Why HSAs matter: How HSAs can help support employees through disabilities, caregiving and aging

Health Savings Accounts (HSAs) have traditionally been positioned as a triple-tax-advantaged way to help employees manage out-of-pocket medical expenses. Contributions can be made on a pre-tax basis through payroll deduction, used tax-free for qualified medical expenses and any growth is tax-free. Yet even as more employers offer high-deductible health plans and HSA adoption continues to grow, many employees may not understand or fully utilize these accounts.

Notably, employees with disabilities, caregivers and those working past traditional retirement age may benefit from understanding that an HSA can be approached as more than a tax-advantaged account. It can serve as a flexible budgeting tool to help them pay for eligible healthcare costs today while also planning for longer-term needs, including those in retirement.

For caregivers and employees with disabilities: A critical planning tool 

Caregiving — whether for a child with a disability, an aging parent or a partner — may come with hidden and cumulative costs. New research conducted by Voya to mark the 10 year anniversary of Voya Cares® — its program committed to making a positive difference in the lives of people with disabilities, who are aging and their caregivers — finds that their monthly caregiving expenses in 2026 average $997.¹

At the same time, individuals with disabilities also face increased day-to-day expenses: $1 out of every $5 spent goes toward disability-related expenses.²

An HSA account holder can use funds in their account to:

• Cover day-to-day qualified medical expenses for themselves or their dependents
• Manage the cost of their or their dependents’ co-pays, prescriptions and ongoing treatments
• Help plan ahead for their own future healthcare and caregiving needs

For aging employees: A bridge to retirement and planning for future care

For employees approaching or working beyond traditional retirement age, HSAs can provide both a near-term resource for eligible healthcare expenses and a long-term planning tool for future healthcare needs.

In the near term, they provide a flexible, tax-advantaged resource from which to pay for their own qualified medical expenses. At the same time, because contributed funds can be saved and can grow tax-free over time* with no “use-it-or-lose-it” requirement, individuals may be better able to build a dedicated balance for future healthcare needs.

As they transition into Medicare, these dollars can continue to be used for qualified expenses, including premiums,** deductibles and other out-of-pocket costs.

Importantly, HSAs also support a more informed and proactive approach to aging. For individuals who are currently caregivers for aging parents, the experience can reinforce the importance of planning ahead for their own care. HSAs can help fund future needs such as long-term care services, home health support or age-related medical expenses.

* HSAs can also be used to invest funds once the account balance reaches a certain threshold. As with any investment, there are risks; so employees or accountholders should make sure to fully explore those risks before choosing to invest their balance. 
**HSA funds can be used towards premiums for Medicare parts A, B, C and D but not for Medigap or Medicare supplemental insurance.

How HSAs work in real life

To fully understand the value of an HSA, it may be helpful to see examples of how an HSA can be used by employees who are also in the disabilities community and may be managing challenging responsibilities.

These are provided as examples only. Actual results may vary. 

Scenario 1: A parent navigating ongoing care for a child with a disability

Maria is a working parent raising a child with autism. Her family’s healthcare needs include multiple hours per week of Applied Behavioral Analysis therapy sessions, prescriptions for co-occurring conditions like anxiety, seizures and a sleep disorder and regular specialist visits.

With an HSA, Maria:

• Uses pre-tax dollars to fund her account and cover the immediate out of pocket eligible expenses of co-pays and therapy services, helping her to save for medical expenses while also reducing her taxable income
• Budgets ahead for longer-term recurring care costs
• Avoids dipping into emergency and retirement savings when unexpected needs arise, to help safeguard her future planning

Recently, Maria’s child experienced an unexpected emergency room visit for an episode of severe anxiety, and she was able to pay for the expenses out of her HSA, helping keep her financial and retirement plans on track.

For Maria, the HSA isn’t just about tax savings; it’s about having a meaningful resource she is able to manage in a way that works for her in an otherwise unpredictable care journey.

