When you should consider spending HSA funds

In this column, we spend most of our time discussing how HSAs are a great tool if you want to save for future medical costs, including long-term care expenses that might crop up down the road. And if you tend to be healthy from one end of the year to the other, you might have found that you're not currently withdrawing anything from your HSA.

If that's your situation -- congratulations! There's no doubt that it's a good idea to build up some funds in your HSA. But spending money on your health now is also a good idea, even if you feel like you're perfectly healthy. You know the line about an ounce of prevention and a pound of cure? It's definitely one to keep in mind when you think about the money in your HSA and whether you should be saving all of it for a rainy day, or spending some of it now in an effort to ward off those rainy days.

First, the ounce of prevention...

The Affordable Care Act made preventive care much more accessible for millions of Americans, by requiring health insurance plans — including HSA-qualified high-deductible health plans (HDHPs) — to cover preventive care for free, without any deductible or copay. But that rule doesn't apply to grandfathered health plans, and it also doesn't mean that all preventive care is free. The list of free preventive care is extensive, but it's certainly not all-encompassing.

Assuming your HDHP isn't grandfathered, you'll find that it fully covers quite a bit of preventive care, regardless of whether you've met your deductible. Take advantage of that — you're paying for it with your premiums, so don't let it go to waste.

And it's all very scientific; the preventive services that health plans are required to cover are the services that are rated "A" or "B" in the United States Preventive Services Task Force recommendations, recommended by the Health Resources and Services Administration, or recommended by the CDC's Advisory Committee on Immunization Practices. In other words, your health plan is likely going to cover the preventive care that scientists and doctors have determined is most essential.

Is everything covered?

Those lists are always evolving, and there may be services that you and your doctor consider important that aren't covered for free by your health plan. And that's why your HSA funds are there! If your preventive care checkup includes tests or diagnostics that aren't covered by your health plan, don't be afraid to spend some money from your HSA to pay for them. But here's a tip -- considering waiting until the claim is processed by your insurer, because the price might end up lower than what's initially billed.

For example, your doctor might want to run some blood tests during your checkup. Some blood-work (like cholesterol screening) is considered preventive care under ACA rules, and would be fully covered by all non-grandfathered health plans. But insurance plans are not required to pay for a complete blood count (CBC), which means that if you have one done, you might have to pay for some or all of the cost (UnitedHealthcare has a helpful guide for understanding how this works).

There are lots of examples of things that we think of as preventive care, but that our health plans do not have to cover. Vitamin D screening, comprehensive eye exams, maintenance medications, a visit to a dermatologist for a full-body skin cancer screening, adult dental cleanings, breast cancer screening beyond basic mammograms (a few states do require coverage for this), vaccines related to travel abroad… and those are just a few.

If you're young (or not-so-young!) and healthy and have been stashing money in your HSA, keep in mind that investments in your health now can pay big dividends years or decades down the road. Find yourself a dermatologist and get your skin checked out. Then get your eyes checked (we're talking about more than just a vision test, too).

Make an appointment with a therapist if you feel like your mental health isn't where you'd like it to be. Visit a chiropractor if doing so makes you feel better. Buy yourself an acupressure mat (they may look simple, but they feel fantastic!).

Don't ignore anything, even the small stuff

A few years ago, I noticed a little bump under my arm, and I fretted about it for several weeks before making an appointment to get it checked out. Since I have an HDHP and hadn't met my deductible, I had to pay for the visit in full. It cost me a couple hundred dollars to find out that the bump was nothing to worry about, but the peace of mind was priceless.

One thing that all of these services have in common? You can use HSA funds to pay for them. And while saving money for future medical bills should absolutely be a priority if you have an HSA, you also have to prioritize your health right now. Don't be afraid to take money out of your HSA to pay for things that will help you stay healthy in the long run. Your future self will thank you!

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