University of Southern Indiana

HSA (Health Savings Account)

If you elect the Anthem HDHP/HSA, USI contributes to an HSA on your behalf. USI contributes both seed money ($282 Single, $525 Family) and per-pay (Bi-weekly: $18 Single, $37.50 Family; Monthly: $39 Single, $81.25 Family); Employees also may make pre-tax contributions. HSA account balances roll over each year and is portable if you leave the University.

Watch a video explaining the basics of an HSA.

What is a Health Savings Account (HSA)?

A Health Savings Account (or HSA) is a tax-advantaged savings account, similar to a traditional Individual Retirement Account (IRA), but designated for qualified medical expenses. An HSA allows you to pay for current qualified medical expenses and save for future qualified medical expenses on a tax-favored basis. HSAs provide triple-tax advantages: contributions, investment earnings, and qualified distributions ― all are exempt from federal income tax, FICA (Social Security and Medicare) tax and state income tax (for most states). Unused HSA dollars roll over from year to year, making HSAs an easy way to save and invest for future qualified medical expenses. You own your HSA and can take it with you when you change medical plans, change jobs or retire. This means the funds in your account, contributed by you and your employer, are non-forfeitable and portable. Funds in your account not needed for short-term expenses may be invested, providing the opportunity for funds to grow. Investment options include money market accounts and mutual funds. To be eligible to set up an HSA and contribute, you must be covered by a qualified High Deductible Health Plan (HDHP) and not have other coverage (e.g., Medicare).

How does an HSA work?

If you enroll in a qualified HDHP and meet other IRS criteria, you may open and contribute to an HSA. All of the money deposited into your HSA, up to the maximum annual contribution limit determined by the IRS each year, is 100% tax deductible for federal income tax, FICA (Social Security and Medicare) tax, and state income tax (for most states). If you choose, you may use your HSA funds to pay for expenses under your HDHP that you incur before you have met your deductible, for coinsurance or copayments you owe after meeting your deductible, or for any other qualified medical expenses. The funds in your account can be used for other non-medical expenses, but distributions used for non-medical expenses are subject to ordinary income taxes, plus a 20% penalty if you are under age 65. The 20% penalty does not apply if the distribution occurs after you reach age 65, become disabled or die; however, ordinary income tax may still apply. Funds remaining in your account at the end of the year roll over and accumulate for your future qualified medical expenses. You may choose not to spend your HSA dollars, use after-tax dollars for your qualified medical expenses and leave your HSA dollars to grow for the future. Choosing which expenses to pay with out-of-pocket, after-tax dollars and which to pay with your HSA dollars is entirely up to you.

Who is eligible to contribute to an HSA?

HSA, contributions help you build a balance to assist with current and future qualified medical expenses. Anyone, including your employer or family members, may contribute to your HSA. You are eligible to make or receive contributions to your HSA if you are:

  • Covered by a qualified HDHP;
  • Not covered by another health care plan, such as a health plan sponsored by your spouse's employer, including a general purpose FSA, Medicare or TRICARE;
  • Not claimed as a dependent on another individual's tax return; and
  • Receiving, or have received Veteran’s Administration (VA) medical or hospital benefits for a service-connected disability.

You are still eligible if you:

  • Have certain limited coverage approved by the IRS, (e.g., dental, vision and long-term care insurance) or
  • Are entitled to benefits under an Employee Assistance Plan (EAP), disease management or wellness program or have a discount card for prescriptions.

If you no longer participate in a HDHP or enroll in Medicare, you can no longer make or receive HSA contributions.

Why establish an HSA? What are the advantages?

There are many advantages associated with establishing an HSA including:

Tax-advantages:

  • Contributions made through payroll deposits are made with pre-tax dollars, meaning they are not subject to federal income tax or state income tax (for most states).
  • Contributions to your HSA that are not made with pre-tax dollars can be deducted from your gross income, meaning you pay less income tax at the end of the year.
  • The interest you earn on your HSA balance is not subject to federal income tax or state income tax (for most states).
  • Withdrawals from your HSA for qualified medical expenses are not subject to federal income tax. As long as you use your HSA funds for qualified medical expenses, you will not have to pay federal income tax or state income tax (for most states).
  • Employers may contribute to your account; these contributions are excluded from your gross income.

Flexibility: There are no "use it or lose it" rules; the money is yours. It grows and remains with you, even when you change medical plans, change employers or retire. Even if you are no longer eligible to contribute, funds in your account may still be used to pay for qualified medical expenses, tax-free.

Portability: Accounts move with you when you change medical plans, change employers or retire.

Asset Accumulation: Unused funds can grow through interest and investment earnings and saved for future qualified medical expenses.

Contributions can come from multiple sources: As long as you are covered by a qualified HDHP, you, your employer, family members or anyone else may contribute to your HSA up to the maximum annual contribution limit.

What health care expenses does my HSA cover?

Your HSA funds can be used tax free to pay for out-of-pocket qualified medical expenses, even if the expenses are not covered by your HDHP. This includes expenses incurred by your spouse or dependents.

There are hundreds of qualified medical expenses, including:

  • Over-the-counter medications for which you have a prescription from your doctor;
  • Dental visits;
  • Orthodontics;
  • Glasses

All of these expenses may be paid for with distributions from your HSA, free from federal income tax or state income tax (for most states).

Refer to IRS Publication 502 for a more complete list of qualified medical expenses.

What happens to the money in my HSA if I become disabled?

Building an account balance in preparation for expenses associated with disability or increasing medical usage in retirement is one of the great benefits of an HSA. If you become disabled and enroll in Medicare, contributions to your HSA must stop as of the first of the month in which you become enrolled. However, you can continue to use your funds to pay for qualified medical expenses, including payments for Medicare Parts A and B. If you use your funds for qualified medical expenses, the distributions from your account remain tax free (i.e., free from federal income taxes or state income tax (for most states)). If you use the monies for non-qualified expenses, the distribution becomes taxable, but due to your disability, exempt from the 20% penalty.

What happens to the money in my HSA after I reach age 65?

At age 65 and older, you may continue to use your HSA funds to pay for qualified medical expenses; for instance, you may use your HSA to pay certain insurance premiums, such as Medicare Parts A and B, Medicare HMO, or your share of retiree medical coverage offered by a former employer. Funds cannot be used tax-free to purchase Medigap or Medicare supplemental policies. If you use your funds for qualified medical expenses, the distributions from your account remain tax free (i.e., free from federal income taxes or state income tax (for most states)). If you use your funds for non-qualified expenses, the distribution becomes taxable, but due to your age, exempt from the 20% penalty. Once you are enrolled in Medicare, you are no longer eligible to contribute to your HSA. If you reach age 65 or become disabled, you may still contribute to your HSA if you have not enrolled in Medicare.

What happens to my HSA if I quit my job or otherwise leave my employer?

Your HSA is portable. This means that you can take your HSA with you when you leave and continue to use the funds you have accumulated. Funds left in your account continue to grow tax-free. If you are covered by a qualified HDHP, you can even continue to make tax-free contributions to your HSA. Distributions from your HSA that are used exclusively to pay for qualified medical expenses for you, your spouse, or dependents are excludable from your gross income. Your HSA funds can be used for qualified expenses even if you are not currently eligible to contribute to your HSA.

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