Regarding complexities - each HSA administrator handles things differently - checks, debit cards, ACH transfers. Some will do the medical expense bookkeeping for you. (Similar to mutual fund companies keeping track of cost basis for you - pre-2012 - as a service, but not reporting it to the IRS.)
Whatever works best for you. Since I view HSAs as savings vehicles, I don't care about the withdrawal mechanism. I just keep track of all my eligible expenses since I opened the account. At some time in the future I'll withdraw a lump sum. I'll be able to justify the withdrawal with those medical expenses, so long as I keep good records.
Fidelity does offer an HSA account, but only to employer-sponsored plans. I've spoken with them for years about this. They tell me that they've gotten lots of requests, and they keep looking into it. My guess is that these are not especially profitable accounts, so they're not too interested.
- Accounts tend not to be large (limited contributions, people take withdrawals for expenses)
- Servicing costs are high (lots of small withdrawals)
- Regulatory costs are high
Question about Saturna - they mention Archipelago, but don't provide detail. Last time I checked (a couple of years ago?), this was a smaller list of funds (but more "interesting" as I recall), and required a $10K min. Did Archipelago vanish from Saturna?

@ msf said:
If you need to pull money out of a traditional IRA and you're under 59.5, then "laundering" it through the HSA gives you a way to do that (if you've got matching medical expenses). That's the only reason I can see for doing a rollover to an HSA.

For those that may have retired early or are retired and under age 65 with little or no earned income this rollover feature provides a way to fully fund an hsa in the form of a rollover without impacting present income. This perfectly legal rollover might help the newly retired "coupon clipper" who also has to do their own "laundry" and may not have the resources to budget for hsa contributions.
At 59.5 I plan on taking IRA distributions equal to my hsa contributions there by offsetting the taxes on the IRA with an equal hsa tax deductible contribution. I will do this until I am 65. I mention age 65 because that is the age at which one can no longer add to their hsa (because medicare kicks in).
Bottom line, without earned income you can't make Roth contributions. Not true with hsa contributions. hsa contributions are tax deductible even without earned income. In my case these hsa contributions will reduce any other taxable income I have (pension, annuities, SS, interest and dividends) and IRA distributions.

As an additional funding source have you considered a rollover into your hsa?
If you haven't already done so and have a tax deferred IRA you can make a one time rollover from your IRA to you hsa. The amount cannot exceed your maximum allowable hsa contribution. For an individual that would be $4350 for 2015 and a but more if you have a family hsa plan.
Its a nice way to move what would be taxable IRA dollars into tax free hsa. This is not a distribution...its a one time rollover.

Generally, I don't see this as an advantage, assuming you have outside money with which to fund your HSA. It's basically a shell game. You're taking money out of an IRA and thus losing the deduction you could have had by making a regular HSA contribution. So effectively, you are paying taxes on that IRA rollover.
If I'm going to pay taxes when I move money from a traditional IRA to another tax-advantaged account, I'd rather pay the taxes (directly) and move it to a Roth, rather than pay the taxes indirectly (by losing a deduction) and move it to an HSA.
With the Roth, after five years, I can take the money out tax free, no questions asked. With the HSA, questions are asked - what were the medical expenses that this withdrawal is covering?
On the other hand, with the rollover to the HSA, there's no five year waiting period.
If you need to pull money out of a traditional IRA and you're under 59.5, then "laundering" it through the HSA gives you a way to do that (if you've got matching medical expenses). That's the only reason I can see for doing a rollover to an HSA.

Hi, Maurice -- I would definitely check again at Fidelity, since HSAs have become more popular. The issue I had was that the maintenance fees were quite steep, and with a small account, it really ate into my return. That's basically why I switched to Saturna...but sometimes I wish I were with my prior firm, because I could "trade" the Rydex funds daily. I really did well with that strategy in 2011.

Yes, I agree...it can be confusing. I had my HSA at another firm before I moved it to Saturna and it was run very differently. I also manage an HSA for my son at TD Ameritrade...also run differently. Like I said, I have not made any withdrawals, but Saturna said if I needed cash for medical expenses, to just let them know and they would send a check (?!?)...no documentation necessary. I guess they are using the honor system there...my prior firm had an actual debit card.

