Can I use a different HSA than PayFlex that came with aetna?
You can ask your employer for anything that you want. However, most employers, if they are contributing their own money into your HSA, or you are contributing to your own HSA through payroll deduction, only work with one HSA, which is much easier for them to manage. You are free to decline their HSA if you want.  However, if they are kicking in free money into your HSA, I don't recommend that you decline it.  Just pick the best option you have for investing. As for the money that you are contributing, if you don't want to put your own money into your employer's Aetna HSA, you can open up an HSA with any institution you like.  You can even do this and still keep Aetna HSA to take advantage of the employer's contributions.  However, your annual limit is still the total of all contributions to all HSA's in your name, whether you make them or your employer makes them. When deciding whether or not to use payroll deduction into the Aetna HSA or to go your own way, keep in mind that payroll deduction skips some payroll taxes. There are some cases I'm aware of where a large employer will offer alternative HSA vendors, but this is not the norm as far as I'm aware, and would only be an option if your employer has already negotiated for this with your insurer. It's likely that this specific vendor is built in for the particular HSA product your employer has elected from Aetna. If this really ticks you off on principle, you can check if they offer a stable value fund. If so, you can essentially treat this money as part of your emergency fund, and somewhat reduce your own emergency fund and invest that money however you see fit. 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.
"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." Your spouse is eligible for an HSA even if you have one as long as she is covered by a qualified high-deductible plan. In the case that you both had HSAs you would be limited in how much you contribute each year, but both can have accounts. In 2015, you could each contribute $3350 to your separate HSA plans. If you have a combined plan, and even if you switched mid year, you could contribute $6650 during that year total to the two HSAs. That can be divided any way you want as long as the total does not exceed that maximum for the year. You can contribute an extra $1000 if you are over 55 years old.  (I should probably also mention that you can still make contributions for the 2015 year until April 15, 2016, because it's relevant to most who would read this. Also you can only contribute a percentage of that limit matching the percentage of months that you are covered, but if you are covered for the last month of the year, you can contribute the full amount as long as you are covered for the ENTIRE following year.) Here are the advantages to the HDHP/HSA option over the PPO option, some of which you've already mentioned: Lower premiums, saving $240 annually. Your employer is contributing $1500 to your HSA.  As you mentioned, this covers your deductible if you need it, and if you don't, the $1500 is yours to keep inside your HSA. The ability to contribute more to your HSA.  You will be able to contribute additional funds to your HSA and take a tax deduction. Besides the medical expenses applied to your deductible, HSA funds can be spent on medical expenses that are not covered by your insurance, such as dental, vision, chiropractic, etc.  Anything left in your HSA at age 65 can be withdrawn just like with a traditional IRA, with tax due (but no penalty) on anything not spent on medical expenses. With the information that you've provided about your two options, I can't think of any scenario where you'd be better off with the PPO.  However, you definitely want to look at all the rest of the details to ensure that it is indeed the same coverage between the two options.  If you find differences, I wrote an answer on another question that walks you through comparing insurance options under different scenarios. With only $2000 in the account, I wouldn't worry about investing it.  Instead, I would roll this over into a new HSA account with a different provider.  Find a provider that doesn't charge ongoing fees, perhaps with a local credit union or bank.  Although you won't be able to add money to it, you can withdraw as you have eligible medical expenses, until it is gone. Yes you are eligible even if your spouse is enrolled in Medicare. As long as YOU are not enrolled in Medicare you can contribute to an HSA. You may use the money to pay the cost of qualified medical expenses for you and your spouse. Here are some resources with additional information: HSA FAQ's HSA Resources 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. There are some points not covered in the other answers that I feel are important to address: In order to be eligible to contribute to an HSA, you must be enrolled in a High Deductible Health insurance Plan (HDHP).  In general, I think this is a great idea for most people (who are responsible enough to save up for medical expenses), but for a small portion it may cost more money to enroll in this type of plan, due to high recurring medical costs.  You should always weigh the costs of the related insurance plans against the benefit of an HSA. Note that once you open an account and contribute, you can use the funds at any point after that.  The eligibility described here is only regarding making new contributions to the account. This may no longer be true, but when I first started using an HSA several years back, I noticed that the fees and costs administered by the providers  were higher than I’d come to expect from, say, my IRA administrator.  