FIRST DOLLAR's EXPERT GUIDE

How To Use Your HSA To Save On Reproductive Healthcare

Let's talk reproductive health

Getting Started

The cost of reproductive health, especially for women and gender-nonconforming folks with a uterus, is far (FAR) from cheap. In fact, it might exceed the price of a Porsche according to this Harvard graduate and healthcare professional.

Pap smears and cancer screenings are just the basics, and a lot of people even shy away from getting those for many reasons, be it the fear of discovering something's wrong or concerns about cost. Recent studies have shown that despite paying more for healthcare than every other developed country, women in the U.S. face higher rates of maternal mortality, more chronic illnesses, and have a higher likelihood of skipping necessary healthcare completely because of cost.

We fully understand that the unknown is scary, and sometimes the idea of not being able to afford the care you need is even scarier. Whether it’s basic check-ups, preventative visits, or healthcare you might be in dire need of, your Health Savings Account (HSA) can be an integral tool for ensuring access to whatever you need for your reproductive health.

HSA Basics

Before we get too deep into this conversation, let's refresh what we know about the powerful tool that is an HSA.

Contribution limits: For 2021, an individual can contribute $3,600 and a family can contribute $7,200! We always recommend maxing these out to the best of your ability to have funds when you need them or to simply decrease your taxable income.

To get your hands on an HSA, you need to be on an High-Deductible Health Plan (HDHP) that supports an HSA. This essentially means that your monthly insurance premiums will be lower, but you have a higher deductible to meet before insurance steps in. Below we've broken down the different insurance plans you'll see out there. These are especially helpful if you're going through Open Enrollment right now, which we also have an ultimate guide for.

Insurance plans and their many acronyms:

  • PPO (Preferred provider organization plans): This is currently still the most popular plan of choice for the masses. Essentially, you pay less money to use providers that are already in the plan’s network. You can access specialists outside of the network without a referral at an additional cost. PPOs monthly premiums vary, but tend to be the most expensive of the options; the average PPO is around $560/month.
  • HMO (Health maintenance organization plans): HMOs allow covered individuals to use any provider within an extended network as long as you’ve chosen a primary care physician (PCP) who coordinates the additional care (e.g. specialists). Generally, this plan won't cover out-of-network unless for emergencies. The average premium for an HMO is around $480/month.
  • EPO (Exclusive provider organization plans): An EPO is a managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network, except in the case of an emergency. Often, EPOs do not provide coverage for services outside of the EPO network, so it’s important to check providers in the network! The average monthly premium for an EPO is about $490.
  • POS (Point-of-service plans): This is basically a combo of the traditional HMO and PPO plan. You’re able to see any provider within a large network and choose a PCP. You are also free to use specialists that might be out of network, but will more than likely pay higher amounts to do so. The average premium for a POS plan is about $510.
  • HDHPs (High-deductible health plans): Well, for obvious reasons, this one is our favorite (HSAs, duh!). HDHPs mean you pay a lower monthly premium but have a higher deductible to reach before insurance steps in. To help offset out-of-pocket costs, qualified HDHPs come with a health savings account (HSA) in which you can put in money tax-free, grow it tax-free through investments, and take out money tax-free to pay for qualified medical expenses! Lots more to come on these bad boys. You can expect to pay about $405/month for your premium. Please note: An HDHP can come in the form of an HMO, PPO, POS or EPO. It simply relies on the deductible to determine its status as an HDHP.

"An HSA is the ideal tool because you contribute pre-federal and most state tax, and funds are used tax free for qualifying healthcare spend. At a 20% tax level, that is significant savings. So for a $100 lab exam,  using after tax money, I would have to earn a wage equal to $125 so that after tax I could take $100 home ($125 minus 20% tax of $25). With an HSA, I use my earned $100 so I'm actually saving $25 in this example for the same treatment."
Everyday Finance Gal
let's go!

So, how much does reproductive care cost across a lifetime?

