MONEY Health Care

4 Smart Year-End Strategies for Maximizing Your Health Benefits  

Tray of dental instruments
Dental plans often have annual coverage caps. Have you used up yours yet? Peter Dazeley—Getty Images

In these winter months, don't overlook these valuable health perks—and the crucial deadlines for getting your money's worth.

The first and last months of the year can be the best time to use your health insurance benefits. Here’s how to make the most of four common scenarios:

You’ve Met Your Deductible

This is the amount you must pay for your own health care before your insurance starts covering a larger portion of the costs. If you’re close to that cut-off, consider a last-minute appointment, says Carrie McLean, director of customer care at online insurance exchange eHealth.com.

“If you’ve already met your deductible for 2014, or are close to it, medical care rendered before the end of the year may be covered at a lower out-of-pocket cost,” McLean says. “Conversely, if you expect to have a lot of health care expenses in 2015, you may want to schedule non-emergency medical care for early next year so you can fulfill your deductible as soon as possible.”

You Have Unused Dental Benefits

In most cases, dental coverage works differently from regular health insurance. This benefit is often capped at $1,000 to $3,000 annually, according to the American Dental Association. If you have unused benefits remaining, now may be the time to schedule a last-minute appointment, especially if you might need serious dental work soon. That way, you can spread the cost over both years and pay less out of pocket for dental care.

You Have an Leftover FSA Money

If you set up a flexible spending account, or FSA, through your employer as a supplemental benefit to your health insurance, you were able to contribute pre-tax money to it each year and use that money for qualifying health expenses. Now’s the time to check your balance.

Some FSAs allow you to roll over up to $500 of unused funds into the following year, or give you a 2 1/2-month grace period to spend the money, but many don’t. In that case, you’ll forfeit your remaining balance.

If you have funds left in your FSA, or you are over your rollover limit, it’s time to spend the money. The good news is that a lot of expenses qualify, starting with purchases you’ve already made. If you can prove it, you can reimburse yourself for health costs you paid earlier in the year, says Craig Rosenberg, benefits specialist at human resource firm Aon Hewitt.

“Check to see if there are any out-of-pocket health care expenses you haven’t submitted for reimbursement. It’s easy to forget co-pays, prescription drug expenses, or certain medical supplies,” says Rosenberg.

“December can be a good time to stock up on health supplies,” he adds, and that goes for a lot of expenses, from bandages to braces and more.

If your FSA has a grace period, you have until March 15, 2015 to use your 2014 funds. In that case, it might be a good idea to schedule checkups for January so the costs count toward next year’s deductible. Check your FSA summary of benefits first, because in some cases that grace period is only for vision and dental expenses.

You Have an HSA

Whatever you do, don’t confuse your health savings account, or HSA, with an FSA and hurry to spend it, Rosenberg says. “FSAs have ‘use-it-or-lose-it’ rules that apply each year, but HSAs do not,” he says. “Any funds in your HSA are yours to keep indefinitely, even if you change jobs.”

Some even look at HSAs as a retirement savings vehicle since the funds can be used to pay for Medicare premiums and medical costs in retirement. That’s a big deal: Fidelity Investments estimates that the average couple retiring this year will face $220,000 in medical costs in retirement.

You may even want to add funds to your HSA now, McLean says. “Maximize on your tax saving by funding [the HSA] fully before year’s end,” she says, but know the limit. The contribution cap for HSAs in 2014 is $3,300 for individuals, or $6,550 for families.

Lacie Glover writes for NerdWallet Health, a website that helps consumers lower their medical bills.

MONEY Health Care

Why Millennials Hate Their Least Expensive Health Care Option

Health plans that shift more up-front costs onto you are rapidly becoming the norm. But millennials don't seem happy about taking on the risk, even in exchange for a lower price.

Millennials want their parents’ old health insurance plan. A new survey from Bankrate found that almost half of 18-to-29-year-olds prefer a health plan with a lower deductible and higher premiums—meaning millennials would rather pay more out of their paycheck every month and pay less when they go to the doctor. Compared to other age groups, millennials are the most likely to prefer plans with higher premiums.

That surprised Bankrate insurance analyst Doug Whiteman. “One would assume people in this age group were not likely to get sick, so they’d choose the cheapest possible plan just to get some insurance,” he says.

In theory, millennials are perfect candidates for high-deductible plans. The conventional wisdom is that since young and healthy people tend to have very low health-care costs, they should opt for a higher deductible and keep more of their paychecks.

