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by reducing your premiums, so your employer’s donation will give you another $1,000. All of a sudden, the effective deductible is down to $500. What’s more, money in an HSA carries over indefinitely, even after you change jobs or stop being in an HDHP, allowing you to have cash on hand when you do have a large medical bill or need nursing care. Given the large medical needs people have as they
get older, and the growing likelihood that they will need high-quality nursing care, this seems like a wise investment in your well-being and that of your family. In contrast, with a low-deductible plan, there is no
financial reserve for when you really need money for healthcare, which is the same as having less coverage.
TRIPLE TAX BENEFITS All of this adds up — especially because you can put HSAs into mutual funds. If your family invests $5,000 a year via an HSA for the next 25 years and earns the historical stock market average over the past 25 years, you would have $550,000 to spend on your family’s care.
But isn’t it better to put savings into a 401(k)? The HSA offers triple tax benefits — the money
that you put in isn’t taxed, the money grows tax-free, and you don’t pay taxes on it when you finally use it. The last two aren’t true for 401(k) savings. Don’t forget the tax savings from putting money
in the HSA. If you’re in the 30% bracket and you put away $5,000, you have saved $1,600 that would otherwise have gone to taxes. Once again, this money would get you a long way toward your annual deductible. One important caveat: If you’re sure to spend over
the deductible, other plans may be more appropriate for you, such as the PPO that will cost you an additional $800. (You forgo the ability to save but face a lower out-of-pocket maximum.) For instance, if you know with reasonable certainty
that you need access to a more expensive provider for a one-time procedure, then you should pick a plan that gives you this access, such as a PPO, and switch back to an HMO with an HDHP and HSA option during next year’s open enrollment period. If you do end up choosing an HDHP, please
remember: Do not cut back on care haphazardly, as many people do. Following a doctor’s recommendations is much more important than saving a bit of money.
Amitabh Chandra is a professor of business administration at Harvard Business School and a professor of public policy and director of health policy research at the Harvard Kennedy School of Government.
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