Great question. For basic needs like pap smears, HPV tests, birth control and menstrual products, that adds up to about $15,000 in a lifetime. But when you throw in out-of-pocket costs for something like pregnancy and childbirth, that could jump up to about $155,000. So depending on what the state of your reproductive organs look like, or your future plans (kids or no kids), you could fall in between these estimates or even exceed the astounding $155,000 cost of having a uterus. With the right planning, your HSA could step in and help out with a lot of these costs.

How to use an HSA to combat the high cost of reproductive healthcare

There are a few strategies we recommend for any phase or hurdle you might be facing. First, let’s talk about why a high-deductible health plan (HDHP) with an HSA could make sense for you in the first place. If you’re young, typically healthy and want to save money, going with an HDHP and HSA is probably a good choice for you. Your monthly premiums are lower and you’re not overpaying for healthcare you may not even use. Additionally, having an HSA provides a whole new savings vehicle that decreases your taxable income. Any money you might have spent on an expensive PPO plan can go straight to the bank, tax-free. No matter what path you choose, your HSA is yours forever, through it all!

There are a few different routes you could go with your HSA

  • Take the costs on yourself. If you’re able to take on the out-of-pocket expenses before insurance steps in, while your HSA sits there and grows, be our guest! Nothing is stopping you from making your HSA a true savings or investing account. You can always keep receipts and be reimbursed later if you’d like. 
  • Pay out of your HSA. You can also fully rely on the savings in your HSA to take on eligible healthcare costs like the ones we’ve mentioned in this article already. Using the HSA exactly as it was intended? We love it. Keep it up.
  • No matter what, please choose healthcare! What we DON’T recommend is choosing no healthcare plan at all based on the cost of it. HDHPs are typically the most affordable option and offer the flexibility of an HSA. Yes, the idea of a “high-deductible” may be scary, but taking on a $7,000 medical bill is a lot better than taking on a $150,000 medical bill. Plus, the option to have an HSA is incredibly helpful!
KEY TO SUCCESS

Plan ahead and understand what reproductive healthcare costs you know you will encounter. Whether you simply need to focus on routine checkups and birth control, or if you see expensive fertility treatments in your future, set savings goals and reach them.

Let's get more specific

Using your HSA for contraception or sterilization

Of the 61 million women in traditional childbearing years (15-44), 62% of them are using some form of contraception, be it pills, condoms, IUDs, etc.

Insurance plans in the Health Insurance Marketplace are required to cover contraceptive methods when prescribed, even if you haven't met your deductible. If you're getting insurance through your employer or elsewhere, chances are contraception is covered, but it never hurts to ask and find out for sure! If you were to go to a place like Planned Parenthood to receive any form of birth control, they should accept your HSA funds as payment. Additionally, more and more direct-to-consumer birth control options are on the market! You can check out some of the options available on First Dollar's Shop feature.

If you're looking for a tubal ligation (getting your "tubes tied) or hysterectomy, there are probably a few more hoops to jump through. For a tubal ligation, you will have to consult the laws wherever you live because they currently vary by state. Most states allow them on a voluntary basis with age limits between 18 and 21. You could expect it to cost anywhere from $1,500 to $6,000 depending on your insurance, and an HSA will absolutely cover it! For a hysterectomy, you will be hard-pressed to find a doctor who will perform a hysterectomy on someone between the ages of 18 and 35 who does not medically need one. Unless it is deemed absolutely necessary by a medical professional with a Letter of Medical Necessity or it's an emergency, getting a hysterectomy by choice will be difficult. They can cost anywhere between $30,000 and $50,000 and many insurances will cover at least some of they bill, and of course, an HSA can help support the cost.

If these procedures are something you see on the horizon, it’s never too early to start putting money in your HSA to help these future costs. Especially because in either case, you could reach your out-of-pocket maximum, meaning your insurance would step in and cover 100% of your medical expenses for the rest of the year after you meet that number. If you have at least that amount in your HSA, there’s no need to worry about other out-of-pocket expenses!

