As Seen In:

Should I Choose an HRA or an HSA?

Written by Ed Snyder on .


Open enrollment is coming. You know, that time of year where you make choices about your benefits at work? One area that I've noticed that people may want to take a little more time in comparing their options is in the health insurance plan that they choose. As an Eli Lilly employee you can choose from two plans; a Health Reimbursement Account (HRA) or a Health Savings Account (HSA). I assume they will again offer these two options for 2018 and will update this article when we find out. My experience has been that most people use the HRA. But I think you should do some analysis and consider whether the HSA might be a good choice for you and your family.

You may have heard about the HSA, but maybe you're not sure how it works or how to use it. HSAs are relatively complex and can be confusing. Is it affiliated with health insurance? Does it have anything to do with my retirement? Is it a bank account, an investment account? It can be all of these things.

HSAs are available to those that have high-deductible insurance plans. The money in the HSA can be used to meet deductible and other out-of-pocket health care costs. The beauty is that the money you put in your HSA goes in pre-tax, like the money you put in your 401(k). Investment growth and interest are tax deferred, and withdrawals spent on qualified medical expenses are also tax free. I call this the trifecta of tax savings. This triple tax benefit increases your buying power compared to using after-tax money.

For example, let's say you had $1,000 in medical expenses for the year.  If you pay those expenses from money that you had in your HSA, you would be paying them with money that had not been taxed.  But, if you did not have an HSA, and paid the expenses from after-tax money (assuming the 25% federal income tax bracket and 5% state income tax), your $1,000 in medical expenses would actually cost you $1,428.57. Why? Here's the math. $1,428.57 - $357.14 (25% federal income tax) - $71.43 (5% state and county income tax) = $1,000 after tax. You can see the year-to-year savings potential of an HSA from this simple example.

You can also use an HSA for long-term retirement savings. Money in your HSA rolls over at the end of the calendar year. They are not "use-it-or-lose-it" like Flexible Spending Accounts Health Reimbursement Accounts. Health Savings Accounts are portable – that means you take it with you when you leave your employer. They are individually owned and not tied to employers. When you retire or leave your employer for any other reason, your HSA goes with you.

To utilize an HSA as a retirement tool you can pay your current medical expenses out of pocket, while making contributions to your HSA. You can let the HSA balance grow, much like you would an IRA or 401(k). The maximum amount you can contribute to an HSA for 2018 is $3,450 for individuals or $6,750 for families.

Let's assume that a worker is 40 years old and works until they are 65 years old and contributes $6,750 each year to his or her HSA. (Lilly contributes $1,600, so the employee contribution is $5,150) We'll assume a 4% average rate of return on the money invested in the HSA. At age 65, the HSA balance would be over $290,000. As long as that money is used for qualified medical expenses it will not be taxed. A recent estimate by Fidelity[i] indicates a couple retiring this year will need $275,000 to cover health care costs in retirement. I think you will likely have plenty of health care costs that you can use that money for.

Withdrawals from an HSA that are not used for qualified medical expenses are taxed at your income tax rate, plus a 20% tax penalty. However, once you reach age 65, distributions are never subject to penalty. You can use the money for whatever you want, the penalty does not apply. If you do not use it for qualified medical expenses, it will be taxable at your income tax rate. This is the same way your 401(k) or a deductible IRA would be treated for tax purposes. So, if you can use it after age 65 for medical costs you'll get the most benefit but even if some of it is used for non-medical costs, it still has a great benefit, like your IRA or 401(k).

So, what is a qualified medical expense? Generally, qualified medical expenses are those that qualify for the medical expense deduction. This includes most medical, dental, vision and chiropractic expenses. You may take tax-and penalty-free distributions to pay for your spouse or dependents' medical expenses as well as your own. You can even take a tax- and penalty-free distribution this year to reimburse yourself for medical expenses in a previous year, as long as the expenses were incurred after your HSA was established.