I have been given a debit card and a bank account has been set up through BNY Mellon. I am having bi-weekly payroll deductions to begin funding the HSA. You have to have a minimum amount in the account before you can branch off into investments for the funds.

Yes, I agree...it can be confusing. I had my HSA at another firm before I moved it to Saturna and it was run very differently. I also manage an HSA for my son at TD Ameritrade...also run differently. Like I said, I have not made any withdrawals, but Saturna said if I needed cash for medical expenses, to just let them know and they would send a check (?!?)...no documentation necessary. I guess they are using the honor system there...my prior firm had an actual debit card.

I'm trying the HSA through my employer for a family this year. It's a little bit confusing to start with, especially if you have prescriptions through mail order, but I'm curious to see how it goes for the year.

As an additional funding source have you considered a rollover into your hsa?
If you haven't already done so and have a tax deferred IRA you can make a one time rollover from your IRA to you hsa. The amount cannot exceed your maximum allowable hsa contribution. For an individual that would be $4350 for 2015 and a but more if you have a family hsa plan.
Its a nice way to move what would be taxable IRA dollars into tax free hsa. This is not a distribution...its a one time rollover.
Article on topic:
rules-for-ira-to-hsa-rollovers
IRA to hsa worksheet:
IRA_to_HSA_Worksheet.pdf

Just reached a certain $$ level. Yes, thankfully, I am healthy and using the HSA as a supercharged savings account for future healthcare expenses. I set up the HSA at Saturna Capital...no maintenance fees there. They have a limited selection of fund families available, so I went with TRP funds, based on MFO recommendations. The downside of Saturna is that you must hold the funds for 180 days, so I have been very careful in my selection and stagger my investments and redemptions accordingly. It is a comparatively small account, so it has been challenging at times.

I just wanted to thank the MFO community....I reached a big milestone in my HSA, thanks to all of you and the T Rowe Price funds you have recommended over the years. It is greatly appreciated!

Hi l5b,
What's the milestone? Hopefully the Health Savings Account finds you healthy, wealthy and wise. Were you able to set an hsa with TRP funds at TRP or through an intermediary?

I just wanted to thank the MFO community....I reached a big milestone in my HSA, thanks to all of you and the T Rowe Price funds you have recommended over the years. It is greatly appreciated!

Ameritrade is a delightful 180 day holding period.... used to be 90.

Depends what kind of account you have with them. 180 days seems "right" for a taxable brokerage account, but their terms are different for IRAs and for HSAs (which seem to be considered IRAs there for most purposes).
For example, here's the fee schedule for a relative's account (90 days):
http://www.tdameritraderetirement.com/forms/ACS1009.pdf

A few more details about medical expenses and taxes (to throw into your personal tax mix):
- The tax laws were changed so that medical expenses are deductible only to the extent that they exceed 10% (formerly 7.5%) of your AGI (Form 1040, line 37). That's net expenses, after ACA subsidies.
- There's a two year exception for people over age 65 (lasting through tax year 2016); for these folks, the floor remains at 7.5%.
- If you use a special tax account (e.g. HSA) to pay for some medical expenses, then you can't use those particular expenses in calculating your medical deduction.
- Insurance premiums (other than Medicare, COBRA, and LTC) can not be paid out of an HSA (so the only place they can be used is in calculating medical itemized deductions).
- A person under age 65 may not pay for their spouse's Medicare premiums out of their own HSA. (You must be over 65 to pay for Medicare premiums from your HSA.)

