I know this post is like a decade late and very boring, but I gotta post it anyway
Basically, with employer-sponsored health insurance the employer pays half and the employee (you) pays half. The cost of your insurance goes way down if you have a high deductible, and a deductible is basically what you’d have to pay before the insurance actually pays anything. So ‘high-deductible’ means you have to pay a lot before insurance pays anything, and it’s a lot cheaper to buy that insurance cause the insurers often just don’t pay anything ever. If it’s $5,000 before insurance pays a dime, often times you have to just pay as though you had no insurance. This is obviously bad, but it’s also cheap so like maybe you just luck out an never get sick or injured, right…?
Anyway, HSAs. Yeah, it’s called “Health Savings Account”. It’s marketed as a tax-advantaged, investor-y, bougie-“we’re comfortable” lifestyle way to really feel like a keen insider. Picture this: what if health insurance was individualized in the same way 401k and retirement stuff was, and you could “call your broker” at your “health savings account” to tell them to invest your tax-free “medical dollars” in the latest gizmo or whatever. Just deeply bad for solidarity and also very weird. And this is how basically everyone thinks about HSAs. A “tax-loophole” for the rich that I can also use because “I’m actually very financially savvy, just like the rich, who got where they are because of a weird hyper-individualized investment thing rather than any underlying systemic basis of societal organization”.
And you’re probably thinking: “But I already hate the suburban petite-bourgeois and their annoying mannerisms for reasons that are way less boring and meaningless.” Well you’re right, but also: high deductible plans are a requirement of HSAs so the employer’s half decreases significantly. Your employer doesn’t contribute to the HSA (they technically could, but if you’re reading this post they don’t [incredibly silly losing battle available there for libs]), so hopefully you do at least up to your deductible, but it’s pretty likely that’s not possible even if you had the money (no one does) because you literally aren’t allowed to due to contribution limits. (if people did have the money it would probably be better to get different / better / additional health insurance anyway.) But importantly and I guess obviously: nobody contributes to their HSA. It’s basically the chance for each person to individually manage an insurance fund for only themselves, which is almost exactly the same as paying out of pocket, the main difference being the additional bank account and a make-work program for MBAs. I’ve talked to almost a dozen office workers about this and they mostly have no idea what I am saying at all or say “yeah, I added money in onboarding, but I canceled it once I realized it came out of my pay.”
There’s no non-scam option btw if that wasn’t clear. And, yeah, obviously all health insurance is a scam, but this is a different scam run by a slightly different set of people (there’s def overlap though don’t get me wrong). The office job benefits world is basically a choice between varying levels of high-deductible plans + HSA (ie. $1.5k, $3k, $5k…) with maybe one ridiculously expensive low-deductible plan.
Anyway, thoughts? I needed to get this rant out, I guess. Maybe I just missed the discourse on this because I was a child at the time lol.
Trying to clear up confusion on what an HSA is:
If you have a high-deductible insurance plan, an HSA is an account where you can save money up to a limit without paying taxes on it (for now). It’s an investment account, which means that you shouldn’t get fucked by inflation if you keep money in it for a long time, but if you need to pull money out at the wrong time you can get screwed (not ideal for money meant for emergencies). Money in that account does not disappear at end of year, and can be left to a beneficiary if you die.
When you take money out of an HSA account, there are a few possible scenarios. If you use the money on a medical expense, you pay no taxes on this money. If you’re over 65 and use the money for a non-medical expense, you count the money as income for this year, essentially delaying you income taxes on that money. This is roughly equivalent to a 401k. If you’re under 65 and use the money for a non-medical expense, then you not only pay income tax on it but also a 20% fee. This is a very bad scenario.
If you’re going to save for retirement and you’re eligible for one, money in an HSA will likely end up being completely tax-free unless you save so much that you can’t spend it on all medical expenses. Unless you’re trying to micro-optimize, make all of your medical payments from the HSA so they’re tax-free.
HSAs are distinct from and mutually-exclusive with FSAs (except for a limited-purpose FSA, which you can have alongside an HSA). FSAs are much weirder, one reason being that the money disappears (IIRC goes to your employer) at end of year.