You may not have 25 years to save in an HSA like the worker in my previous example. Maybe you're 5 or 10 years away from retiring. The HSA may still make sense for you. When you reach age 55 you can contribute an additional $1,000 per year to your HSA, for a total of $7,750 (Lilly contributes $1,600. The employee contribution is $6,150). If you contributed that for 5 years and it grew at 4% it would be worth $43,000. And remember, you didn't pay tax on that money. $43,000 can pay a lot of health care expenses during retirement with tax-free dollars. If you're 5 to 10 years from retirement, you still have time to benefit from using an HSA.

Last year, 26 percent of employers helped offset the costs of HSA contributions by making contributions to employee accounts. Those contributions averaged $868, according to Devenir, a consulting firm that works with HSA providers and employers.[ii] Eli Lilly is one of those employers. In 2017 they contributed $800 for an individual or $1,600 for a family.

But what about the actual health insurance part? How do the HSA and HRA compare as far as paying for medical expenses? I've analyzed what your costs would be under both the HRA and the HSA as they are in 2017. These numbers will likely change for 2018 and I will update them when I have them. These numbers were run assuming a family of four or more with the Lilly employee salary between $100,001 and $150,000, using the maximum family out of pocket amounts, not individual. The premiums, annual deductibles and Lilly's contributions all change based on the number of people covered, and the out-of-pocket maximums change based on the number of people and your salary, so your situation may be different. I'm happy to run numbers for you if you want to compare. For this first example, we are assuming that the family spends $2,000 for the year in medical expenses in addition to the premium.

HRA – Health Reimbursement Account

Premium                       $4,848 ($202 per pay period)

Medical Expenses       +$2,000

Costs                            $6,848

Lilly's Contribution         -$2,000

Your Net Cost                $4,848


HSA – Health Savings Account

Premium                      $3,864 ($161 per pay period)

Medical Expenses       +$2,000

Costs                             $5,864 

Lilly's Contribution        -$1,600

Your Net Cost               $4,264


The HSA would cost $584 less for the year than the HRA in this situation.

What if your medical expenses were much higher for the year though. Maybe someone had a surgery that was very costly. Let's assume that your expenses were $40,000. How would that be covered by each plan and what would your total costs be?


Premium                       $4,848 ($202 per pay period)

Medical Expenses        +$6,700 (deductible + coinsurance)*

Costs                           $11,548

Lilly's Contribution        -$2,000

Your Net Cost               $9,548

*$40,000 - $3,000 deductible = $37,000 X 10% coinsurance = $3,700



Premium                       $3,864 ($161 per pay period)

Medical Expenses      +$10,080 (deductible + coinsurance)*

Costs                           $13,944

Lilly's Contribution        -$1,600

Your Net Cost              $12,344

*$40,000 - $2,600 deductible = $37,400 X 20% coinsurance = $7,480


In this case, the HRA would cost $2,796 less for the year. You can see that which plan is most cost-effective depends on what your medical expenses are. Obviously you don't know those ahead of time. You can estimate based upon what they have been the last few years and plan accordingly.

Based on what I've calculated, if your medical expenses (not including premiums) are less than $9,000 for the year, the HSA will be less expensive for you and if your expenses for the year exceed $9,000, the HRA will be less expensive. This is based off a family of four or more with a Lilly employee salary of $100,001 to $150,000. Different situations will produce different numbers.

These examples do not take into account using the Health Savings Account for the year-to-year tax savings. If you contributed $5,150 to your HSA for the year, you would have a tax savings of $1,546. (25% federal income tax, 5% state income tax). They also do not include how the balance of the HSA can grow over time. Want to see how much you could save in income taxes and how much your contributions could grow to? Check out the Resource Center at BenefitWallet

Often people ask me how they can save more money for retirement. They are maxing out their 401(k) contributions and their Roth IRAs, but want to save even more. An HSA is an often- overlooked tool for this. And it's a tax savings trifecta! The money goes in pre-tax, grows tax-deferred and comes out tax free, as long as you use it for health care expenses.

Open enrollment is a busy time and there are a lot of choices to be made. Many times, it's easier just to continue doing what you've been doing. Hopefully this article can help you take some time to consider whether the Health Savings Account might be a good option for you.

Thanks for reading!



The preceding examples were hypothetical in nature and are for illustrative purposes only. No specific investments were used in these examples. Actual results will vary. Past performance does not guarantee future results.