tax-free

HSAs can also serve as a complementary retirement account as HSA funds never expire, and belong to the account holder, even with employer-sponsored HSAs. In addition, after age 65 HSA funds can be spent on anything, penalty-free, though non-medical expenses are still subject to ordinary income tax. Withdrawals used for medical expenses are both penalty and tax free.

To demonstrate how much someone can save with an HSA, use our HSA Savings Calculator.

What are the benefits of an HSA for employers?

When paired with an HDHP, HSAs offer several significant benefits for employers, including:

  • Enhanced, flexible benefits package for recruitment and retention
  • Savings on taxes with tax-deductible employer contributions
  • Reduced payroll taxes when employees contribute through their paychecks
  • Lower healthcare premiums with High Deductible Health Plans (HDHP)

To see how much an employer can save with an HSA, use our Payroll Tax Savings Calculator.

How to use an HSA

How does money get into an HSA account?

HSA money can come from a variety of sources:

  1. If an employer is working directly with Lively or another HSA provider, then the HSA provider will pull an employees’ HSA contributions from the employer (both employer contributions, if applicable, and payroll deductions).
  2. If an employer doesn't work with any HSA provider and invites an employee to choose their own, then the employee can provide their employer with their Lively account and routing number and they can push funds into the account electronically via ACH.
  3. If you are an individual making contributions directly, you can link an external bank account (checking or savings), and make direct contributions to your Lively HSA account.
  4. Any other person can make an after-tax contribution to your HSA. This contribution will not be tax-deductible for the contributing individual and annual IRS limits still apply.

Account holders can choose to schedule one-time contributions or ongoing monthly contributions up to the annual contribution limit.

Other ways of getting funds into an HSA account include:

  1. An IRA to HSA transfer: This can be done once in a lifetime and counts against the account’s annual contribution limit. Any contributions already made to the account should be taken into account when calculating how much can be rolled over and the account holder still has to be eligible to make contributions into an HSA account in the year that they do this.
  2. A rollover or trustee-to-trustee transfer: This is when existing HSA funds are moved from one provider to another.

What are qualified HSA expenses and how does spending and reimbursement work?

HSAs can be used to pay for thousands of qualified expenses incurred both today and in the future. These expenses are set and regularly updated by the IRS. In addition to everyday expenses and over-the-counter items like first aid, sunscreen, and menstrual products, some extra HSA expenses are eligible if prescribed by a doctor or with a note of medical necessity.

The only requirements are that the account holder had the HSA established at the time the expense was incurred (date of service) and that the expense was not reimbursed in any other way. Because these expenses are regulated by the IRS, it’s up to the account holder to stay compliant. In order to substantiate a qualified medical expense purchase to the IRS in case of an audit, account holders need to keep documentation, such as a copy of their receipt. If an account holder spends money on non-qualified HSA expenses before the age of 65, they can incur a 20% penalty in addition to income taxes. At Lively, we give account holders the ability to store various documents tied to an expense.

To access HSA funds, account holders can either use a debit card provided by their HSA provider at the point of purchase or submit receipts for reimbursement from their HSA provider. An account holder can use their HSA funds to pay for medical expenses for themselves, their spouse, or other tax dependents even if they only have individual coverage through an HDHP.

To see what’s eligible, consult Lively’s list of qualified HSA expenses.

How does investing HSA funds work?

HSAs allow account holders to invest their funds and those investments grow tax-free. However, not every HSA provider allows investment or every investment option. In general, HSAs come in three forms: traditional savings accounts, self-directed investment accounts, and guided portfolio investment accounts.

Traditional savings accounts do not offer the ability to invest, but account holders can earn interest on their funds.

A self-directed HSA allows account holders to invest in a wide range of investment options including: individual stocks, ETFs, mutual funds, CDs, and bonds.

A guided portfolio HSAs gives account holders personalized investment suggestions based on the account holder’s preferred risk profile and how long they have until retirement.

If an HSA provider allows HSA funds to be invested, account holders will have two actual accounts under their HSA umbrella: a cash account and an investment account. The cash account is where contributions are deposited and from where they pay for qualified medical expenses. The investment account is what is used to buy and sell investments.

Some HSAs, like Lively, offer first-dollar investing, though many providers require minimum account balances in order to invest HSA funds. All types of investments are typically subject to some fees, whether those are commissions, trading fees, or other varieties of fees.

Learn more about HSAs and investments.

What is an HSA catch-up contribution?

If an individual is enrolled in a HDHP (HDHP) that is HSA-eligible, and is at least 55 years old—or will turn 55 any time in the calendar year—they can make an additional $1,000 contribution to an HSA. Once they are enrolled in Medicare—typically age 65—they are no longer allowed to contribute to an HSA. But using the 10-year window between the ages of 55 and 65 to make higher “catch-up” contributions can be valuable come retirement, as it gives the account holder more tax-free dollars to use for out-of-pocket medical expenses at any time in retirement.

How does an HSA work in retirement?

HSAs are an excellent option for saving on healthcare in retirement, when medical expenses tend to increase. Once the account holder decides to participate in any type of Medicare (Part A, Part B, Part C - Medicare Advantage plans, Part D, and Medigap), they can no longer contribute to an HSA.

After 65, account holders can use HSA funds tax-free for qualified medical expenses such as Medicare premiums, long-term care insurance, and other out-of-pocket expenses. Account holders can also use their HSA like any other retirement account. Before 65, if you withdraw money from your HSA for a non-qualified medical expense, you must pay income tax and an additional 20% penalty. After 65, the 20% penalty no longer applies and they can use their HSA funds for non-medical expenses, though these expenses are subject to income tax.

Learn more about HSAs after retirement.

What is the difference between a rollover and a trustee-to-trustee transfer?