I agree with Desota - I would be quite surprised if you could get an R-class share outside of an employer-sponsored retirement plan.
When American Funds came out with class F shares (now called F-1), they were available not only through advisors, but through some offbeat discount brokers (e.g. Citicorp Investment Services - doesn't exist any more). Later, when American Funds added F-2 (same as F-1 but w/o 12b-1 fee), they seemed to tighten up on access to the F-1 shares.
Nevertheless, there appear to be a few access points remaining. I don't know how useful any of this will be, but here's what I know about those access points.
Several HSA (Health Savings Accounts) offer access to a limited number of mutual funds (i.e. they have a menu, like an employer's 401(k) plan does). Among these offerings one can often find one or two American Funds (class F-1). For example, here's the fund list from HSA Bank.
Some HSAs offer brokerage options, and these tend to be treated as retirement accounts or institutional accounts, rather than generic retail accounts. As such, they seem to offer greater access to some investments. Many of these HSA accounts use TDAmeritrade as the brokerage partner, and it looks like AMPFX (AMCAP F-1) may be available that way, NTF, despite a search on the brokerage site turning up a page saying the fund is not available for sale there.
Another back door is via a no load VA. What you get there are usually clones of the retail funds, but that's often close enough. You can access the American Funds Insurance Series VA funds through Jefferson National Monument Advisor VA. There isn't a clone for AMCAP, but there is one for Growth Fund of America.
Finally, there's the solution for the high rollers - dump $1M into American Funds, and you can get their A shares without a load. (Though there's a 1% redemption fee if you sell within a year.) If you're investing that much, you're probably not worrying about whether there's a transaction fee.

My portfolio is quite low on small-caps (and mid-caps to a lesser extent), and I'm thinking it's time to invest in a quality small cap fund.
I have a Fidelity 401k account, as well as an HSA. I'll list the HSA funds to help narrow it down a bit.
Delaware Small-cap Value: DEVLX
Schwab Small Cap Stock Index: SWSSX
Janus Triton: JGMAX
Robeco Small Cap Value II: BPSCX
Pimco Small Cap StocksPlus: PCKAX
Royce Dividend Value: RYDVX
Transamerica Small/Mid cap Value: IIVAX
Legg Mason ClearBridge Small Cap Growth: SASMX
Of course I'm leaning towards the Schwab index fund, though the Pimco fund has better returns at the price of a much higher expense ratio. Much of the rest seems to be average performance for higher expenses, but I'm listing them for sake of posterity.
Any suggestions for my HSA (and perhaps what would be a nice NTF for my Fidelity 401k)?

Hi @mcmarasco
You noted: "Does anybody have any thoughts on Blackrock Healthcare (SHSAX) "Load Waived" at FIDO or Vanguard Healthcare (VGHCX) also at FIDO and GOLD rated by M*?
I like the idea a pairing with another fund such as FBIOX, any suggestions or comments?
FIDO shows PRHSX (TROWE) as "closed" to new investors even though it is "open" at TROWE. Any insight or suggestions?"
>>>For broadbased healthcare, I do not find an advantage to holding Vanguard or others when compared to FSPHX. The performance is similar looking backwards. There is and will be variances over other time frames depending on manager actions. As you are already "inside" of Fido with your account, I personally don't find a need to move outside of Fido offerings. I have not checked for overlap; but you could also consider a more directed play towards pharma with FPHAX or directed towards the delivery side of medical services with FSHCX.
With the exception of FBIOX, of which; FSPHX has a chunk of this action, over a 5 year time frame, FSPHX is a most suitable and able performing healthcare fund when compared to all other active managed funds.
We've considered mix and match with the several Fido medical area funds; but have remained with our monies in FSPHX.
Fido also has an etf (can't recall the ticker), either via I-shares or Fido for healthcare.
Lastly, I personally would not invest any less than 5% of a total portfolio in a given sector, in order to provide enough momentum to a portfolio. 'Course 5% can also go against the portfolio, too. :)
As others have also noted; your other equity fund holdings may alread have your portfolio at 5% of total holdings in healthcare. Many broadbased equity funds owe their YTD gains to healthcare holdings. I personally find no problem with adding to this sector, as dedicated holdings.
As always, just suggestions; eh?
Take care,
Catch