If, for example, you go to the doctor only for free preventive care, switching from the average employer-sponsored traditional PPO plan to the average high-deductible health plan would save a single person $229 a year in premiums, according to the Kaiser Family Foundation’s 2014 data.

Millennials shopping in the new health insurance marketplace last year didn’t want the cheapest plans either. According to the Department of Health and Human Services, more than two-thirds of 18-to-34-year-olds chose silver plans, which have mid-level premiums and deductibles. Only 4% picked catastrophic plans, the ones with the lowest premiums and out-of-pocket limits of around $6,000.

Why Millennials Are Risk Averse

Why are millennials choosing to pay more for health care? Turns out the “young invincibles” don’t feel so invincible after all, says Christina Postolowski, health policy manager at a youth advocacy group called—as it happens—Young Invincibles. “Millennials are risk-averse and concerned about their out-of-pocket costs if something happens to them,” Postolowski says.

High-deductible plans saddle young adults with risk they can ill afford. According to Kaiser, the average employer-sponsored high-deductible plan made singles pay $2,215 out-of-pocket in 2014 before they ever saw a co-pay.

Yet according to Bankrate, 27% of 18-to-29-year-olds have no emergency savings. A $2,200 bill could sink them. Indeed, Bankrate found that the two groups most likely to prefer a low-deductible plan are millennials and those with incomes between $30,000 and $49,999.

“Young people don’t have money in a bank account to pay for high deductibles,” Postolowski says. “Our generation is carrying $1.2 trillion in student loan debt. An unexpected medical incident isn’t just physical pain. It can be economic pain too.”

That’s why Bankrate’s Whiteman thinks millennials are being “really smart.”

“One of the concerns I have is too many people might only look at the price and neglect the fact that some of these plans that seem really cheap can come with deductibles as high at $6,000,” he says. “That’s a significant amount of money out of your own pocket.”

Fighting the Tide

Some young workers, however, have little choice, or won’t soon. Employers are increasingly shifting to health plans that make workers shoulder more of the costs. Towers Watson found that 74% of employers plan to offer high-deductible plans in 2015, and 23% of them will make it the only option.

Plus, across all employer plans, you have to pay more out-of-pocket than in years past. According to Kaiser, the average deductible for single coverage in 2014 was $1,217, up 47% from five years ago. The generous, low-deductible health plan your parents once had probably won’t be available to you.

How to Make the Best of It

If you end up in a high-deductible plan, learn to make the most of the tax-free savings plan that goes with it—a health savings account (HSA). Yeah, a monthly HSA contribution is one more recurring expense on top of your student loan payments, car payments, rent, and (hopefully) 401(k) contributions. But at least this one can give you the peace of mind that you’ll have the funds to cover a health emergency.

Here’s how an HSA works: You make contributions with pre-tax income. The money carries over year-to-year. You can invest the funds in your HSA, the way you invest the money in your 401(k), and the account will grow tax-free. If you need the money for medical expenses, you withdraw it, again, tax-free. Or, if you stay healthy and have money leftover at age 65, you’re free to spend it on anything.

You qualify for an HSA if your deductible for single coverage is $1,300 or more, or $2,600 for family coverage (and if you’re not claimed as a dependent on someone else’s tax return). And your company might help you out. Some employers make contributions to their employees’ HSAs, of $1,006 a year on average, according to Kaiser.

For ultimate peace of mind, save enough to cover your entire deductible. But if you’re feeling pinched, at least put away the money you saved on premiums by switching from a more expensive plan.

More:

Read next: 4 Ways Millennials Have It Worse Than Their Parents

MONEY Health Care

6 Questions to Ask Before You Sign Up for a Health Plan This Year

tweezers and pill
Geir Pettersen—Getty Images

Employers are changing your health insurance options more than ever. Rushing through your open enrollment paperwork could cost you.

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans—where most working-age folks get coverage—are changing too.

Rising costs, a looming tax on rich benefit packages, and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015.

“If there’s any year employees should pay attention to their annual enrollment material, this is probably the year,” says Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don’t blow off the human resources seminars. Ask these questions.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”

Insurers publish directories, but the surest way to see if docs or hospitals take your plan is to call and ask.

“People tend to find out the hard way how their health plan works,” says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “Don’t take for granted that everything will be the same as last year.” (Kaiser Health News is an editorially independent program of the foundation.)

