Is the HSA plan worth it if you’re healthy?
Usually, yes — but being healthy turns out not to be what decides it. Worked through on one employer’s real 2027 plans, the HSA plan is the cheapest at every level of routine care, and even its worst possible year costs less than the copay plans’ worst. What does decide it is two things the usual advice skips: whether you actually put money into the HSA, and your tax bracket.
The plans
The example uses Emory University’s three plans for 2027, employee-only, because they are a typical menu: a high-deductible plan with a health savings account, a POS plan with copays, and a Kaiser HMO. They are also what the HSA vs. copay calculator opens with, so every figure below is one click from being re-run on your own numbers.
| HSA plan | POS | Kaiser HMO | |
|---|---|---|---|
| Premium, per month | $50 | $85 | $71 |
| Deductible | $1,750 | $850 | none |
| Out-of-pocket maximum | $3,750 | $3,000 | $3,000 |
| Doctor’s visit | full price until the deductible | $15 | $25 |
| Employer HSA deposit | $300 | — | — |
On premiums and deductibles alone, the HSA plan looks like the gamble it is usually described as: cheaper every month, but you pay full price for care until you have spent $1,750. Two things change that picture. The employer puts $300 a year into the account. And whatever you put in yourself comes out of your pay before income tax and before Social Security and Medicare tax. At a 27% combined federal and state rate plus the 7.65% payroll tax, the $4,200 you are allowed to add saves $1,455 in tax. The money itself is still yours: it sits in your account, not with the insurer.
What a year costs at each level of care
Net cost is what the year takes from you: premiums after the tax saved on them, plus what you pay for care, minus the employer’s deposit and the tax saved on your contribution. Money left in the HSA is not a cost. A typical year in the model is three primary-care visits, one specialist, one urgent-care visit, two rounds of labs or imaging and six generic prescriptions — $2,130 of care at the prices the insurer has negotiated.
| Care in the year | HSA plan | POS | Kaiser HMO |
|---|---|---|---|
| None | −$1,363 | $667 | $557 |
| A quarter of typical ($532) | −$831 | $728 | $606 |
| Typical ($2,130) | $425 | $912 | $752 |
| Twice typical ($4,260) | $638 | $1,157 | $947 |
| Four times typical ($8,520) | $1,064 | $1,647 | $1,337 |
| The worst possible year | $2,387 | $3,667 | $3,557 |
A negative figure means the year paid you: the tax saved and the employer’s deposit came to more than the premiums. For a healthy person it is not close — with no care at all, the HSA plan is about $1,900 a year ahead of Kaiser. But it stays ahead all the way down the table, and the last row is the surprise. The HSA plan’s worst year, with the whole maximum paid, still costs about $1,200 less than either copay plan’s worst. On these plans, being healthy is not the condition. Open the one-year comparison.
When the copay plan wins
You don’t put money into the HSA
Most of the HSA plan’s lead is the tax saved on your own contribution. Leave the account with only the employer’s $300, and a typical year costs $1,880 on the HSA plan against $752 on Kaiser. On these plans the HSA plan only comes out ahead in a typical year once you contribute about $3,250 a year — roughly $270 a month. If that money is not there, the HSA plan is a high deductible and not much else. Run it with no contribution.
Your tax rate is low
The same saving shrinks with your bracket. With everything else as above, the HSA plan wins a typical year only when your combined federal and state marginal rate is above about 19%; below that, Kaiser does. The payroll-tax saving comes on top and does not depend on your bracket. In the 22% federal bracket the HSA plan is comfortably ahead. In the 12% bracket the answer depends on your state’s income tax and on how long you stay on the plan: over many years the line falls to about 14%, for the reason in the next section. Run it at a 12% rate.
You know a hospital stay is coming
Kaiser charges $250 for a hospital admission; the HSA plan sends the stay through the deductible and coinsurance until you reach the $3,750 maximum. In a year with typical care plus one hospital stay, Kaiser costs $1,002 and the HSA plan $2,387. Nobody can plan for an emergency, but some stays are known in advance — a scheduled surgery, say — and for that year the copay plan can be the better choice. Run a year with a hospital stay.
Over the years, the gap compounds
An HSA is not a spending account you have to empty each year. It can be invested, it grows untaxed, and money taken out for medical care is untaxed too — at any age, retirement included. That changes the comparison from one year to many.
Run from age 35 to 65 with typical care that rises as you age, the HSA invested at an 8.5% return, and every plan’s household spending the same on health each year — so whatever a cheaper year saves is invested in an ordinary brokerage account — the net cost over thirty years is:
- HSA plan: about $95,000
- Kaiser HMO: about $163,000
- POS: about $198,000
These are future dollars, large because they are thirty years of compounding; the gaps between them are what matter. Three of the scenarios the calculator runs alongside are worth seeing:
- With a quarter of typical care every year, the HSA plan’s net cost is −$159,000: the account ends up worth more than everything spent on health in thirty years, premiums included.
- With the HSA left in cash rather than invested, it becomes the worst of the three, at about $382,000. An HSA that is never invested gives up most of what makes it worth having.
- Paying for care out of pocket and keeping the receipts — which can be reimbursed from the HSA tax-free years later — leaves the whole balance compounding, and brings the HSA plan’s net cost down to about $14,000.
What this leaves out
- Your plans are not these. The premium gap, the employer’s deposit and the deductible differ from employer to employer, and each one moves the answer.
- Cash flow. The HSA plan can mean a $1,750 bill before the insurance pays much, and contributing $4,200 a year means less take-home pay. If a large bill would end up on a credit card, that cost is not in these figures.
- Networks. For many people Kaiser’s closed network is the real trade-off, and it is not a number.
None of this is advice about your own situation. It is what follows from the stated plans and assumptions, and the methodology page sets out exactly how every figure was computed.
Run your own numbers
The HSA vs. copay calculator opens with these plans. Replace them with your employer’s from its benefits guide, set your tax rate and the care you expect, and it shows what each plan costs this year, where the cheapest plan changes hands, and what each leaves you after the years you plan to stay.