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A Health Spending Account is a great way to pay for healthcare or save for retirement. To help, we’ve surveyed the very best HSA accounts available today.

best hsa accounts

It used to be that consumers didn’t have much choice when it came to HSAs. Many of these accounts were little more than dedicated-use high-interest savings accounts.

Now more options are on the market. And this means more investing options for your health savings account.

This makes choosing an HSA a bit more work. But that work can pay off in the end.

Just think of your HSA as a way to invest an additional few thousand bucks a year. If you’re healthy and don’t generally have high medical costs, that money can roll over from year to year. Invested wisely, it can grow tax-free. And as long as you use withdrawals for qualified medical expenses, those will be tax-free, as well.

This can make a big difference in retirement, when your medical expenses will rise naturally. (Old age eventually catches up with the healthiest of us!)

So you’ll want to put some work into choosing an HSA. Even if you have a convenient employer-sponsored option available, you can still go off-route with an HSA of your own. You’ll just contribute post-tax income, and then take the contributions as a write-off when you file your taxes.

Here, we’ll talk about what to look for in an HSA and outline some of the best options available on the market today.

What to Look for in an HSA: Two Options

Looking at an HSA is similar to looking at an IRA. You want to look at a couple of factors, including:

  • Fees: This is how much the account will cost you on a monthly basis, including any expense ratios. But you should also look at fees attached to trading or making new investment decisions within your account.
  • Investment Options: You’ll also need to consider what investment options are available. This used to be a big weakness with HSAs, but things are getting better. Several of the accounts we’ll highlight here offer IRA-like investing options, including mutual funds.

While both of these factors are important, they shouldn’t carry equal weight. Depending on your circumstances, you’ll need to look at one factor more than the other.

If you’re planning to spend down much of your HSA, look more closely at the fees–especially any potential per-transaction fees. If the money isn’t going to sit in your account for long, you don’t need to worry much about your investment options.

This would be the case if you have a sick individual in your family, or if you have young kids with constant doctor’s appointments. This would also be the case if you can’t afford to max out your account annually. Maybe you can only put in $500 or $1,000. That’s fine. But in this case, you should be more concerned with fees eating away at your account balance each month than with investing options.

If you’re planning to invest your HSA for the long run, be concerned about investing options. You should also be concerned about investing fees. After all, fees can quickly eat up your earnings within your account.

However, you’ll also want to look closely at the investing options. It can be worth paying some small fees for access to investing options that can far out-earn those fees. If your goal is to get a good return on your money, be sure your account gives you options that can do that.

If you’re closing in on retirement, you may also want to look at accounts with a wide variety of investing options. As you get closer to retirement, you may want to pull your investments from high-risk, high-reward investments to low-risk but stable investments. This is just like you’d manage your 401(k) or IRA.

How We’re Assessing HSAs

There are plenty of HSA options on the market. So there’s a chance that we missed a good one. If so, let us know in the comments.

We looked at data from a Morningstar study called The 2017 Health Savings Account Landscape. The study did a deep dive into HSA investing options and fees. We dug through this data–as well as data from a couple of other reputable roundups–to find the lowest-fee and best-investment HSAs.

First, we’ll talk about the low-fee options. Then we’ll dive into those with the best investing possibilities. Finally, we’ll highlight the account we think balances both the best.

Best HSA for Low Fees

So you’re one of those people who will likely use your whole HSA balance this year? In that case, you need to search for an HSA that has the lowest possible fees. Otherwise, your balance will slowly get worn away by expenses that are not medical expenses.

Saturna Capital

This administrator specifically focuses on HSA options for individuals. It has two account options–one that allows you to invest only in Saturna’s affiliated mutual funds and another that’s a self-directed brokerage HSA.

As you might guess, the first account type comes with lower fees. Saturna doesn’t charge any fees for account opening, account maintenance, statements, low balances, or closing your account. It also charges no fees for contributions, trades or exchanges, or account transfers.

In fact, the only fees Saturna charges are for wire transfers and overnight delivery of reimbursement checks. These rates vary, depending on the industry rate.

Saturna offers conveniences like the ability to invest directly from your bank account, redemption requests by phone or in writing any business day, and reimbursements into your bank account at no charge.