2. Is my employer changing where I get labs and medications?

For expensive treatments—for diseases such as cancer or multiple sclerosis—some companies are hiring preferred vendors. Getting infusions or prescriptions outside this network could cost thousands extra, just as with doctors and hospitals.

3. How will my out-of-pocket costs go up?

It’s probably not a question of if. Shifting medical expense to workers benefits employers because it means they absorb less of a plan’s overall cost increases. By lowering the value of the insurance, it also shields companies from the “Cadillac tax” on high-end coverage that begins in 2018.

Having consumers pay more is also supposed to nudge them to buy thoughtfully—to consider whether procedures are necessary and to find good prices.

“It gets them more engaged in making decisions,” says Dave Osterndorf, a benefits consultant with Towers Watson.

How well this will control total costs is very unclear.

Your company is probably raising deductibles—the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation. One large employer in three surveyed by Marcotte’s group planned to offer only high-deductible plans (at least $2,600 for families) in 2015.

Employers are also scrapping co-payments—fixed charges collected during an office or pharmacy visit.

Once you might have made a $20 copay for a $100 prescription, with the insurance company picking up the other $80. Now you might pay the full $100, with the cost applied against your deductible, Marcotte says.

4. How do I compare medical prices and quality?

Companies concede they can’t push workers to shop around without giving information on prices and quality.

Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5. Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren’t that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time.

Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

Don’t necessarily think of HSAs as money down the drain, says Osterndorf. Think of them as a different kind of retirement savings plan.

6. How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharma benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary’s bottom tiers–usually cheap generics—and highest for specialty drugs and biologics.

If you’re on a long-term prescription, check how it’s covered so you know how much to put in the savings account to pay for it. Also see if a less-expensive drug will deliver the same benefit.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

MONEY 401(k)s

Why Millennials Are Flocking to 401(k)s in Record Numbers

hand clicking Apple mouse connected to egg with 401k on it
Jason York—Getty Images

First-time 401(k) plan enrollees are soaring as young workers enter the labor force. This is a positive development. But it won't solve our savings crisis by itself.

Young workers have received the message about long-term financial security—and with increasing assistance from employers they are doing something about it, new research shows.

In the first half of 2014, the number of Millennials enrolling for the first time in a 401(k) plan jumped 55%, according to the Bank of America Merrill Lynch 401(k) Wellness Scorecard. This twice-yearly report examines trends among 2.5 million plan participants with $129 billion of assets under the bank’s care.

The brisk initial enrollment pace is due partly to the sheer number of Millennials entering the workforce. They account for about 25% of workers today, a figure that will shoot to 50% by 2020. But it also reflects a broader trend toward 401(k) enrollment. Across all generations, the number enrolling for the first time jumped 37%, Bank of America found.

One key reason for the surge in 401(k) participation is the use of auto-enrollment by employers, as well as other enhancements. The report found that number of 401(k) plans that both automatically enroll new employees and automatically boost payroll contributions each year grew 19% in the 12 months ended June 30. And nearly all employers (94%) that added automatic enrollment in the first half also added automatic contribution increases, up from 50% the first half of last year.

Enrolling in a 401(k) plan may be the single best financial move a young worker can make. At all age levels, those who participate in a plan have far more savings than those who do not. Another important decision is making the most of the plan—by contributing enough to get the full company match and increasing contributions each year.

Other added plan features include better educational materials and mobile technology. In a sign that workers, especially Millennials, crave easy and relevant information that will help them better manage their money, the bank said participants accessing educational materials via mobile devices soared 41% in the first half of the year.

The number of companies offering advice online, via mobile device or in person rose 6% and participants accessing this advice rose 8%. A third of those are Millennials, which suggests a generation that widely distrusts banks may be coming around to the view that they need guidance—and their parents and peers may not be the best sources of financial advice.

Millennials have largely done well in terms at saving and diversifying. They are counting more on personal saving and less on Social Security than any other generation, the report found. They seem to understand that saving early and letting compound growth do the heavy lifting is a key part of the solution. Despite its flaws, 401(k) plans have become the popular choice for this strategy.

Yet this generation is saddled with debt, mostly from student loans and credit cards, and most likely to tap their 401(k) plan savings early. Millennials are also least likely take advantage of Health Savings Accounts, or HSAs, which allow participants to set aside pre-tax dollars for health care costs. Health savings account usage jumped 33% in the first half, Bank of America found. But just 23% of Millennials have one, versus 39% of Gen X and 38% of Boomers.

