General Questions

What is a Health Savings Account (HSA)?

An HSA is an individual account designed to work together with an HSA-eligible high deductible health plan (HDHP). HSA contributions are pre-tax when contributed via payroll deduction, and you can use your HSA money to pay for qualified medical (including prescription, dental and vision) expenses for you, your spouse and your qualified dependents.

For more information on what qualifies, learn more on the IRS website.

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Why should I use an HSA?

With an HSA you get a triple-tax advantage¹ to help you save money. All your HSA contributions are tax-free, when contributed directly through payroll deductions. And if you invest a portion of or all of your HSA funds, your investments grow tax-free, and withdrawals for qualified medical expenses are not taxed either.

At age 65, your HSA can be used for things other than qualified medical expenses penalty-free; however, you would be required to pay taxes on that money. In addition, you can use HSA funds to pay for Medicare premiums once you are enrolled.

Learn more about the benefits of an HSA here.

How can I become eligible to use an HSA?

In order to be eligible to contribute to an HSA, you must be covered under a high deductible health plan. If married, a spouse (if eligible) may also contribute to their own HSA through their own employer, but your combined contribution amounts cannot exceed the annual contribution limit.

Please Note: You can no longer contribute or receive employer funding to an HSA once you are enrolled in any part of Medicare; however, you can still utilize the funds you have saved. You can also designate a beneficiary for your HSA and as long as your beneficiary utilizes the funds for qualified medical expenses, they will not pay taxes on those funds.

Can I change my contribution amount or view my account balance?

Yes. Contribution changes can be completed at any time throughout the year at Duke@work. You can view your balance anytime through Fidelity NetBenefits^®. Your balance is listed under “Health Savings Account” on the NetBenefits^® homepage. 

How can I maximize my HSA?

You can make the most of your HSA by contributing up to the annual IRS limits. For 2026, a person with individual health coverage can contribute up to $4,400 or someone with a family plan can contribute up to $8,750 in an HSA. If you are 55 or older, the IRS allows participants to contribute an additional $1,000, so your limits would be $5,400 for individual coverage or $9,750 for family coverage.

Please Note: The employer contributions count towards the IRS limits.

Can I invest my HSA?

You can choose to invest some or all your HSA money for potential growth to help pay for qualified medical expenses in retirement. If it grows, that growth is also tax-free.

Learn more about your HSA investment options here.

If I don’t use my HSA, do I lose the money?

No. What you don’t spend from your HSA each year carries over from year to year and can be used in retirement.

Investment Options

What happens to the money that is contributed to my HSA? 

Contributions without an investment election on file are placed in the Fidelity^® Government Cash Reserves account to help you grow your money. This default position is available for you to withdraw and use to cover your medical expenses. Click here for more information about this money market. You can also request your funds to default into Fidelity's FDIC Insured Deposit Sweep Program.⁵ More information about this program is avilable here. If you need help or have additional questions, you can call a Fidelity HSA service specialist at 800-343-0860.

You could lose money by investing in a money market fund. Although the fund seeks to preserve the value of your investment at $1.00 per share, it cannot guarantee it will do so. An investment in the fund is not a bank account and is not insured or guaranteed by the Federal Deposit Insurance Corporation or any other government agency. Fidelity Investments and its affiliates, the fund’s sponsor, is not required to reimburse the fund for losses, and you should not expect that the sponsor will provide financial support to the fund at any time, including during periods of market stress.

Fidelity's government and U.S. Treasury money market funds will not impose a fee upon the sale of your shares.

Can I invest in my Fidelity HSA?

You may choose to invest your HSA balance in a number of investment options. However, it is suggested that you keep enough cash available to cover any eligible medical expenses. If all of the account funds are invested, there would be no funds available for withdrawal or debit card payments, and some liquidation of assets would be needed.

How much do I need in my Fidelity HSA before I can invest?

There is no minimum balance required to start investing your Fidelity HSA money. However, certain mutual funds may have minimum investment requirements.

Changing Employers or Retiring

What happens to my HSA if I change employers or retire?

The funds in your HSA are yours to keep forever, even if you leave the company or retire.

What happens to my HSA when I turn 65 and want to enroll in medicare?

You and your employer will need to end your HSA contributions up to 6 months before enrolling in Medicare. Click here to read more about navigating an HSA once you are Medicare eligible.