Scenario 2: An employee managing their own chronic condition

James lives with a mobility-related disability that requires medications, including regular infusion treatments, assistive equipment, periodic physical therapy and specialized medical supplies, such as leg braces.

With the funds he contributes to his HSA, James is able to:

• Pay for mobility equipment, aids and related supplies, as they are needed
• Cover ongoing and potentially increasing therapies that support his independence
• Set aside funds over time for future care needs

In addition to medical equipment, infusion therapy and physician-recommended treatments, home modification expenses can be eligible under an HSA, allowing him to use funds from his account to widen doorways and add ramps to his home in support of his mobility and safety*.

Because HSA funds roll over year-after-year, James also has the opportunity to build an account balance that reflects the long-term nature and potential needs of his healthcare situation.

*A Letter of Medical Necessity may be needed for home modifications and other provisions may apply. See IRS Publications 502 and 969 for additional information on qualifying expenses. 

Scenario 3: Working past retirement while caring for an aging parent

Anita is balancing her full-time job with caring for her two young adult children and her aging mother, who requires frequent doctor visits, several medications and occasional medical transportation.

Although she cannot use the funds in her HSA to pay for her mother’s medical expenses — her mother is not her dependent — she can learn from her experiences in caring for her. She plans to prepare now for the care she may need when she gets older, so that her children will not need to do so.

Her HSA can serve as both an account to help cover her current medical expenses, and as an account through which she can save for her future needs.

Today, her HSA allows her to:

• Cover out of pocket monthly prescription costs to manage chronic conditions associated with aging, such as high blood pressure and cholesterol
• Pay deductibles, copays or coinsurance costs

As a resource for future expenses, her HSA offers the opportunity to contribute and save funds to be able to:

• Pay for eligible Medicare premiums, deductibles and out-of-pocket costs 
• Use for long-term care needs, such as home health support or assisted living
• Be prepared for major health events in the years ahead, like surgery or extended rehabilitation

Why HSAs were valuable in these examples

Overall, HSAs assist Maria, James and Anita with costly and sometimes unpredictable eligible healthcare expenses. Across each of these scenarios, a few themes emerge:

1. Flexibility for unpredictable needs
   Healthcare needs tied to disabilities, aging or caregiving can change quickly. As long as they are in the account, HSA funds can be used as eligible expenses arise, without restrictive timelines.
2. Financial planning 
   Funds in an HSA can help cover ongoing eligible expenses, offering some predictability and the ability to budget. And by using pre-tax dollars, employees can stretch their income further and have an opportunity to consider and manage ongoing or unexpected expenses.
3. Long-term opportunities
   Unlike “use-it-or-lose-it” accounts, funds in an HSA roll over indefinitely and can even be invested once they reach a designated threshold, offering an opportunity to support future healthcare needs even into retirement.

Why employees may wish to pay attention

From a benefits perspective, HSAs are more than a cost-management tool; they are a powerful way to support inclusion and equity.

For eligible employees who are aging, have disabilities and/or are caregivers, HSAs offer employers a meaningful opportunity to:

• Support employee financial resilience
• Increase employee confidence in managing healthcare needs
• Demonstrate a more inclusive benefits approach by recognizing real-life challenges employees may face outside of work

As healthcare needs continue to evolve for employees, especially those with disabilities, caregivers and those working later in life, HSAs may offer a useful way to help manage qualified medical expenses today — and in the future. With clear education and support, employers can help all employees better understand how HSAs can fit into their broader healthcare and financial planning decisions.

Citations

¹ Voya Cares survey conducted between Feb. 3-17, 2026, among 666 employees, featuring n=224 gen pop employees, n=239 employees who are caregivers, and n=231 employees with disabilities, as well as n=306 employers.

² Brown, Amir. “National Study Finds an Even Tougher Financial Picture for the Disabled.” AbleNews, The Viscardi Center. Feb. 1, 2026.