Still, the trends are encouraging: employers are making saving easier and workers are signing up. That alone won’t solve the nation’s retirement savings crisis. Individuals need to sock away 10% to 15% of every dime they make. But 401(k)s, which typically offer employer matching contributions, can help. So any movement this direction is welcome news.

Related:

How can I make it easier to save?

How do I make money investing?

Why is a 401(k) such a good deal?

MONEY Ask the Expert

What You Need to Know Before Choosing a Beneficiary for a Health Savings Account

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Robert A. Di Ieso, Jr.

Q: “What happens to the money in a health savings account when the account owner dies?”–James McKay

A: It’s up to you to decide.

But let’s back up a step: A health savings account offers those in high-deductible health insurance plans the opportunity to save pretax dollars and tap them tax-free to pay for qualified medical expenses, with unused funds rolling over from year to year. Unlike a Flexible Spending Account, you have the opportunity to invest the money. And once you hit age 65, the money can be used for any purpose without penalty—though you will pay income tax, similar to a traditional IRA. So for many people, an HSA also functions as a backup retirement account.

When you open an HSA, you will be asked to designate a beneficiary who will receive the account at the time of your death. You can change the beneficiary or beneficiaries any time during your lifetime, though some states require your to have your spouse’s consent.

Your choice of beneficiary makes a big difference in how the account will be treated after you’re gone.

If you name your spouse, the account remains an HSA, and your partner will become the owner. He or she can use the money tax-free to pay for qualified healthcare expenses, even if not enrolled in a high-deductible health plan, says Todd Berkley, president of HSA Consulting Services. Should your spouse be younger than 65, take a distribution of funds and use them for something other than medical expenses, however, he or she will pay a 20% penalty tax on the amount withdrawn plus income taxes (a rule that also applies to you while you’re alive).

Thus, Berkley warns against a spouse taking a full distribution to close the HSA. He says that it’s better to leave money in the account first for medical expenses, then later for retirement expenses both medical and non—since your partner gets the same perk of penalty-free withdrawals for other expenses after turning 65.

When the beneficiary is not your spouse, the HSA ends on the date of your death. Your heir receives a distribution and the fair-market value becomes taxable income to the beneficiary—though the taxable amount can be reduced by any qualified medical expenses incurred by the decreased that are then paid by the beneficiary within a year of the death.

Failure to name a beneficiary at all means the assets in your account will be distributed to your estate and included on your final income tax return.

MONEY Health Care

The Biggest Healthcare Benefits Decision You’ll Have to Make This Year

Teddy bears with bandages
Zachary Zavislak—Prop Styling by Linda Keil

This year, your company may push you to a high-deductible health plan that looks cheaper, but it may not be.

This benefits open-enrollment period, your employer may ask you—even force you—to enroll in a high-deductible health insurance plan with a health savings account. Nearly three-quarters of companies expect to offer this type of plan as an option for 2015, up from 63% in 2014. And 23% say it will be the only option, Towers Watson found.​

While premiums on high-deductible health plans are typically 10% less than those of more tradi­tional PPO plans, according to data from the Kaiser Family Foundation, co-insurance doesn’t kick in until you’ve paid much more out of pocket.

On average, you’ll foot the first $2,200 in costs as an individual, or $4,500 as a family. (Employers like the plans because they motivate you to be more discerning about your spending.) To pay the bills, you can save pretax dollars—up to $6,650 for a family—in a health savings account (HSA). Most companies throw in cash to sweeten the pot.

According to conventional wisdom, high-deductible plans save money for the young and healthy, who rarely see doctors. But with deductibles and premiums rising across all plans and more companies offering only this coverage, everybody needs to know how to best use high-deductible plans. “Whether we like it or not, higher levels of cost ­sharing is the way of the future,” says University of Michigan Medical School professor Dr. Jeffrey Kullgren. Here’s how to assess your options if you have options—and how to hedge your risk if you don’t:

If you have a choice of plans

Compare costs for a typical year. Your employer, hopefully, will make this easy for you: This fall, 76% of companies plan to offer tools to help employees assess plan options, says Towers Watson. Often these build in your current year’s usage of health services.