The one thing that Saturna is missing is a debit card or checkbook attached to your account. This is one of the reasons it’s able to charge such low fees. This can be problematic if you’re on a tight budget, as you’ll have to first fund the account, then pay medical expenses out of pocket, and then wait for a reimbursement. It sounds like reimbursements come quickly, but for a few days, maximum, you’ll basically have paid those medical expenses twice.

Still, even with this limitation, Saturna looks like an excellent option for consumers who want to spend down their HSA balances frequently. We’ll talk more about their self-directed account option in the section on investing.

Credit Unions

I actually came across loads of local credit unions in my search that offer very low–or even no–monthly maintenance fees on HSAs. They often specialize in FDIC-insured accounts earning a bit of interest based on average daily balance.

However, I’ve chosen not to list all the credit unions here because many have very specific eligibility requirements for members. But the bottom line here is that if you’re looking for a low-fee, no-frills HSA that you don’t particularly want to invest, check your local credit unions first.

Best HSAs for Investing Options

Of course, all good investors also care about fees. But if you want to invest your HSA funds for the long-term, it’s important to have investing options. Here are the accounts we think have the best ones.

One thing to note is that the individual investments you choose with your HSA funds may have fees of their own. Read this article to learn more about these types of fees, and be sure to pay attention to these as you choose invest.

Health Savings Administrators

This administrator offers first-dollar investing. So even if you start out contributing a few bucks a month, you can invest it. They don’t charge investment transaction fees, either, which can keep more of your money around for investing.

These accounts let you choose from over 100 investment options, including options from Vanguard, Dimensional, and Franklin Templeton, among others. The account investors should choose is the InvestorSelect option. It has a $45 per year administrative fee plus a 6.25 basis points per quarter custodial fee.

Health Savings Administrators’ transactional fees look pretty hefty, but you can avoid most of these fees.

Optum Bank

Optum Bank has relatively low fees, though its monthly fees are variable and difficult to suss out. But they do have a good variety of investing options, including access to the Charles Schwab target date funds.

It offers access to a variety of mutual funds, which you’ll find here. Optum does not charge trading fees, and all the funds are available without paying any fees. Again, you’ll have to check the fees for the individual funds you choose, though, as they will carry fees.

Best Balance of Both Worlds

What if you want a bit of both? You’ll spend some of your HSA each year, but you also want to invest it? These are the two accounts I think win out in that arena:

HealthEquity

I actually stumbled on HealthEquity when looking for Alliant Credit Union. Alliant’s HSAs were the highest-scored option in the Morningstar spending account category. But they’re actually transitioning over to HealthEquity accounts in 2018.

According to their list of fees, there’s an account setup and monthly administration fees are typically paid by the plan sponsor. However, if you use one of these accounts independently, HealthEquity will charge up to $3.95 per month in maintenance fees.

You can use a debit card to pay your qualified healthcare expenses for free. Or you can order reimbursement checks, but those cost $2 each.

The interesting thing about HealthEquity is the variety of account types they offer. You can choose to keep your funds in an FDIC-insured account that earns a basic–pretty low–interest rate. Or you can invest in one of three account types:

  • Auto-Pilot: This account offers full service advice, automatic implementation and rebalancing, and portfolio alerts. It charges monthly service fees of .08% and monthly investing administration fees of .033%.
  • GPS: This account option splits the difference between full-service and self-directed. You can get some investing guidance from HealthEquity, but you’ll be primarily responsible for doing your own investing. You can, however, get portfolio alerts. The fees are slightly lower: .05% monthly service fees plus .033% investing administration fees.
  • Self-Driven: With this type of account, you’re totally on your own. You’ll have plenty of investing options, but you’ll be totally responsible for checking out your account and making choices. There are no monthly service fees, but the account still carries the monthly investing administration fees of .033%.

Saturna Capital

If you want to take complete control over your HSA investing and have lower fees, Saturna is, again, a great option. Again, it lacks some of the conveniences of other HSAs. But if your primary goal is long-term investment, that’s not a big deal. You could always invest for the long term with Saturna, then move your account to a spending-oriented, FDIC-insured account with a debit card when it’s time to spend down the money.

Saturna’s self-directed Saturna Brokerage HSA has very low fees. The only monthly fee is a potential inactive account fee if you have had no trades for the entire year. Other investing-related fees are charged according to this commission schedule. In general, trading online by yourself will be cheaper than broker-assisted trading.