Thank you all for some great info, insight and suggestions!!
Does anybody have any thoughts on Blackrock Healthcare (SHSAX) "Load Waived" at FIDO or Vanguard Healthcare (VGHCX) also at FIDO and GOLD rated by M*?
I like the idea a pairing with another fund such as FBIOX, any suggestions or comments?
FIDO shows PRHSX (TROWE) as "closed" to new investors even though it is "open" at TROWE. Any insight or suggestions?
Thanks,
Matt

So, some links below to current ratings on long term top-tier performers. All notable. All struggling this past year...or more.
http://www.mutualfundobserver.com/fund-ratings/?symbol=TCWAX+OAKIX+UMBWX+TIGAX+SHSAX+PRHSX+VCHSX+MHNAX+UNHIX+HABDX+PTTRX+AMANX+YAFFX+BBTEX+FEVAX+FMIHX+GABEX+MPGFX+MVPFX+PIXAX+&submit=Submit
http://www.mutualfundobserver.com/fund-ratings/?symbol=CVGRX+FTQGX+MFCFX+SEQUX+PRGFX+WTEAX+AMRMX+ARDEX+AUXFX+FAIRX+BAEIX+FMIEX+IEF+PMHIX+VBLTX+ADAIX+BCMSX+ACRNX+MERDX+NBGNX+&submit=Submit
http://www.mutualfundobserver.com/fund-ratings/?symbol=RYSEX+ARTQX+DEFIX+FPPTX+PHO+FOBAX+MACSX+PVFAX+RYSEX+PRSVX+WEMMX+VVPSX+CCASX+WAAEX+WSCVX+WSTCX+UNSCX+WGRNX&submit=Submit
Broad category set.
This board especially should recognize a lot of familiar names:
Oakmark International I (OAKIX)
Waddell & Reed High-Income A (UNHIX)
PIMCO Total Return Instl (PTTRX)
AMG Yacktman Focused Service (YAFFX)
BbH Core Select N (BBTEX)
FMI Large Cap (FMIHX)
Mairs & Power Growth Inv (MPGFX)
PIMCO Fundamental IndexPLUS AR A (PIXAX)
The Cook & Bynum Fund (COBYX)
Sequoia (SEQUX)
T. Rowe Price Growth Stock (PRGFX)
American Funds American Mutual A (AMRMX)
ASTON/River Road Dividend All Cap Val N (ARDEX)
Auxier Focus Inv (AUXFX)
Fairholme (FAIRX)
iShares 7-10 Year Treasury Bond (IEF)
AQR Diversified Arbitrage I (ADAIX)
Meridian Growth Legacy (MERDX)
Neuberger Berman Genesis Inv (NBGNX)
Royce Premier Invmt (RYPRX)
Artisan Mid Cap Value Investor (ARTQX)
Delafield Fund (DEFIX)
FpA Capital (FPPTX)
Tributary Balanced Instl (FOBAX)
Matthews Asian Growth & Inc Investor (MACSX)
Royce Special Equity Invmt (RYSEX)
T. Rowe Price Small-Cap Value (PRSVX)
TETON Westwood Mighty Mites AAA (WEMMX)
Vulcan Value Partners Small Cap (VVPSX)
Wasatch Small Cap Growth (WAAEX)
Walthausen Small Cap Value (WSCVX)
Ivy Science & Technology C (WSTCX)
Wintergreen Investor (WGRNX)
SEQUX, arguably greatest mutual fund ever...no longer a Great Owl.
FAIRX, what a difference a decade makes...although, still top quintile across last two full cycles (through September anyway).
Perhaps somehow related to bond yield? IEF or TLH?
Valuations? Defensive funds not buying into current bull market?
Or, just the normal ebb and flow of investing styles across cycles?

I recently open an health svings account with The Bruce Fund. I will add to this hsa for the next 10 years (until age 65). The website leaves a lot to be desired, but I believe my occassional health care related reimbursements won't create too much of a hassle. It would be nice if Bruce accounts could be linked electronically to external bank accounts for dispursement. As mentioned by Mozart325, nice YTD performance.

I hold BRUFX as my singular HSA investment. I now afford my next box of band-aids.