No such luck? Estimating your total costs under each plan isn’t easy, but it’s necessary to make the right choice. Start by reviewing your 2014 explanation of benefits statements—probably available on your insurer’s website—to see the insurer-negotiated prices for your usual services, says Paul Fronstin of the Employee Benefit Research Institute. Add the premiums to your expected out-of-pocket costs in each plan—up to and after deductibles—and subtract any employer HSA contribution for the high-deductible option.

Assess a worst-case scenario. In more than 58% of high-deductible plans, families could rack up bills exceeding their yearly HSA contribution limit, according to Kaiser data. In such cases, if you suffer a health crisis, “you’re at risk of using a lot of post-tax dollars,” says Katy Votava, founder of health insurance consulting firm Goodcare. “I like to see an out-of-pocket max that isn’t much more than the HSA limit.”

Gauge your cost tolerance. An American Medical Association study found that 43% of higher-income families in high-deductible plans had delayed or forgone care because of the cost. Almost a third of them reported greater stress, and 15% suffered a disability as a result of putting off care. If you’re likely to skip treatment to save a buck, this plan isn’t your best choice, particularly if you have a chronic condition.

09.15.14 PLA

If you go high-deductible

Budget for your costs. Set aside at least enough in the HSA—­including employer contributions— to cover your expected care, and ideally more, says Kullgren. That way, “when you need care, you’re not faced with the decision to get the service or go without.” Rather than worrying about saving too much, think of this as a backup account for retirement: Leftover funds carry over year to year, growing tax-free, and can be withdrawn penalty-free for any purpose once you’re 65. (You will owe income taxes if the funds are used for anything but health costs.)

Be a savvy consumer. High- deductible plans put the onus on you to be price-conscious. Learn the costs of procedures in advance, and ask questions like “How will this test result affect what you do for me?” says Jacksonville financial planner and MD Carolyn McClanahan. Prices vary wildly, so comparison shop for services like blood tests and MRIs. It’s in your interest to get the best deal you can.

MONEY Taxes

5 Things to Do Now To Cut Your Tax Bill Next April

If you want to owe less for 2014, start your year-end tax planning today.

When everyone else starts loading their backpacks and shopping the back-to-school sales, I know it is time for me to dive back into TurboTax.

That’s because fall is the perfect time to plan my approach to the tax forms I won’t file until next April. By using the next four months strategically, I may be able to reduce the amount I have to pay then.

This is a particularly easy year to do tax planning, because the rules haven’t changed much from 2013. If you do your own taxes on a program like Intuit’s TurboTax or TaxAct, you can use last year’s version to create a new return using this year’s numbers, and play some what-if games to see how different actions will affect your tax bill.

If you use a tax professional, it’s a good time to ask for a fall review and some advice.

Here are some of the actions to take now and through the end of the year to minimize your 2014 taxes.

1. Feed the tax-advantaged plans. Start by making sure you’re putting the maximum amount possible into your own health savings account, if you have one associated with a high-deductible health plan. That conveys maximum tax advantage for the long term. Also boost the amount you are contributing to your 401(k) plan and your own individual retirement account if you’re not already contributing the maximum.

2. Plan your year-end charitable giving. You probably have decent gains in some stocks or mutual funds. If you give your favorite charity shares of an investment, you can save taxes and help the charity. Instead of selling the shares, paying capital gains taxes on your profits and giving the remainder to your charity, you can transfer the shares, get a charitable deduction for their full value and let the charity—which is not required to pay income taxes—sell the shares. Start early in the year to identify the right shares and the right charity.

3. Take losses, and some gains. If you have any investment losses, you can sell the shares now and lock in the losses. They can help you offset any taxable gains as well as some ordinary income. You can re-buy the same security after 31 days, or buy something different immediately. In some cases, you may want to lock in gains, too. You might sell winners now if you want to make changes to your holdings and have the losses to offset them.

4. Be strategic about the alternative minimum tax. Did you pay it last year? Do you have a lot of children, medical expenses and mortgage interest payments? If so, you may end up subject to the alternative minimum tax, which taxes more of your income (by disallowing some deductions) at a lower tax rate. Robert Weiss, global head of J.P. Morgan Private Bank’s Advice Lab—a personal finance strategy group—says there are planning opportunities here. If you expect to be in the alternative minimum tax group, you can pull some income into this year—by exercising stock options or taking a bonus before the year ends—and have it taxed at the lower AMT rate. It’s good to get professional advice on this tactic, though. If you pull in too much money you could get kicked out of the AMT and the strategy would backfire.

