HSA vs. HMO: What's the Difference? | SoFi (2024)

A health savings account (HSA) and a Health Maintenance Organization (HMO) are both meant to help with medical costs, but there are vast differences between the two. An HSA acts as a personal saving account, where you can set aside tax-free dollars to be used toward out-of-pocket health care expenses. An HMO is typically a low-cost health insurance plan.

It’s tough to directly compare an HSA vs. HMO, as they serve different functions. But understanding how each works, and their pros and cons, can help lower medical costs and keep more money in your wallet. Here, you will learn:

• How an HSA works

• How to set up an HSA

• The pros and cons of an HSA

• How an HMO works

• How to set up an HMO

• The pros and cons of an HMO

• The key differences of an HSA vs. HMO

• How to fund healthcare costs.

What is a Health Savings Account (HSA)?

A health savings account (HSA) allows individuals to put away pre-tax dollars to be used for future medical purposes. These funds can be used for copays, dental and eye care, and a host of other expenses not covered by a healthcare plan.

Here’s the catch: You have to be enrolled in a high-deductible health plan (HDHP). An HDHP is geared to offer you lower monthly health-insurance payments. The downside, however, is that you could get hit with a lot of out-of-pocket expenses before meeting the plan’s high deductible.

That’s where a Health Savings Account (HSA) comes in. The money in your HSA can help bridge the gap between your high deductible and your pocketbook.

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How Does a Health Savings Account Work?

A Health Savings Account works similarly to other kinds of saving accounts. You can transfer funds and pay bills online. You are free to withdraw HSA funds at any time to pay for health costs not covered by your HDHP.

Employers can contribute to your HSA, with direct deposits made straight from payroll. HSA funds can be used for you or any family member covered by your HDHP.

The money in your HSA can remain in the account and roll over every year, accumulating tax-free interest. You can even use your HSA for retirement. After the age of 65, you can start withdrawing from your HSA with no penalty.

There are rules and limits to an HSA. For tax year 2023, the IRS limits contributions to no more than $3,850 for individuals and $7,750 for families with HDHP coverage. Those 55 and older can contribute an additional $1,000 as a catch-up contribution. For 2024, HSA contribution limits are $4,150 for individuals and $8,300 for families. Those 55 and older can contribute an additional $1,000 as a catch-up contribution.

How to Set Up an HSA

Setting up a tax-advantaged HSA is pretty straightforward. If you are self-employed, take the time to compare different HSAs online. Many of them have reasonable fees (or none) and minimal requirements.

If your HSA is offered directly through your employer, that makes the decision easy.

The steps to enroll in an HSA are not unlike opening a bank account. You’ll need proof of a government-issued ID, your Social Security number, and proof of your enrollment in a HDHP.

Once you have set up an HSA, you may be able to opt for regular, automatic deposits straight from your paycheck or your bank account, and start reaping the benefits of using a health savings plan.

Pros of an HSA

A health savings plan provides a range of advantages, including:

• Covering out-of-pocket medical expenses, including dental costs, copays, new eye glasses, and hearing aids. The IRS has a lengthy list of all the goodies you can buy with your tax-free dollars.

• Lowering taxable income. HSA contributions go into your account before taxes, so you could pay less taxes down the line.

• Investing for the future. You can opt to have your HSA money invested in chosen mutual funds once you reach a minimum requirement balance.

• Covering health expenses for your family. HSA benefits anyone who is currently covered by your high-deductible savings plan.

• Rollover contributions. Unused contributions don’t vanish. They roll over into the next year, growing and accumulating tax-free interest.

• Retirement savings. Any unused funds can be used to boost retirement savings. They can be withdrawn after the age of 65, and spent as you please. You can put the money toward a beach vacation or any other purpose.

• Portability. If you move or change jobs, the money is still yours. You don’t have to surrender it.

Cons of an HSA

There are some potential disadvantages to having an HSA, including:

• Penalties for non-qualified expenses. Before the age of 65, the IRS can impose a substantial 20% penalty on monetary amounts spent on unapproved purchases. This money will also be viewed as taxable income.

• Monthly/annual fees. Some health savings accounts may charge a low monthly service fee. Service fees tend to be no more than $5 per month. Some HSAs allow you to invest in mutual funds after your balance reaches a certain amount. If you choose this option, you will probably be charged an annual account management fee.

• Unable to contribute. Budgets can get tight. There are times when you might not be able to regularly contribute money to your HSA.

• Tracking for your taxes. HSA expenditures and contributions must be reported on your tax return. Keeping tabs on those transactions can be tedious.

• Monetary losses. As with an IRA or 401(k), if you choose to invest your HSA money in mutual funds, your balance can experience gains and losses as the market fluctuates. These investments are not FDIC-insured like bank accounts are.

