The Health Savings Account (HSA) is absolutely still around and, in many ways, became more important after the Affordable Care Act (ACA/Obamacare).

Here is the breakdown of what is still available to self-employed people today:

1. Health Savings Accounts (HSAs)These are the closest equivalent to the "medical savings account" you remember.

Status: Still very much active.

How they work: You must have a High-Deductible Health Plan (HDHP). You contribute pre-tax dollars to the HSA, which can be used to pay for medical expenses (doctors, prescriptions, etc.) tax-free.

Post-ACA: The ACA did not eliminate HSAs. In fact, many self-employed people use them to offset the higher premiums or deductibles that sometimes come with ACA marketplace plans. Contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free.

2. Self-Employed Health Insurance Deduction Status: Still active.

How it works: This allows self-employed individuals to deduct 100% of their health insurance premiums from their taxable income. This was expanded under the ACA and remains a key benefit for self-employed people today.

3. Flexible Spending Accounts (FSAs)Status: Still active, but with changes.

How they work: These are employer-sponsored accounts (not available directly to self-employed individuals unless they set up a solo 401(k) with an FSA feature).

Post-ACA: The ACA introduced the carryover or grace period option, allowing up to $610 (for 2024) to roll over into the next year instead of "use-it-or-lose-it."

Key Changes After the ACA:No pre-existing condition exclusions: Insurers cannot deny coverage or charge more due to pre-existing conditions, making HSAs safer to use since you’re guaranteed coverage.

Tax credits: The ACA introduced premium tax credits to help lower-income individuals and small business employees afford marketplace plans, which can be combined with HSA contributions if you have an HDHP.

Summary Yes, the mechanism you’re thinking of—HSAs—is still widely used. The ACA actually strengthened the safety net around health insurance, but HSAs remain a powerful tool for self-employed people to save for medical costs on a tax-advantaged basis.

Would you like help comparing HSA eligibility requirements or how to set one up as a self-employed individual?

   If I had 10 employees, would it be better for them to have a $10,000 deductible health plan, plus an employer paying them $10,000 into their medical savings account. I am thinking that after a few years they will have so much money saved up

  This is a sophisticated strategy that blends a High-Deductible Health Plan (HDHP) with a Health Savings Account (HSA) funded by the employer. While it sounds attractive for building long-term wealth, there are significant legal, administrative, and competitive hurdles you need to consider before implementing this for 10 employees.

Here’s a breakdown of the pros, cons, and critical rules:

 The Potential Benefits Triple Tax Advantage for Employees:

Pre-tax contributions: Your $10,000 contribution is deductible for your business and not counted as taxable income for employees (avoiding income tax and FICA taxes).

Tax-free growth: The money in the HSA grows tax-free (if invested).

Tax-free withdrawals: Withdrawals for qualified medical expenses are tax-free.

After age 65: Withdrawals for any reason are penalty-free (though non-medical withdrawals are taxed as income). This effectively turns the HSA into a supplemental retirement account.

 Lower Premiums: HDHPs have much lower monthly premiums than PPO or HMO plans. The savings on premiums might partially offset the high deductible.

 Employee Retention & Recruitment: Offering a large HSA contribution can be a powerful recruiting tool, especially if you position it as a "health wealth" benefit.

  The Critical Legal & Compliance Risks1. Nondiscrimination Rules (The Biggest Hurdle)

Rule: HSAs are subject to nondiscrimination testing under IRC Section 105(h). This means you cannot favor Highly Compensated Employees (HCEs).

Problem: If you offer a larger HSA contribution to yourself or any HCEs, and the benefit disproportionately favors them, the entire HSA benefit can become taxable to the HCEs.

Solution: You must offer the same contribution structure to all eligible employees. If you contribute $10,000 to each employee, you must do it for everyone who is eligible. You cannot pick and choose.

2. Affordable Care Act (ACA) Compliance

Rule: With 10 employees, you are likely considered an "applicable large employer" (ALE) if you have 50+ full-time equivalents, but with 10, you’re small. However, you must ensure the HDHP is ACA-compliant (covers preventive services without cost-sharing).

