Can I buy health insurance through the exchange that’s compatible with an HSA?

Depending on your income, you might be eligible for premium tax credits (subsidies) that make the premiums more affordable. Most enrollees are subsidy-eligible,¹ and the subsidies are temporarily larger and more widely available due the American Rescue Plan and Inflation Reduction Act. It's also important to note that contributions to your HSA will reduce your ACA-specific modified adjusted gross income, which could result in a larger premium subsidy.

The Affordable Care Act's open enrollment period (OEP) – from November 1 through January 15 in most states – is your chance to secure health coverage. You can also enroll outside of that window if you qualify for a special enrollment period.

Your goal in choosing a health insurance plan likely involves keeping your total costs as minimal as possible, while ensuring you have access to the services and providers you need.

And when you run the numbers on what each health plan will cost you, you're apt to focus on two main factors: premiums and out-of-pocket costs. But remember, there's a less obvious form of healthcare savings you might reap, depending on the plan you choose, and it's the tax savings associated with a health savings account (HSA).

Read one couple's story of how they ended up selecting an HSA-qualified health plan after transitioning away from a more robust employer-sponsored plan.

How to find an HDHP

HDHPs are available through the Affordable Care Act's marketplaces in almost all areas of the country, and can be found at the Bronze, Silver, and Gold levels. The higher the metal level your plan falls under, the more the plan covers enrollees' average healthcare costs, and the less the enrollees pay (based on average costs for a standard population, as opposed to each individual's costs):

*These percentages are calculated across a standard population, and are not representative of what each individual will pay, since that will depend on the person's utilization of medical services throughout the year.

Your premium costs will generally rise as you go from level to level, so that a Silver plan charges a higher premium than a Bronze plan, and a Gold plan charges a higher premium than a Silver plan (but that's not always the case, now that the cost of cost-sharing reductions is being added to silver plan rates; Gold plans in some areas are less expensive than Silver plans). But since premiums and deductibles tend to have an inverse relationship, the higher your premiums, the lower your deductibles. It’s for this reason that HDHPs are more commonly found at the Bronze and Silver levels.

When you explore your plan options through HealthCare.gov or the state-run exchange/Marketplace in your state, each listing will indicate whether the coverage is HSA-eligible. Keep in mind that some plans with higher deductibles won't qualify as an HDHP because their out-of-pocket maximums exceed the aforementioned thresholds, or because they cover part of the cost of non-preventive services before the minimum deductible is met (for example, they offer copays for office visits, instead of requiring the member to pay the full network-negotiated cost of office visits until the deductible is met).

Learn why catastrophic health plans are not HSA-qualified.

Is an HDHP right for you?

To give you a sense of what an HDHP might cost you, consider this:

In 2024, a family of three (two adults in their mid-40s plus one 10-year-old dependent) in Chicago with an income of $100,000 (ie, above 400% of the poverty level so normally not eligible for premium subsidies, but eligible for a subsidy of $444/month in 2024 due to the American Rescue Plan) could purchase a Bronze-level HDHP at a monthly premium of $588 (after the subsidy is applied), with the deductible of $6,700 and out-of-pocket maximum of $8,050 (both double that amount for the family).

Meanwhile, a Gold plan (non-HDHP) with a monthly premium of $798 (after the subsidy is applied) comes with an annual deductible of $3,000 for the whole family, $30 primary care copays and $60 specialist copays, and a total family out-of-pocket cap of $17,400 for the year. The higher-cost Gold plan includes more robust coverage (unless the family has significant medical needs that cause them to meet the out-of-pocket maximum; in that case, the HDHP would provide more robust coverage, as it would cap their costs at $16,100). But the family would not be eligible to contribute to an HSA with this plan, and would spend about $210 in additional premiums each month.

It's also important to note that HSA contributions will reduce your ACA-specific modified adjusted gross income, which means that your premium subsidy could be larger if you enroll in an HDHP and fund an HSA, versus if you can't or don't fund an HSA.

There are trade-offs on both ends of the spectrum, and no single solution works for everyone. And even if you're set on an HSA-qualified plan, you'll want to be sure to compare other plan features and costs (like the scope of your provider network and prescription formulary) to land on the right decision.

HDHPs can be a smart choice because they open the door to HSA contributions, which can defray or, in some cases, completely cover the costs of the deductibles you then face (assuming you're willing and able to contribute to your HSA). As you weigh your health plan options during open enrollment — or during a special enrollment period if you have a qualifying event — you may find that it pays to switch to an HDHP to capitalize on the tax savings HSAs offer.