Saturna offers a wide range of investing options. It’s a good choice if you’re planning to do very little shifting of your investments over the year, but want to invest for the long term.

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Health care costs go up every year. But you don’t need to be stuck with a big bill. Here are 5 ways to lower your medical bills.

Lower your medical bills

A visit to a doctor or hospital can be stressful if you don’t have health insurance. Even insurance with a high deductible can make any visit an expensive trip. The good news is that many medical providers are willing to help. They will work with patients to ensure that they can receive care and realistically pay off bills.

The first step is letting your care provider know about your situation. Your provider may allow you to skip certain routine tests or procedures that aren’t totally necessary based on your age, health and medical history if it’s known ahead of time that you’re paying out of your own pocket. Your care provider may also give you generic medications to help lower your bill.

You can also take steps to help you reduce the financial burden of getting the care you need. Here are five smart things to remember if you’re interested in negotiating your medical bills.

Ask About a Care Provider’s Policy for Uninsured Clients

Some care providers and medical institutions have policies that automatically reduce bills for uninsured patients. The same policies often extend to patients in specific income brackets. For example, UNC Medical Center offers an automatic 40 percent discount to uninsured patients, while Cedars-Sinai Medical Center offers full financial assistance to those who are at or below 200 percent of the federal poverty level.

What if your care provider doesn’t have any type of policy for reducing bills? Look for a new provider in your area that offers similar services with the option for bill reductions. Be sure to inquire about options for payments when you book your appointment with a new provider.

Ask About Cash Discounts

You could receive special rates for medical services if you’ll be paying with cash in some offices. It’s important to mention that you’ll be paying with cash before you receive any services. Many doctors, labs, hospitals, and facilities offer discounts of as much as 20 percent, or more if you’ll be paying your bill in full using cash at the time of your visit.

Resource: How to afford health care in retirement

Inquire About Bill Reductions

What do you do if you arrive home from a stay in a hospital and find a large bill waiting for you? The first step is to contact the hospital’s billing department. The hospital is unlikely to forgive your entire bill. However, many hospitals have forgiveness policies that could drastically reduce your bill by thousands of dollars. It’s important to reach out to a billing department as soon as you receive your bill. Ignoring the bill or putting off taking action could result in delinquent payments that could create a real financial mess for you.

Seek Help Beyond Your Medical Provider

There’s a possibility that the specific medical office or hospital that you’re using doesn’t provide any sort of discount or forgiveness plan for patients who do not have medical insurance. That doesn’t necessarily mean that you’re out of options. There are a number of charitable organizations and advocacy groups that specialize in helping people pay medical bills or receive assistance. Your medical provider should be able to recommend an organization near you.

Don’t Forget to Make Sure Your Medical Bills Are Accurate

The last thing you need is to overpay for a bill because of an error. Be sure to inspect all of the medical bills you receive to check for inaccurate or duplicated charges. You should examine any charges that seem unusually high. Don’t be afraid to challenge charges that seem inaccurate. You should also make sure that dates of service are correct to ensure that you’re only being billed for appointments that actually happened.

One bright piece of news for people with medical debt is that the three major reporting agencies are about to change the way they handle medical debt on credit reports. The agencies will begin using a waiting period of 180 days before including medical debt on a consumer’s credit report to ensure that enough time has passed for disputes to be addressed.

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After pulling out of a merger deal with Aetna, major insurance company Humana announced that it will drop out of the Affordable Care Act exchange in 2018. The company had already been scaling back its plans available on the exchange. For 2017, it was only selling policies in 11 states.

Although Humana has been a relatively small provider in the Obamacare healthcare marketplace, its pulling out of Obamacare may signal more changes to come. Humana cited an “unbalanced risk pool” as its reason for pulling out of the marketplace. But Humana, like many insurance companies, is likely anxious about the future of the entire Affordable Care Act.

Related: Insurance Giant Aetna Pulls Out of Obamacare

Congress and President Trump have promised to “repeal and replace” the ACA, but haven’t given many details about their plans. Because of this, many insurance companies have already pulled out of the healthcare marketplace.

According to the Kaiser Family Foundation, 18 states have only one or two insurers in their marketplaces in 2017. In general, insurer participation increased between 2014 and 2015, but dropped significantly between 2016 and 2017. Alabama, Alaska, Oklahoma, South Carolina, and Wyoming each have only one insurance company operating in their exchanges. Many states maintain diverse exchange offerings, but participating insurers are still on the decline.