Problem: If the plan is not "minimum essential coverage," employees could face penalties (though the federal penalty is $0, some states have their own).

3. Administrative Burden

Reporting: You must report HSA contributions on employees’ W-2s (Box 12, Code W).

Fiduciary Responsibility: As the employer, you are a fiduciary for the HSA plan. You must ensure the HSA provider is reputable, fees are reasonable, and the plan is properly administered.

Recordkeeping: You need to track contributions, distributions, and ensure distributions are for qualified medical expenses to avoid penalties.

The "After a Few Years" Scenario: What Actually Happens?Let’s assume an employee contributes $10,000/year from you for 3 years:

Year 1: $10,000 contributed.

Year 2: $10,000 contributed + investment growth (e.g., 5% = $500).

Year 3: $10,000 contributed + growth on $20,500 (e.g., 5% = $1,025).

Total after 3 years: ~$31,525 (plus any additional growth).

Key Point: The employee can keep the HSA even if they leave your company. The account is theirs, not yours. This is a powerful retention tool.

 Major Drawbacks & Risks for Employees High Out-of-Pocket Risk:

A $10,000 deductible means the employee pays 100% of medical costs (except preventive care) until they hit $10,000.

Scenario: If an employee has a car accident, sudden illness, or needs surgery, they could face a $10,000+ bill before insurance kicks in. Can they afford that? Do they have emergency savings?

Warning: This is not "savings" until they pay the deductible. If they can’t pay it, they may delay care, leading to worse health outcomes and higher costs later.

 Cash Flow Issues:

The $10,000 goes into the HSA, but the employee still needs to pay doctors/hospitals upfront. They must front the cash and then get reimbursed from the HSA. This can be stressful for lower-income employees.

 Investment Risk:

If the HSA funds are invested in the market and the market drops, the account value decreases. However, HSAs are generally stable over the long term.

 Comparison: Is It "Better"? Factor HSA + HDHP Strategy Traditional PPO/HMO Premiums Low High Deductible High ($$10,000)Low ($$1,000–$3,000)Tax Benefits Triple (Pre-tax, Tax-free growth, Tax-free withdrawals)Pre-tax premiums only Portability Employee owns account Lost if job changes Risk High out-of-pocket costs Lower out-of-pocket costs Admin Complexity High (Nondiscrimination, Reporting)Low

Recommendation This strategy can work well if:

Your employees are relatively healthy and financially stable enough to handle a $10,000 deductible.

You are willing to contribute the same amount to all eligible employees (including yourself, if applicable) to pass nondiscrimination tests.

You provide financial education to help employees understand how to use the HSA effectively.

You partner with a reputable HSA provider that offers investment options and low fees.

It is a bad idea if:

Your employees are lower-income and cannot afford a $10,000 deductible in an emergency.

You want to favor yourself or a few key employees (nondiscrimination rules will bite you).

You lack the administrative bandwidth to handle the compliance requirements.

 Alternative Suggestion Consider a Hybrid Approach:

Offer an HDHP with a lower deductible (e.g., $3,000–$5,000) to reduce risk.

Contribute a smaller but meaningful amount to the HSA (e.g., $2,000–$5,000/year).

This still provides tax advantages and portability but reduces the financial shock for employees.

 Next Steps Consult a CPA or Benefits Advisor: Nondiscrimination rules are complex. A professional can help you structure the plan to comply.

Survey Your Employees: Ask if they would feel comfortable with a $10,000 deductible. Gauge their financial readiness.

Compare Total Costs: Calculate the total cost (premiums + your HSA contributions) vs. a traditional plan. Sometimes the total cost is similar, but the tax benefits make the HSA route more valuable for employees who don’t need frequent care.

Would you like help drafting a survey for your employees or comparing specific HSA providers?

Here is a draft for your forum post, structured to be engaging and clear. I’ve organized your points into a logical flow that highlights the synergy between the HSA strategy and your preventative health routine.

