HSA & Health · Day 3 of the series · 6 min read · Man Nguyen, CPA · Nov 26, 2025

Day 3: HSA, diet, and exercise

The best health insurance isn't Blue Cross. It's a pair of running shoes. Here is how to handle the rest.

I want to start Day 3 with a reality check that most CPAs won't tell you. The best tax strategy for healthcare isn't an HSA. It isn't a deduction. It's diet and exercise.

If you want to save money, stay out of the hospital. The healthcare system is designed to extract wealth from sick people. The most profitable thing you can do for your portfolio is to do some pushups and eat real food.

But for the unavoidable stuff, like broken arms, weird rashes, or preventative scans, you need a financial strategy that doesn't bleed you dry.

Most people get this wrong. They treat health insurance like a prepayment plan. They want a low deductible so they can use it for a $150 sinus infection visit. That is a trap. Here is the mindset shift you need to make.

1. It's catastrophe insurance

I view my High Deductible Health Plan (HDHP) as catastrophe insurance. I don't want insurance for a check-up. I want insurance for a car accident or cancer. For everything else, I am the insurer.

By taking the high deductible, you lower your monthly premiums. You take the savings, put them into your HSA, and you invest them. You are betting on your own health. If you take care of yourself, you keep the profit. If you pay Blue Cross a high premium for a low deductible, they keep the profit.

2. The "cash price" hack (the secret menu)

This is the single most effective tactic for saving money on medical care, and almost nobody does it. Medical providers have two prices:

• The insurance price: Inflated to cover the nightmare of coding, billing, and fighting with claims adjusters.
• The cash price: The "I'll pay you right now" price.

Warning, the Kaiser problem: This strategy requires an open ecosystem. It does not work well with closed systems like Kaiser Permanente. In those systems, you are a number, and pricing is a black box. They often won't tell you the cost until the bill arrives weeks later.

I actually prefer going to an out-of-network primary care doctor who runs a Direct Primary Care (DPC) model. I know exactly what I am paying, usually around $100 a visit, and the service is better. I pay cash, save the receipt, and move on.

3. The "shoebox" strategy

Now that you are paying cash for these lower rates, what do you do with the HSA money? You don't touch it. The HSA is the only account in the US tax code with a triple tax advantage:

• Tax-free in (deduction).
• Tax-free growth (invested in the S&P 500).
• Tax-free out (for medical bills).

There is no deadline to reimburse yourself from an HSA. You can have a medical expense in 2025 and pay yourself back in 2045.

• Step 1: Pay the $350 MRI bill with your personal credit card.
• Step 2: Store the receipt digitally.
• Step 3: Let the $350 sit in your HSA, invested.

The math: in 20 years, that $350 has grown to $1,300. You pull out your original $350 tax-free, and you have $950 of pure profit remaining.

4. The "lazy" way to handle receipts

I know what you are thinking. "I'm not going to scan receipts every time I buy generic Tylenol." Neither do I. Here is the batch-processing workflow:

• Doctors: In January, email the front desk and say, "Please send me a PDF of my patient ledger for the full prior year." One document, every expense. Done.
• Pharmacies: Log into your CVS, Walgreens, or Costco account online. Go to order history or the FSA/HSA section and export the annual summary.
• Storage: Drop those PDFs into a Google Drive folder named "2026 HSA Receipts."

The 2025 limits (fill the bucket)

Since we are closing out the year, check your numbers. You have until April 15, 2027, to fund for 2026. If your employer contributes to your account, that counts toward these limits.

The action plan

• Prioritize health: Go for a run. Eat an apple. It's the highest ROI activity you have.
• Negotiate: Next time you need a scan or procedure, ask for the cash price.
• Invest: Log into your HSA. Make sure your balance is invested in index funds, not sitting in cash earning 0%.