The basic requirement: you need a high-deductible health plan

To open a Health Savings Account (HSA), you must be enrolled in a high-deductible health plan (HDHP) — a specific type of health insurance with lower premiums and higher out-of-pocket costs. The IRS sets the minimum deductible each year. For 2024, that means your plan's deductible must be at least $1,600 for individual coverage or $3,200 for family coverage. Your plan's out-of-pocket maximum cannot exceed $4,000 for individual coverage or $8,000 for family coverage. These numbers change annually.

Not all high-deductible plans are HSA-may be able to access. Your insurance company will tell you whether your specific plan qualifies. If you're shopping for coverage, look for plans labeled "HSA-may be able to access" or "HSA-compatible." Many employers offer at least one HSA-may be able to access option during open enrollment, and the individual market has them too.

You cannot have an HSA if you're covered by any other health plan at the same time — not Medicare, not a spouse's traditional plan, not a parent's plan if you're under 26. The only exception is coverage for accidents, disability, dental, vision, or long-term care, which doesn't disqualify you.

Key Takeaways

  • You must be enrolled in an HSA-may be able to access high-deductible health plan with a deductible of at least $1,600 (individual) or $3,200 (family) in 2024.
  • You cannot be covered by Medicare, Medicaid (with limited exceptions), or any other health plan at the same time you hold an HSA.
  • You must be a U.S. citizen or resident alien with a valid Social Security number or Individual Taxpayer Identification Number.
  • You can open an HSA through your employer, a bank, a credit union, or an insurance company — the plan itself does not open the account for you.
  • If you lose HSA may be able to access mid-year, you can still make contributions for the months you were may be able to access, but you cannot make contributions for months after you lose coverage.

Citizenship and tax filing status

You must be a U.S. citizen or resident alien to open an HSA. You'll need either a Social Security number or an Individual Taxpayer Identification Number (ITIN). If you're a resident alien, you must file a U.S. tax return for the year you want to contribute.

You cannot claim the HSA tax deduction if you're a nonresident alien, even if you have an ITIN. This matters because the whole point of an HSA is the tax benefit — you get to deduct contributions, earn interest tax-free, and withdraw money tax-free for medical expenses. Without that deduction, an HSA is just a regular savings account with restrictions.

Age and Medicare may be able to access

There is no minimum age to open an HSA, but you lose may be able to access the moment you enroll in Medicare, even if you're still working. This is the most common reason people lose HSA may be able to access. Once you turn 65, you're automatically enrolled in Medicare Part A (hospital insurance) unless you actively decline it. If you decline, you can keep your HSA, but you cannot make new contributions once you're may be able to access for Medicare, even if you haven't enrolled yet.

If you contributed to an HSA in a month when you were already may be able to access for Medicare, you owe a 6% penalty tax on that contribution, plus income tax on the earnings. The IRS does not waive this penalty easily. The safest move is to stop contributing the month before you turn 65 or the month you enroll in Medicare, whichever comes first.

Dependent coverage and family plans

If you have family coverage through an HSA-may be able to access plan, everyone on that plan can benefit from the account — but only one person can own it. Typically the primary policyholder opens the account, and the family's medical expenses all come out of the same pool of money. You don't need separate accounts for your spouse or children.

If your spouse also has their own health insurance (through an employer or the individual market), they cannot contribute to your family HSA. They would need to open their own HSA if their plan is HSA-may be able to access. The same rule applies if your adult child has separate coverage.

Employment status and self-employed coverage

You do not have to be employed to open an HSA. Self-employed people, freelancers, and gig workers can open one as long as they have an HSA-may be able to access high-deductible plan. If you buy coverage on the individual market, look for plans marked HSA-may be able to access during open enrollment or outside it if you have a may have access to life event.

If you're self-employed and have employees, you can offer an HSA-may be able to access plan as part of your benefits package. Your employees can open their own HSAs independently — you don't manage their accounts. You can contribute to your own HSA even if you also contribute to employees' health insurance premiums.

Medicaid and other government coverage

Having Medicaid disqualifies you from opening or contributing to an HSA in most cases. However, some states have carved out exceptions for specific Medicaid programs. For example, a few states allow people in certain limited Medicaid plans to also hold an HSA. Check with your state's Medicaid agency or your HSA provider if you're unsure.

Veterans using VA health benefits can still open an HSA as long as they also have an HSA-may be able to access health plan. The VA coverage doesn't count as disqualifying coverage. Similarly, if you receive coverage through the Indian Health Service, you may still be able to open an HSA — this is one area where the rules are more flexible.

When you lose and regain may be able to access

If you drop your HSA-may be able to access plan mid-year — because you switched jobs, lost coverage, or enrolled in Medicare — you can still contribute to your HSA for the months you were covered. You cannot contribute for the months after you lost may be able to access. For example, if you were covered January through June and then switched to a non-HSA plan in July, you can only contribute for seven months (January through July, counting the month you lost coverage).

If you regain HSA may be able to access later — say you switch jobs and your new employer offers an HSA-may be able to access plan — you can open a new HSA or reopen an old one. There's no waiting period. You start contributing again for the months you're covered going forward.

Frequently Asked Questions

Can I have an HSA if I'm on my spouse's health plan?

Yes, as long as your spouse's plan is HSA-may be able to access. You both can contribute to the same family HSA. If your spouse has a non-HSA plan through their employer and you're covered under it, you cannot have an HSA. You would need your own HSA-may be able to access coverage.

What happens to my HSA if I lose my job?

Your HSA stays yours. The account is separate from your job. If you lose coverage, you can no longer contribute, but you can keep the money in the account and withdraw it for medical expenses anytime. If you get a new job with an HSA-may be able to access plan, you can resume contributions.

Can I open an HSA if I'm on my parent's plan?

If you're under 26 and covered under your parent's plan through the Affordable Care Act's dependent coverage rule, you cannot open your own HSA unless your parent's plan is HSA-may be able to access. If it is, you would need to be listed as the account owner, not your parent.

Do I lose my HSA when I turn 65?

You lose HSA may be able to access when you enroll in Medicare, which typically happens at 65. You cannot make new contributions after that, but the money already in your account stays there. You can withdraw it for medical expenses tax-free for the rest of your life, or for non-medical expenses (with income tax and a penalty) just like a regular retirement account after age 65.

Can I open an HSA if I'm self-employed?

Yes, if you have an HSA-may be able to access high-deductible plan. You buy the plan on the individual market, and then open an HSA through a bank, credit union, or insurance company. You can deduct your contributions on your tax return as a self-employed person.