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What is a Health Maintenance Organization (HMO)?

A Health Maintenance Organization (HMO) is a type of health insurance plan. An HMO tends to offer lower monthly or annual premiums and a specific pool of doctors. If you stay within their network of healthcare providers, you may have lower out-of-pocket costs and, unlike with a HDHP, a lower deductible or even no deductible at all.

How Does a Health Maintenance Organization Work?

A health maintenance organization (HMO) plan consists of a group of insurance providers who have contracted certain doctors and hospitals to work with them. These medical professionals and facilities agree on a payment rate for their services, which can translate into reduced costs for you.

As long as you use the doctors in the HMO network, you are eligible for medical services that cost less. HMOs typically require a referral from an in-network primary care physician in order to receive low-cost services from specialists, such as an oncologist or gynecologist.

Many health insurance companies offer HMO plans as a coverage option. An individual can choose the HMO plan and go through the steps of enrollment, either on paper or via an online form. The process includes selecting your primary care physician.

Pros of an HMO

The advantages of enrolling in an HMO plan can include:

• Lower monthly premiums versus other insurance plans.

• Lower out-of-pocket expenses when you see your GP or specialists, have tests done, and access other kinds of medical care.

• Lower prescription costs for your medications.

• Fewer medical claims, as the paperwork is filed in-network.

• Appointing a primary care doctor, whose office may coordinate and advocate for your various medical services.

Cons of an HMO

There are disadvantages of having an HMO, including:

• Limited access to doctors and facilities. You must stay within their network of providers or risk paying out-of-pocket, except in the case of certain emergencies.

• A new primary care doctor. If your current doctor isn’t in the HMO’s network, you’ll have to find a new primary care physician. For some people, this may be a difficult switch to make.

• Referral requirements. To see a specialist and have your HMO pay for those services, you’ll need referrals; you can’t just look up a specialist and see them.

• Strict definitions. There are times when you must very specifically meet requirements to have medical services paid for. This can be important to know during emergencies and other medical situations.

Can You Have Both an HMO and HSA?

Yes. There is no real rivalry happening with HMOs vs. HSAs, as they are so different. But if you are wondering if you can have an HSA with an HMO, here’s what you need to know. You can use an HSA with an HMO, as long as the HMO qualifies as a high-deductible health plan (HDHP). Since HMOs are often low cost healthcare plans, an HMO may not qualify as an HDHP. Check with your particular plan to see.

Key Differences Between an HMO vs HSA

• An HSA acts like a savings account, an HMO is a health plan offering savings through lower-cost healthcare options.

• An HSA does not offer a network of doctors, but can offer investment opportunities and help you save for retirement.

Recommended: How to Save for Retirement

Ways to Fund Healthcare Costs

Besides enrolling in a low-cost HMO, or opening an HSA, there are other ways to save money and pay for medical expenses.

Flexible Spending Account

A flexible spending account (FSA) acts very much like an HSA. It is similar to a savings account, and can be used for medical expenses and saving for retirement.

An FSA, however, can only be obtained through an employer. Self-employed people cannot have an FSA.

Money Market Account

A money market account works like a traditional checking or savings account. You could use the money for healthcare costs, or any other purchases. Money market accounts can offer a higher interest rate than other saving accounts, but there may be a higher minimum account balance required and more costly fees.

Savings Account

A traditional savings account can be set up with a bank or a credit union. Funds in a savings account can be spent on anything. But savings accounts may offer lower interest rates than other types of saving options. However, high-yield savings accounts may help close that gap somewhat.

The Takeaway

Enrolling in a health savings plan (HSA) or a health maintenance organization plan (HMO) provides different advantages, with the same goal in mind: saving you money on healthcare costs. Enrolling in one (or both) can bring a sense of security for you and your family and help you hold onto more of your hard-earned cash.

Interested in opening an online bank account? When you sign up for a SoFi Checking and Savings account with direct deposit, you’ll get a competitive annual percentage yield (APY), pay zero account fees, and enjoy an array of rewards, such as access to the Allpoint Network of 55,000+ fee-free ATMs globally. Qualifying accounts can even access their paycheck up to two days early.

FAQ

Is an HSA better than an HMO?

An HSA isn’t better; it’s just different. An HSA is a kind of savings account for people enrolled in a high-deductible healthcare plan and is used to pay for medical costs. An HMO is a low-cost health insurance plan that gives you access to a specific network of healthcare professionals.

What happens to an HSA if you switch to an HMO?

You can keep and use an HSA with any type of health plan, as long as it qualifies as a high-deductible health plan (HDHP). If not, you can keep and access the money in the HSA, but you can no longer contribute to it.

What happens to my HSA if I cancel my insurance?

You can continue to use the money in the HSA account, but can no longer contribute to it until you’re enrolled in another HDHP.

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