An HSA can stick with you forever

Using your HSA for chronic reproductive conditions

There’s a lot of back and forth about how well HDHPs + HSAs work for folks with chronic illnesses like PCOS, PMDD, endometriosis and more, and at the end of the day, it’s up to the individual. We’re not here to steer you in one direction or another, simply letting you know what we know.

The main argument against HDHPs + HSAs when you have a chronic condition is that you know you’ll be spending a lot of time in doctor’s offices and a lot of money on prescriptions. Right off the bat, you’ll be taking on those out-of-pocket expenses until you meet your deductible. And if you’re spending a lot of your money on those copays and prescriptions, you won’t have much money to put into an HSA. All of the above arguments are totally fair, and if an HDHP with an HSA doesn’t make sense, you don’t have to get one!

If you’re still interested in keeping an HDHP with an HSA for the flexibility of the health savings account, we get it. HSAs are powerful. The best recommendations we can give is to really set your savings goal and work hard to reach them. The faster you’re able to save your out-of-pocket maximum every year, the faster insurance can step in and take on the entirety of your medical expenses. Additionally, if you’re just financially able to cover expenses related to your chronic condition completely out-of-pocket, you can transform your HSA into a powerful savings account and focus on investing or saving for retirement.

Here’s some math to compare the outcomes of a traditional PPO vs. an HDHP with an HSA...

So depending on the goals you’re willing to set for yourself in terms of savings, an HDHP + HSA could actually save you money in the long run.


Pro-tip: Even with insurance, the prescriptions meds copay could be higher than the actual cost. To make sure you’re getting the best price possible, check out prescription discount programs like GoodRx.
Take care of yourself, first

Using your HSA for preventative care

We cannot stress this enough: Cost should not stop anyone from taking charge of their health, especially when it comes to preventative care. Routine check ups and general health maintenance are just as important as going to the doctor when something serious is going on. Fear of the unknown and the cost of healthcare should not bar you from putting your health first, and an HSA can be an integral part in keeping costs down. So how does that work?

Firstly, preventative healthcare for reproductive health looks like pap smears, STI/STD testing, cancer screenings, and wellness check-ups--most of which are recommended every 1-3 years and can all be done at the same time at your OB/GYN. If you have a uterus, cervix and vagina, it is truly the least amount of work to do to ensure your reproductive system is in check. Plus, it’s the best way to catch any problems early and start treatment as soon as a diagnosis is made. As we mentioned earlier, HDHPs + HSAs are great plans for those who are young and generally healthy, and might only go to the doctor’s office a few times a year for check-ups like this. So if you want to use your HSA the traditional way to reduce your out-of-pocket costs, use it to pay for copays, tests and any related prescriptions. Whatever additional money you might save instead of paying for high premiums can be put away or even invested so it will grow further!

"We know heading to the doctor for an annual checkup is recommended for maintaining and ensuring our reproductive health, but we also know that those checkups come with a cost. And that’s where HSAs come in – by putting money into your HSA each month, you can prepare in advance for any costs associated with your annual checkup! By proactively funding your HSA over time, you won’t be left wondering if you’ll have enough money to cover the cost of your next appointment; you’ll already know you have the funds set aside."
—Taylor from ImperfectFinance (@imperfectfinance on Instagram)

Pro tip: Take care of yourself on your time at your own home with First Dollar’s exclusive discount on convenient, at-home lab tests by Everlywell.
Choose your own path

Using your HSA on fertility treatments + alternative routes to parenthood

No matter which path you take to parenthood, it’s going to be expensive. Luckily, a tool like an HSA can be there to support the costs you’ll face. For those fighting against infertility, you might have fertility treatments, or go for in-vitro fertilization, surrogacy or adoption.

