How can I find/compare custodians for my HSA in the United States?
In general, things to look for are: Things to look out for: I'd recommend two places: I'd recommend reading up on HSA's in this related question here. "The account I have found that works best as a HSA is Alliant Credit Union. They have fee-free HSA (no fees for almost all types of transactions or monthly fees) and a fairly decent online banking website. I've been with them for about 5 years now without trouble. FYI - They are a credit union not a bank so you do have to make a small $10 donation to one of their charities to become ""eligible"" for opening the account."
Yes on the August expenses, No on the April; the expenses must have happened after the HSA was opened.  Also, note that you're limited to (in 2015) $3350 of deposits to the HSA in a single year, so you can only put $2350 more into the HSA. The IRS form for HSAs looks something like this:   1) How much money did you take from your HSA? 2) How much were your qualified medical expenses? 3) If (1) > (2), give us a bunch of money. But they aren't, your number fails to compare the US to any other countries in 2013. My numbers do compare the rate in the US to other countries over four different years.   Edit: also, it is funny that the rate cost rise in the US has increased since we passed the afordable care act... hmmm.... You can't roll her HSA account into yours, but you can roll her HSA account into another HSA account that is hers.  A $5 per month fee for an HSA account is ridiculous. Find another account that has no fees, and move the money there. I suggest talking to your local credit union. I fell into a similar situation as you.  I spent a lot of time trying to understand this, and the instructions leave a lot to be desired.  What follows is my ultimate decisions, and my rationale.  My taxes have already been filed, so I will let you know if I get audited! 1.)  So in cases like this I try to understand the intent.  In this case section III is trying to understand if pre-tax money was added to your HSA that you were not entitled too.  As you describe, this does not apply to you.  I would think you should be ok not including section III (I didn't.) HOWEVER, I am not a tax-lawyer or even a lawyer!   2.) I do not believe these are medical distributions From the 8889 doc....   Qualified HSA distribution.   This is a distribution from a health flexible spending arrangement (FSA) or health reimbursement arrangement (HRA) that is contributed by your employer directly to your HSA. This is a one-time distribution from any of these arrangements. The distribution is treated as a rollover contribution to the HSA and is subject to the testing period rules shown below. See Pub. 969 for more information.   So I don't think you have anything to report here.   3.) As you have no excess this line can just be zero.   4.) From the 8889 doc This is a distribution from your traditional IRA or Roth IRA to your HSA in a direct trustee-to-trustee transfer.   Again, I don't think this applies to you so you can enter zero. 5.) This one is the easiest.  You can always get this money tax free if you use it for qualified medical expenses. From the 8889   Distributions from an HSA used exclusively to pay qualified medical expenses of the account beneficiary, spouse, or dependents are excludable from gross income. (See the line 15 instructions for information on medical expenses of dependents not claimed on your return.) You can receive distributions from an HSA even if you are not currently eligible to have contributions made to the HSA. However, any part of a distribution not used to pay qualified medical expenses is includible in gross income and is subject to an additional 20% tax unless an exception applies.   I hope this helps! Yup, if he/she is talking about a broker/dealer, but if he's talking to an RIA and is trying to find out who the custodian is then he won't have a statement yet. I don't think he has opened the account yet, but I'm not sure and could be totally misunderstanding the question. Hey, I was thinking back to that X-Ray you got done at the hospital, that you said was cheaper than 90% of the population. I am wondering if maybe that hospital wasn't one of the many that qualify for DSH reimbursement payments. What could have happened is that they saw that you are uninsured, and made a decision that they would only charge you for the portion that they didn't think Medicare / Medicaid would reimburse. If that happened, it wouldn't even show up on your credit report, as the hospital is the one that would file a credit claim. Likely, if they have to go through this a lot, they wouldn't even waste time filing a credit claim, they would just go after a reimbursement through Medicare / Medicaid. And thus, to you, it would just look like a very small bill, but in reality it would only represent a smaller portion of the true bill.   I would also wonder, if they do a lot of these, if they aren't also one of the hospitals that article I linked to showed was super-inflating the prices of uninsured in the hopes of getting a larger portion reimbursed. First, as noted in the comments, you need to pay attention to your network providers.  If you are unable to pay exorbitant prices out of pocket, then find an in-network medical provider.  