At least, this was true for the accounts I found – perhaps I missed a better option. Furthermore, there was a much smaller selection of investment options available in those HSAs than in other brokerage accounts.  If you are not maxing out retirement already, it’s worth comparing fees and historical returns versus those accounts rather than assuming that the tax benefits will make the HSA a better deal. In my book, if it passes these two checks, then the HSA is a tremendous deal that is highly under-utilized. Contributing the $150 to put you over the $3k mark is somewhat pointless. The reason is that, although you won't be accumulating any fees, you won't be able to use the money, either, because as soon as you take a distribution, you'll be back under $3k.  Instead, I would look at two things: First, are you considering all the ways you can spend this money? Doctor visits, dentist, prescriptions, eyeglasses, chiropractic, and more: there are lots of ways to spend this money, and if you can spend it all in a relatively short amount of time, your problem is solved. The full list of things you can spend it on is in IRS Publication 502.  Second, have you talked to a local credit union? Credit unions often offer an HSA account with only a small setup fee and no ongoing monthly fee or minimum balance. If you roll your current HSA money over into your new account, you can then take your time spending the money until it is gone.  If you are having trouble locating a good HSA, there is a large list at hsarates.com. Look for one that is available in your state (or nationwide) and has low/no fees. You could open an HSA with a company like Vanguard or Fidelity that offers lower fees and roll the money there if you want to avoid the $3.50/month. The chances of you going until retirement without opportunities to spend down the money in that account on medical expenses seems rather low. An important risk is that the government may decide to change the rules. For example, prior to 2011, over the counter drugs like aspirin, Tylenol, Nyquil, etc. were eligible expenses. You could use your HSA money to buy as much as you wanted. Beginning in 2011, those rules changed. Now, if you want to spend your HSA money on Tylenol, you need a prescription for it. The value of HSA dollars was diminished in the sense that the universe of eligible expenses was diminished. No one knows what the HSA rules will be in the future. What will be eligible expenses? Who will be eligible providers? What kind of compliance paperwork will be required? What kind of fees will be imposed? Personally, I'm a great believer in HSAs. I've saved in one for years. But remember that the government makes the rules regarding their use. They've changed the rules to the detriment of HSA owners at least once; I won't be surprised if it continues. I work in the FSA/HSA/HRA industry and just wanted to point out that if your wife has a medical FSA, you cannot contribute to an HSA whether or not you are covered by her medical insurance plan. The only exception to this per the rules is if your wife's employers plan limits the medical FSA benefit to the employee, your wife, which I can say from experience is extremely rare. It's possible, but I've never personally seen an employer with this in their plan document, so better check first to be sure the FSA is restricted to your wife only. You have to understand the FSA to know why this is true. Unless restricted, your wife can use her medical FSA for herself, her spouse, and any tax dependents. Meaning whether or not she uses the FSA for your eligible expenses you still have 1st dollar coverage from the FSA, making you in-eligible to open and contribute to an HSA until the end of the plan year and possibly grace period if her employer has one in place and she does not spend her funds by the end of the plan year. Hope this helps. If your still not sure, talk to a tax professional, which I am not, but do advise employers and participants on both HSAs and FSAs. I use healthequity. It's just the one I was given, but they actually have really good fund options. There's a .396% yearly administration fee to access their low-cost funds, but the fund fees are really low (.02% for VIIIX, .03% for VBMPX) "The presenter suggested we keep records of our claims for 10+ years in paper form. This seemed to be overkill. It would be overkill if you're taking distributions regularly and you have enough valid (and otherwise unreimbursed) medical receipts each year to correspond to your distributions. However, if you are pumping money into the HSA without regular distributions, then you may need to keep receipts for a long time, possibly since the beginning of your HSA. For example: If the IRS was to audit my HSA deductions would the Aetna online claims be adequate? It's better than nothing, but it is not ideal. You need to provide proof of what you actually paid, not just what was billed. (How would the IRS know if you actually paid the bill?) So, the bill and receipt together would be preferred. Also, there are many eligible expenses for HSA that would not be covered by your health insurance and would not appear in your Aetna statements (dental work for example). Personally I have an excel spreadsheet with every eligible expense listed, every contribution and distribution I make, and a box of receipts since I opened the HSA account. Should I also archive screenshots of these claims digitally somewhere? If you have the time and diligence to do it, then it wouldn't hurt. I personally am only one house fire away from having to make a lot of phone calls if I wanted to re-build my receipts folder from scratch. I actually have ""scan my HSA receipts"" on my todo list (where's it