Depending on your insurance, treatments may or may not be fully covered. Infertility care is often not included in the “essential benefits” like maternity and newborn care is, so we always recommend double, even triple-checking with your insurance provider to know what costs you will have to take on in the process. For example, in-vitro fertilization (IVF) can cost upwards of $20,000 per cycle, and most folks using IVF will go through at least two cycles to be successful. Egg freezing to use in the future can cost between $10,000 and $12,000, often with an additional yearly storage fee. Depending on the route you’re taking, you could use the same strategy we discussed above: save at least your out-of-pocket maximum in your HSA, so that you can take on those costs tax-free and then let insurance take care of the rest. In the event that your insurance plan dubs fertility treatments as an elective, meaning they don’t cover it (similar to some plastic surgeries), then the cost falls on you. In which case, we still recommend maxing out your HSA as best you can if fertility treatments are in your future.


As for surrogacy, there is less freedom with insurance and HSAs since a few more outside parties are typically involved. You can use your HSA to assist in surrogacy only when you’re covering things for you and your partner, not the surrogate. So the egg retrieval, sperm donation, embryo creation and any related prescription meds are HSA-eligible. However, there are some surrogacy-specific insurance plans you can look into.

welcome in a new life

Using your HSA to plan for a baby

Having a baby is straight-up expensive. With insurance, someone could expect to pay around $4,500 for a traditional vaginal birth. Without insurance, that number surges upwards of $40,000.

Most people would probably immediately tell you to switch to a PPO plan with a low deductible and high premium when you know you’re having a baby. However, the decision is up to you, and an HDHP with an HSA could actually still make more sense. 

One of the largest misconceptions is that an HSA is a "use it or lose it" type of account, and it is NOT! The money you contribute to your HSA will always be yours, year after year.. you never are penalized for not withdrawing or using money from your HSA during a specific duration of time. Another common misconception is individuals simply not realizing ALL of the pre-qualified expenses you can use your HSA money on. Beyond just your medical bills, there are many over the counter baby products that you could potentially purchase with your HSA!
—Malia, Founder of LittleMissFinance

For starters, items like condoms, fertility trackers, ovulation tests, pregnancy tests, fertility treatments, OTC meds, prescriptions and prenatal vitamins are only a short list of HSA-eligible items you might need when planning for a kiddo, some of which aren’t necessarily covered by all insurance plans. There’s some savings right there when you use an HSA.

Now let’s answer the big question: PPO or HDHP with an HSA? Let’s let the numbers speak for themselves.

While the total out-of-pocket costs look higher for the HDHP w/ HSA, factoring in the monthly premiums and the HSA savings, you come out on top. 

Pro tip: If you want to go on a deep dive into planning for a baby with an HDHP + HSA, check out our in-depth ultimate guide.


We'll all get there someday

Using your HSA during menopause

Anyone with a uterus will go through menopause at one point or another, most commonly happening after the age of 45. There’s a slew of symptoms that come along with it, oftentimes uncomfortable and severe enough to affect your quality of life. Luckily, there are plenty of treatments to help out and of course, your HSA is there for you, too!  


Because menopause is hormone-related, one of the treatments includes hormone therapy to counteract the loss of estrogen and progesterone. This treatment is generally covered by insurance, but if your plan doesn’t, you can use your HSA to use tax-free dollars for this out-of-pocket cost. Additionally, for common prescriptions like Estrogel, you can use First Dollar’s pharmacy discount program to save up to 85% on prescribed menopause treatment. In the same vein, doctors will often prescribe antidepressants to help with mood swings and imbalances that come with menopause and you can use the discount program above along with your HSA to save and cover the cost. If you’re looking for over-the-counter options, many are HSA-eligible and can be delivered straight to your door.

Your reproductive health is worth every penny

So what have we learned from this deep dive into reproductive health? It’s unnecessarily expensive for something so necessary to your wellbeing. Luckily there are tools like the HSA and experts like us to guide you through it all so you don’t have it go it alone. No matter what life stage your reproductive health is in, an HSA can help take on the costs that you might not have normally been able to afford. Always remember to ask questions, set goals and plan for the life you truly want, not what you think you have to do based on finances.

THE KEY TO SUCCESS

Understand your needs and plan for them accordingly. Sometimes the route that everyone else is taking isn't the best option for you, and that's okay! Putting your health--financial and physical--first is more important than the status quo.