if you are unhappy with the in-network provider list (e.g. too distant or not specialists), then discuss switching to another plan or insurer with your employer or broker. Second, many providers will have out of pocket or uninsured price lists, often seen in outdated formats or disused binders.  Since you have asked for price lists and not been provided one, I would pursue it with the practice manager (or equivalent, or else a doctor) and ask if they have one.  It's possible that the clinic has an out of pocket price list but the front line staff is unaware of it and was never trained on it. Third, if you efforts to secure a price list fail, and you are especially committed to this specific provider, then I would consider engaging in a friendly by direct negotiation with the practice manager or other responsible person.  Person they will be amenable to creating a list of prices (if you are particularly proactive and aggressive, you could offer to find out of pocket price lists from other clinics nearby).  You could also flat out ask them to charge you a certain fee for office visits (if you do this, try to get some sort of offer or agreed price list in writing).  Most medical practices are uncomfortable asking patients for money, so that may mean flat refusal to negotiate but it may also mean surprising willingness to work with you.  This route is highly unpredictable before you go down it, and it's dependent on all sorts of things like the ownership structure, business model, and the personalities of the key people there. The easiest answer is to switch clinics.  This one sounds very unfriendly to HSA patients. I compared it to NJ, NY and various other states through a database that escapes me now.  It's an independent database that was partially funded by the Bill and Melinda Gates foundation and I cannot find it now.  I also went through the arbitration opinion between CPS and the union, as another datapoint.  I'm sorry.  I will try to find it and get back to you. "I had an HSA for two or three years. I found very routinely that my insurance company had negotiated rates with in-network providers. So as I never hit the deductible, I always had to pay 100% of the negotiated rate, but it was still much less than the providers general rate. Sometimes dramatically so. Like I had some blood and urine tests done and the general rate was $450 but the negotiated rate was only $40. I had laser eye surgery and the general rate was something like $1500 but the negotiated rate was more like $500. Et cetera. Other times it was the same or trivially different, like routine office visits it made no difference. I found that I could call the insurance company and ask for the negotiated rate and they would tell me. When I asked the doctor or the hospital, they either couldn't tell me or they wouldn't. It's possible that the doctor's office doesn't really know what rates they've agreed to, they might have just signed some contract with the insurance company that says, yes, we'll accept whatever you give us. But either way, I had to go to the insurance company to find out. You'd think they'd just publish the list on a web site or something. After all, it's to the insurance company's advantage if you go to the cheapest provider. With a ""regular"" non-HSA plan, they're share of the total is less. Even with an HSA plan if you go to a cheaper provider you are less likely to hit the deductible. Yes, medical care in the U.S. is rather bizarre in that providers routinely expect you to commit to paying for their services before they will tell you the price. Can you imagine any other industry working this way? Can you imagine buying a car and the dealer saying, ""I have no idea what this car costs. If you like it, great, take it and drive it home, and in a few weeks we'll send you a bill. And of course whatever amount we put on that bill you are legally obligated to pay, but we refuse to tell you what that amount will be."" The American Medical Association used to have a policy that they considered it ""unethical"" for doctors to tell patients the price of treatment in advance. I don't know if they still do." "Uniform Transfer to Minors Act (UTMA) and Uniform Gift to Minors Act (UGMA) accounts in the United States are accounts that belong to your child, but you can deposit money into.  When the child attains his/her majority, the money becomes theirs to spend however they wish.  Prior to attaining their majority, a custodian must sign off on withdrawals.  Now, they are not foolproof; legally, you can withdraw money if it is spent on the child's behalf, so that can be gamed.  What you can do to protect against that is to make another person the custodian (or, perhaps make them joint custodians with yourself, requiring both signatures for withdrawals). UTMA/UGMA accounts do not have to be bank savings accounts; for example, both of my children have accounts at Vanguard which are effectively their college savings accounts.  They're invested in various ETFs and similar kinds of investments; you're welcome to choose from a wide variety of options depending on risk tolerance.  Typically these accounts have relatively small fees, particularly if you have a reasonable minimum balance (I think USD$10k is a common minimum for avoiding larger fees). If you are looking for something even more secure than a UGMA or UTMA account, you can set up a trust.  