A rollover requires the account holder to deposit withdrawn funds with a new custodian. The trustee-to-trustee transfer occurs without the account holder taking possession of the funds.

A direct rollover involves withdrawing funds from an HSA in the form of a check and then transferring (depositing) those funds with a new HSA provider. The account holder has 60 days from withdrawal to deposit the funds with a new custodian—or face a 20% income tax. The account holder is limited to one HSA rollover every 12 months.

A trustee-to-trustee transfer is when the previous health savings account provider makes a direct transfer to the new account provider. In this instance, the account holder never takes possession of the funds. There is no limit to the number of trustee-to-trustee transfers an account holder can make.

Learn more about the differences between a rollover and trustee-to-trustee transfer.

HSA rules

What happens if an account holder makes an excess contribution to their HSA?

If an account holder goes over their contribution limits, the IRS considers that money an excess contribution. There are three consequences for making excess HSA contributions:

  • 6% excise tax on the excess contribution
  • Income taxes on the excess contribution
  • Income taxes on any investment earnings the excess contribution made

To avoid potential penalties, the excess contribution must be withdrawn before the tax year ends. Account holders can make a request with their HSA provider to remove the excess contribution. If they have been contributing to their HSA via payroll, they should also inform their employer.

Once the money is taken out it will be considered regular, taxable earned income. If the excess contribution is removed before the end of the calendar year, in most cases the account holder will not need corrected tax forms, but may need them if they remove it after the calendar year, but before the tax filing deadline. If the excess contribution is not removed until after the tax year has ended the account holder will be subject to excise tax for that year and all other years the excess contribution remains in the account.

What happens if an account holder is no longer eligible for an HSA?

To be eligible to contribute to a health savings account (HSA), an account holder must be enrolled in a qualified high deductible health plan (HDHP). Some reasons an account holder may no longer be eligible for an HSA include:

An HSA and the funds in the account belong to the account holder and never expire. It can also be transferred from provider to provider. The funds don’t go anywhere even if the account holder becomes ineligible to contribute to an HSA. The account holder can still spend the money, or use the funds to reimburse themselves tax-free for qualified medical expenses. In addition, they can still invest the money in their HSA even if they’re no longer eligible to contribute to their account.

What happens if an account holder becomes eligible or ineligible for an HSA mid-year?

Becoming eligible for an HSA mid-year is a common occurrence. It may happen if an employer changes insurance plans mid-year, or an account holder gets a new job with a different insurance plan.

HSA eligibility always starts on the first of the month. If someone enrolls in an HSA-eligible HDHP plan on June 15, and they become HSA-eligible on July 1. If they stay at the job all year and their insurance plan and eligibility doesn’t change, they would be HSA-eligible for six months (July, August, September, October, November, and December). Their contribution amount will be prorated. This is based on their eligibility start data (by month) and prorated for the number of months they are HSA eligible.

The same prorating happens if someone becomes HSA-ineligible mid-year. This happens often for people enrolled in medicare coverage.

There’s an important caveat to the info above—the Last Month Rule (also called the “full contribution rule”). The last month rule says if someone is HSA-eligible on December 1, then they can choose to contribute the full amount for the year, even if you weren’t eligible for the whole year. However, there is a “testing period” of twelve months. This means they must stay eligible through December 31 of the next year, or their excess contributions will be subject to a 10% penalty.

What is the “last month rule?”

The Last Month Rule (also called the “full contribution rule”) says if someone is HSA-eligible on December 1, then they can choose to contribute the full amount for the year, even if they weren’t eligible for the whole year. They are subject to a twelve month “testing period,” meaning that the account holder must stay eligible through the end of the next year, or else face taxes and penalties.

For example, if an individual became HSA-eligible on December 1 and chose to contribute the full amount up to the annual contribution limit to their HSA, they must continue to be eligible all the way through December 31 of the following year. If they don't, their excess contributions will be taxable and subject to a 10% penalty. If an individual becomes disabled during the following year, there are specific reasons they may no longer be eligible, which may impact this rule.

The last month rule presents an opportunity to weigh the risks and rewards of making a full HSA contribution. If an account holder foresees no change to their job or eligibility status, and wants to build their HSA savings, it could be a smart choice. However, if they are planning on changing their job or coverage it may not be the right option.

What happens to an HSA if the account holder dies?

The HSA is transferred to the spouse, a non-spouse beneficiary, an estate, or completes a no beneficiary designated transfer.

Whether an account holder of an individual or family health plan, an HSA account is ultimately owned by the individual. Therefore, the Health Savings Account is an integral part of the estate planning process. And there are tax considerations that will determine whether an HSA transfer from an individual to a spouse, beneficiary, or estate is the best option.

Spouse transfer: There are no tax implications. The HSA is transferred directly to the spouse. They can then continue using the HSA money for spending, saving, or investing within the standard IRS guidelines. It remains an HSA, and the same tax-advantaged rules continue to apply. This type of transfer does not happen automatically and requires that the account holder designate their spouse as a beneficiary directly with the bank holding their funds to qualify for the tax benefits.

Beneficiary (not a spouse) transfer: The HSA ends on the date of the individual’s death. The funds are then distributed and taxed as income to the beneficiary at fair market value. However, the beneficiary can use the HSA funds to pay for medical expenses of the account holder for up to 12-months after their death.

Estate or no beneficiary designated transfer: The HSA will be distributed to the estate and taxed as income on their final income tax return.

Work with the HSA provider that gets it right

In a world of burdensome benefits platforms, Lively stands out. Lively’s unparalleled customer service and innovative features enables easy set up and simple Health Savings Account administration that saves valuable time and money. Lively’s HSA is simple, trusted, and reliable. In short, it just works for your clients and your employees.

To learn more about how our benefit solutions can help you achieve your goals reach out to us.