5. Look at the list of deductible items and plan your approach. Many items, such as union dues, work uniforms, investment management fees and more are deductible once they surpass 2% of your adjusted gross income. Tax advisers often suggest taxpayers “bunch” those deductions into every other year to capture more of them. Check out the Internal Revenue Service’s Publication 529 to view the list, and try to determine if you want to amass your deductions this year or next. Then shop accordingly.

Do you have a personal finance question for our experts? Write to AskTheExpert@moneymail.com.

MONEY Health Care

Health Savings Accounts: A Rx for Retirement

A health savings account can do double duty and help you build your retirement nest egg. Photo: Joshua Scott

A health savings account helps you stash cash for today's medical costs, but it can also help you build a bigger nest egg.

How would you like a triple-tax-free way to save for certain retirement expenses?

No, this isn’t the latest Nigerian email scam. Rather, it’s the very real advantage of a Health Savings Account (HSA), an investment vehicle available to those with qualifying high-deductible health insurance plans.

The pretax money you put in is meant to be used for that year’s unreimbursed health costs, but unspent funds can be rolled forward to grow tax-deferred and withdrawn tax-free at any later date to pay for health care.

After 65, you can also tap the account for nonmedical expenses without penalty; those withdrawals will be taxed as income just like a traditional IRA.

Considering that a 65-year-old couple leaving the workforce today can expect to spend $220,000 on health care, as Fidelity reports, it’s no wonder HSAs are gaining traction as a retirement savings tool. “They’re the best deal in town,” says Scottsdale, Ariz., financial planner Dana Anspach, author of Control Your Retirement Destiny.

Of course, the HSA works as a retirement account only if you can sock away more than you need for this year’s medical costs. Therein lies the challenge. Here’s how to ensure an HSA will offer you a healthier retirement.

Make sure you’ll benefit

Premiums on HSA-eligible health plans are less expensive than those of lower-deductible plans, but you could spend more overall depending on your health. That’s because of the deductible. In 2013, this must be at least $1,250 for individuals and $2,500 for families.

The HSA is meant to help you save for this and other out-of-pocket costs; in 2013, individuals can stash $3,250, families, $6,450. Those 55-plus can add another $1,000. Also, 72% of employers contribute—an average $920 for singles, $1,600 for families, Kaiser Family Foundation reports. Assuming you’re covered through work, your employer will pick a default custodian for the account.

To end up with a balance at retirement, you’d need to let some of the money in the HSA ride each year. The more you pay in, the better your odds of having leftover funds. Being healthy helps too. (Use the tool at WageWorks to compare an HDHP/HSA with other insurance plans, based on last year’s usage.) Medical needs are unpredictable, though, so also consider how you handle costs when they come up.

Jacksonville financial planner and MD Carolyn McClanahan says you’re more likely to have money to spare if you know how to work the health care system—e.g., comparing prices and asking for generic meds.

Fill the right buckets

Most HSA users tap their accounts for immediate health care costs, allowing what’s left to roll forward. To really grow the HSA, however, you could dedicate it to retirement by paying health costs with other savings. “This makes sense for those who have spare cash flow,” says Coral Gables, Fla., financial planner Joshua Mungavin.

Wherever you store the money, aim to set aside at least two times the deductible for current bills, says Anspach. Beyond that, how does an HSA fit into the hierarchy of retirement accounts? Though it has the best tax benefits, it isn’t as flexible as a 401(k) or IRA. Prior to 65, you pay a 20% penalty on nonqualified withdrawals, for example. So fund your 401(k) up to any match, then split your remaining money among a Roth IRA, 401(k), and HSA.

Invest for now and later

Keep money earmarked for today’s health care in cash. (Some custodians require you to maintain a cash balance anyway—typically $1,000 to $2,500—before you can invest.) The rest of the HSA can be allocated as you would your other retirement dollars, says Mungavin.

Mutual fund choices tend to be limited though, notes Roy Ramthun, president of HSA Consulting Services. Some custodians offer less than 20.

No good ones in your employer’s offering? Roll it over to another custodian; compare options at HSASearch.com. You should be able to find investments you like.

HSA Bank, for example, offers a full brokerage via TD Ameritrade, while Health Savings Administrators lets you pick from 22 low-cost Vanguard funds. Examine account fees, too, as charges for banking services and account maintenance are common. You don’t want to avoid the drag of taxes only to have your balance pulled down by fees.

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