These have several major differences over the UGMA/UTMA accounts: Some of course consider the second point an advantage, some a disadvantage - we (and Grandma) prefer to let our children make their own choices re: college, while others may not prefer that. Also worth noting as a difference - and concern to think about - in these two.  A UGMA or UTMA account that generates income may have taxable events - interest or dividend income.  If that's over a relatively low threshhold, about $1050 this year, those earnings will be taxed (on the child's own tax return).  If it's over $2100 (this year), those earnings will be taxed at the parents' tax rate (""kiddie tax""). Trusts are slightly different; trusts themselves are taxed, and have their own tax returns.  If you do set one of those up, the lawyer who helps you do so should inform you of the tax implications and either hook you up with an accountant or point you to resources to handle the taxes yourself." Much of this is incorrect. Aetna owns Payflex for starters, and it's your EMPLOYER who decides which banks and brokers to offer, not Payflex. An HSA is a checking account with an investment account option after a minimum balance is met. A majority of U.S. employers only OFFER an HSA option but don't contribute a penny, so you're lucky you get anything.  The easy solution is just keep the money that is sent to your HSA checking account in your checking account, and once a year roll it over into a different bank's HSA. The vast majority of banks offer HSAs that have no ties to a particular broker (i.e. Citibank, PNC, Chase). I have all my HSA funds in HSA Bank which is online but services lots of employers. Not true that most payroll deductions or employer contributions go to a single HSA custodian (bank).  They might offer a single bank that either contracts with an investment provider or lets you invest anywhere. But most employers making contributions are large or mid-market employers offering multiple banks, and that trend is growing fast because of defined contribution, private exchanges and vendor product redesigns. Basically, nobody likes having a second bank account for their HSA when their home bank offers one. It is my understanding that the money in the HSA is yours to keep forever, even if you leave the country.   When you leave the country and no longer have an HSA-eligible High Deductible Health Plan, you will no longer be able to contribute new money to your HSA.  However, you can still spend the money on eligible medical expenses, even if these expenses are outside the U.S.  However, there are a few caveats: The HSA money will remain in a U.S. HSA bank account.  You won't be able to transfer the entire account to a new account in your home country without paying taxes and penalty.  Therefore, you need to have a mechanism for accessing and transferring the money from abroad, so that you can reimburse yourself as you have medical expenses, until the HSA account is empty. Even after you leave the U.S., as long as you have the HSA in place, you will need to file a U.S. tax return (form 1040NR) in any year that you have an HSA distribution. If you decide to take the money out without medical expenses, you will need to pay income tax on the money plus a 20% penalty. See How do I withdraw all money from my HSA account as a non-resident? for more information. Ironically, anyone can say anything, but it doesn't make it true. In normal times, the IRS can audit you for 3 years, or up to 6 for certain cases of fraud - From the IRS site -  How far back can the IRS go to audit my return? Generally, the IRS can   include returns filed within the last three years in an audit. If we   identify a substantial error, we may add additional years. We usually   don’t go back more than the last six years. HSA spending is reported each year, just like any Schedule A deductions. Each year, I have my charitable receipts, and they are not sent in. They are there in case of audit. I don't need to save them forever, nor does one need their medical bills forever. 3 years. 6 if you wish to be paranoid. The EOBs should be enough.  The HSA is unique in that you deposit pretax dollars (like a traditional IRA or 401(k)) yet withdrawals for qualified expenses come out tax free (like a Roth).  In my opinion, as long as your medical plan qualifies you for an HSA, I'd maximize its use. The older you get, the more bills you'll have, and at some point, you'll be grateful to your younger self that you did this. You can open an HSA account with any financial institution that you like, and roll over the money from your current account into the new one.  Since you are no longer in a High Deductible Health Plan, you can't contribute any new money into an HSA, but you can still spend the money in your HSA on eligible medical expenses, until it is gone.  There are lots of things that you can spend HSA money on, so there is no need to cash out and take on taxes and penalties. Yes, there are HSA accounts that don't charge ongoing maintenance fees.  Check with a local credit union; they usually have no-fee HSA accounts. Paytrust seems to be the only game in town.  We've changed banks several times over the last 15 years and I can tell you that using a bank's bill pay service locks you in, big time.  I loved paytrust because I could make one change if we changed banks.  If you're using a bank directly for your bills, the ides of recreating your payee list is daunting.