So what does it mean for you?

As noted above, Humana was only offering health insurance plans in 11 states for 2017. If you’re one of the consumers currently covered by a Humana plan through the individual marketplace, you’ll have to find an alternative plan next year. You can, however, keep your current plan through the end of the year.

On a grand scale, Humana’s change of heart won’t directly affect many consumers. With that said, Humana’s exit puts even more pressure on the Republican Congress and White House administration to make some serious changes to the healthcare law.

More Ahead: President Trump’s Proposals for Childcare

With more insurers leaving the marketplace, those that remain are likely to increase their 2018 rates in an attempt to ward off further financial losses. Those costs will fall to the consumers if the law isn’t altered or replace quickly and efficiently.

It remains to be seen what sorts of changes the Trump administration and the Republicans in Congress have for the Affordable Care Act. But with major players like Humana pulling out, the pressure is on to come up with a solution–one the insurance companies can live with–sooner rather than later.

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An estimated 9.1% of the population in the United States have symptoms of depression, according to the Centers for Disease Control (CDC) Morbidity and Mortality Weekly Report.

Depressive illnesses are more than just being sad occasionally. Among people with depression, there is a measurable chemical imbalance in their brands, and this prevents signals from being transmitted from neuron to neuron correctly. So depression changes how people think. And any obstacle to rational decision-making has significant long-term effects on an individual’s quality of life. As a family’s financial situation is one of the primary concerns of this blog and a primary factor in the quality of one’s life, it stands that depression can cause difficulties with money worth a discussion here.

Although depression is often chronic, it can be triggered by external events, or at least correlated to life factors. One of these factors is state of employment; the longer someone is out of work and looking for a job, there is a higher probability of that person showing symptoms of depression. To be certain, the CDC study shows 21.5% of unemployed persons in the United States have depression, compared to 6.6% of the employed population. Of those unable to work 39.3% have depression.

A cycle exists that makes depression particularly dangerous, even when putting aside the increased risk for self-harm, suicide, or violent behavior. Frequent or consistent financial problems, stemming from the loss of a job, a divorce, a bankruptcy, health problems, or a variety of other reasons, can lead to depression’s chemical imbalances. Those imbalance can prevent what others might consider “clear thinking,” the type of cognitive abilities that might, in other situations, be able to help people improve their finances. And that frustrating mental condition can lead to more financial trouble, keeping the depression persistent.

In some cases, people have the ability to adjust their thinking on their own, and change their circumstances — or at least, change the way they perceive their circumstances. There was an example of this recently in a story on CNN Money:

When Ray Camp lost his job at a Dell supplier at the height of the recession, it took a toll on his soul and his family. After nearly four years of looking, all he found was 16 hours of work every other week at a company fours away from his home in Nashville, Tenn.

He was crushingly depressed and felt worthless. His sour mood made him difficult to be around, putting a strain on his family. His story is a familiar one among the 3.1 million Americans who have been unemployed for more than six months…

In February, Camp finally decided he was no longer a failed job applicant but a new retiree. After four years, he had embraced retirement and started collecting social security since he had also turned 62. “Once I finally got into the mindset that I’d never have to face rejection again, I started to feel 100%,” said Camp, who now spends the hours he lost on job searches playing with his grandchildren and mowing his lawn.

For some people with depression, the mindset change is only possible with therapy or medication. In fact, the CDC distinguishes between “major depression” and “other depression,” and it is this “major depression” that is less likely to be overcome through nothing more than a decision to look on the bright side of life.

The Suicide Awareness Voices of Education group explains the differences between a healthy brain and a brain with depression:

A person living with depression does not always have the same thoughts as a healthy person. This chemical imbalance can lead to the person not understanding the options available to help them relieve their suffering. Many people who suffer from depression report feeling as though they’ve lost the ability to imagine a happy future, or remember a happy past. Often they don’t realize they’re suffering from a treatable illness, and seeking help may not even enter their mind. Emotions and even physical pain can become unbearable.

It should thus be no surprise that depression can become an obstacle not only to financial independence but to basic financial stability.

Depression affects your performance at your job. Motivation is a casualty of depression, so this affects how you work, if you do happen to have a job. Motivation is crucial for performing as you’re expected to perform at your job. As depression goes untreated, it may be difficult to hold onto that job.