been for years as a pretty low priority). Lastly it makes sense to spend the money in my HSA on anything eligible because you can never roll it over into a retirement account, its shaky if another person (spouse) could get reimbursed for eligible medical expenses if you die, and if you lose your receipts you may not be able to spend all of the HSA money tax free. Is this an accurate assessment or is there a reason why I should not touch the HSA money at all and wait to reimburse my eligible expenses. First off, if you are married the HSA can be transferred to your spouse. But in general, it really depends on what you would do with the money if you distributed it right away. If you need the money to pay debts, bills, etc, then it might make sense to take it, but if it would be extra money that you would invest somewhere, then you should leave it in the HSA because it grows tax free while it's in there and (probably) wouldn't if you take it out. The caveat though is that you need to find an HSA administrator that offers your preferred investment choices. As for your worry that you might lose your receipts, well, that's a valid point- but I wouldn't drive my decision based on that- I would archive them digitally to remove that concern completely. ...Should I reimburse myself from ... the HSA funds if I am not hitting the 401k limit yet? It depends. If it's a Roth 401k, all other things being equal, (you are able to choose the same investments with your HSA as you can choose in your 401K, and the costs are the same), then you are better off leaving the money in your HSA rather than pulling it out and putting it into the Roth 401k. The reason is that there is no tax difference, and once you put it into the 401K you (probably) can't touch it (for free) until you retire. With the HSA, if you could have taken a distribution but chose not to, then you can take that amount of money out anytime you want to without any consequences, just like your normal checking account. However, if you have a traditional 401k, and if taking HSA distributions would increase your cash flow such that you could afford to contribute more to the 401k, then this would lower your tax burden that year by reducing your taxable income." First off, you should contact your health plan administrator as soon as possible.  Different plans may interact differently with Medicare; any advice we could provide here would be tentative at best.  Some of the issues you may face: A person with both Medicare and a QHP would potentially have primary coverage from 2 sources: Medicare and the QHP. No federal law addresses this situation. Under state insurance law an individual generally cannot collect full benefits from each of 2 policies that together pay more than an insured event costs. State law usually specifies how insurance companies will coordinate health benefits when a person has primary coverage from more than one source. In that situation, insurance companies determine which coverage is primary and which is secondary. It’s important to understand that a QHP is not structured to pay secondary benefits, nor are the premiums calculated or adjusted for secondary payment. In addition, a person with Medicare would no longer receive any premium assistance or subsidies under the federal law. While previous federal law makes it illegal for insurance companies to knowingly sell coverage that duplicates Medicare’s coverage when someone is entitled to or enrolled in Medicare Part A or Part B, there has been no guidance on the issue of someone who already has individual health insurance and then also enrolls in Medicare. We and other consumer organizations have asked state and federal officials for clarification on this complicated situation. As such, it likely is up to the plan how they choose to pay - and I wouldn't expect them to pay much if they think they can avoid it.  You may also want to talk to someone at your local Medicare branch office - they may know more about your state specifically; or someone in your state's department of health/human services, or whomever administers the Exchanges (if it's not federal) in your state. Secondly, as far as enrolling for Part B, you should be aware that if she opts not to enroll in Part B at this time, if your wife later chooses to enroll before she turns 65 she will be required to pay a penalty of 10% per 12 month period she was not enrolled.  This will revert to 0 when she turns 65 and is then eligible under normal rules, but it will apply every year until then.  If she's enrolling during the normal General Enrollment period (Jan-March) then if she fails to enroll then she'll be required to pay that penalty if she later enrolls; if this is a Special Enrollment Period and extends beyond March, she may have the choice of enrolling next year without penalty. There is no distribution limit, only a contribution limit.  You can empty your HSA completely without tax or penalty, as long as the expenses are used for eligible medical expenses. In addition, you can reimburse yourself in the future for expenses that you have now, as long as you have an HSA account in place.  For example, you said that your dental bill was $3500, and you only had $3300 in your HSA, so you emptied your HSA and paid the rest from your checking account.  When you do get more money in the HSA, even if it isn't until next year, you can reimburse yourself for the $200 that you had to pay out of pocket on your dental bill.  And if you don't have enough money in your HSA this year to cover all of your birth expenses (congrats, by the way), you can reimburse yourself in a future year. Just make sure you keep good records on what the distributions were used for, in case you get audited.