Depression affects your spending. With depression, people may seek behaviors that heighten their sense of pleasure to counteract the general depressive moods. One method of self-therapy involves spending money. Buying things and experience can create a high feeling that masks emotional pain, at least temporarily. “Retail therapy” is a common type of self-medication, so to speak. And the temporary feeling of satisfaction gained from buying a present is more powerful than the reasoning and logic behind the idea of spending only what you can afford.

Depression can increase debt. From spending more than you earn in order to feel good to the lack of an expectation of feeling good when paying off debt, depression can lead to a larger portion of one’s life spent in debt or accruing new debt. Debt severely limits your options in life, and when in combination with unemployment, it can leave you with nothing over the long-term.

Treating depression can be expensive. Stories like the one in CNN Money about someone overcoming depression on his own are not the norm. Dealing with major depression requires professional help. And doctors are not cheap. Health insurance comes in handy when paying for psychologist visits or medication, but many with depression are not working. Until the Affordable Care Act, citizens in the United States have typically relied on employer assistance to subsidize the expense of health care, but the Act may be ushering in a new era in which individuals manage their own health care insurance, with the potential for subsidies from other taxpayers. Regardless, treatment is expensive, and those needing the treatment may not be in the best position to afford the help they need. Thus, they don’t get the help, and depression and its financial effects continue.

I think the best thing that those of us without depression can do is to learn to be somewhat empathetic towards those who do. We, who are often too smart for our own good, expect people to be able to make rational decisions about their lives, and I’ve seen many people get frustrated when people in their lives do not act in responsible ways with their finances. We want to believe in personal responsibility and accountability, where good results come about from hard work and good decision-making, and where people have the capability of improving their lives. We want people to be able to take action. We want people to control the way they react to certain situations.

We want people to “choose happy.”

But depression is one of many things that prevent people from seeing these “truths” that we want so much to share with the world.

It took me a long time, but I now live under the philosophy that happiness isn’t something that needs to be sought, it’s just a choice. I can always choose how I react to any situation in which I find myself. But every once in a while, I still have to remind myself that this is not a choice everyone is free to make at every moment. The ability to make a choice rests on the brain’s ability to make neurological connections, and that ability can be impaired.

Read the latest CDC report on depression.

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5 Tips for Paying for Health Care During Early Retirement

by Luke Landes
Nurse and Patient via Flickr

The issue of healthcare is one that keeps people in jobs far longer than they’d like. I’ve seen up close how someone with chronic health issues must deal with these choices, and in certain situations, the choices can be difficult. Medicare coverage doesn’t begin until age 65, so where does that leave someone who stops […]

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How Much is the Obamacare Penalty?

by Luke Landes
Take up thy stethoscope and walk

The Affordable Care Act requires most American citizens to have health insurance or health care starting in 2014. Many of those required to have health insurance will owe additional tax if they are not enrolled in a plan. It’s no surprise that many citizens are not happy about being told by the government that they […]

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When Do You Call Out of Work Sick?

by Luke Landes

Looking back over my career, which for me started in non-profit out of college in 1998 and 1999, included teaching middle school and high school, transitioned into the finance industry, and eventually culminated in working for myself full-time, I’ve had an opportunity to consider my approach to “sick days.” In the early days, I took […]

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Adult ADD/ADHD Limits Financial Success

by Luke Landes

As a kid, I might have had attention deficit disorder (ADD). I was never diagnosed as far as I know, but I had many of the symptoms of the “inattentive” type of ADD, and some of those symptoms continued into adulthood. An actual diagnosis of ADD as an adult would require exhibiting at least six […]

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Concierge Medicine As a Replacement for Insurance

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Although I’ve mostly figured out how to get my financial life in order, other aspects of my life still need work. For example, I’ve visited a physician only a few times over the past ten years. I should be seeing a doctor about once a year if I were to listen to the typical medical […]

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How to Work Out Without Over Working Your Budget

by Guest Author

This is a guest article by Jennifer Calonia, Junior Editor at GoBankingRates. In the article, the author offers suggestions for staying fit without breaking the bank. It’s that time again: Beach season is fast approaching and franchise gym promotions are in full swing to lock you and your checking account into a pricey workout regimen. […]

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