Subject: Beyond the HSA: How I Combined Employer-Funded Medical Savings with Aggressive Prevention to Score Like a 20-Year-Old at Age 80

Hi everyone,

I’ve been reading about the new trend of self-employed businesses offering High-Deductible Health Plans (HDHPs) paired with large employer contributions to Health Savings Accounts (HSAs). The idea is that you get tax-advantaged savings that grow over time.

I’ve been thinking about how this financial strategy can be paired with a biological one. I want to share my personal protocol: I used these tools not just to save money, but to actively reverse aging markers.

The Financial Strategy: The "Health Wealth" Fund For my 10 employees, I proposed an HDHP with a $10,000 deductible, but my company contributes $10,000/year directly into their HSAs.

The Goal: After a few years, they have a significant tax-free nest egg.

The Catch: They must manage their health proactively to avoid triggering that $10,000 deductible unnecessarily.

The Result: This incentivizes prevention. If you stay healthy, that $10,000/year becomes pure wealth you can use in retirement.

The Biological Strategy: My Prevention Protocol I applied this same "invest in prevention" mindset to my own health. I lost 60 pounds and reversed my arterial health. At age 80, my blood pressure and vascular health score better than most people in their 20s. Here’s what I focused on:

Nutritional Support for Vascular Health:

Broccoli Sprouts: Rich in Sulforaphane, which supports detoxification and cellular health.

Fermented Beets: A natural source of nitrates that boost nitric oxide production, improving blood flow and lowering blood pressure.

Fermented Cherry Tomatoes: I focused on fermentation to enhance bioavailability and include compounds that may help prevent angiogenesis (the growth of new blood vessels that can feed disease).

Arterial Plaque Reduction:

Nattokinase: An enzyme from natto that I used to help break down fibrin and reduce arterial plaque buildup.

Cayenne Capsules: Used to support circulation and metabolic rate.

 Lifestyle Foundations:

Resistant Starch: A key part of my diet to feed healthy gut bacteria and improve insulin sensitivity.

Consistent Exercise: Non-negotiable for maintaining muscle mass and cardiovascular efficiency.

 The Synergy When you combine a financial structure that rewards health (the HSA) with a rigorous prevention protocol, you create a powerful feedback loop. You aren’t just saving money; you’re investing in your longevity.

I’d love to hear if others have experimented with combining financial health benefits with specific preventative health protocols. Has anyone else seen significant reversals in their health markers using natural supplements and diet?

  I am on Medicare and not familiar with health insurance. How much would a healthy couple about 40 years of age with 2 healthy children pay annually with a modest $500 deductible? And how much would it cost them just for a $10,000 family deductible? I live in rural Tennessee if that matters.

 To give you an accurate estimate, we need to clarify a key distinction: Medicare is only for people aged 65+ (or those with specific disabilities). Since the couple in your scenario is 40 years old, they are not on Medicare. They would be buying insurance through the Affordable Care Act (ACA) Marketplace (Healthcare.gov) or directly from an insurance company.

Because you live in Rural Tennessee, this actually works in their favor. Rural areas often have more competition among insurers and may qualify for additional subsidies or lower-cost "Bronze" or "Silver" plan options.

Here is a breakdown of estimated annual costs for a family of 4 (2 adults, 2 children) in rural Tennessee, assuming they do not qualify for income-based subsidies (if they do, costs could be significantly lower):

1. The $500 Deductible Plan (Typically a "Silver" or "Gold" Plan)This plan has higher monthly premiums but lower out-of-pocket costs when care is needed.

Monthly Premium Estimate: $1,200 – $1,800 per month

Annual Premium Cost: $14,400 – $21,600 per year

Deductible: $500 per person (or $1,000–$1,500 per family, depending on the plan)

Best For: Families who expect to use doctors, prescribe medications, or have routine care.

2. The $10,000 Deductible Plan (Typically a "Bronze" Plan or High-Deductible Health Plan - HDHP)This plan has very low monthly premiums but high out-of-pocket costs if medical care is needed. This is the type of plan required to open an HSA.

Monthly Premium Estimate: $500 – $800 per month

Annual Premium Cost: $6,000 – $9,600 per year

Deductible: $10,000 per family (sometimes phrased as $5,000 per person)

Best For: Healthy families who rarely go to the doctor and want to build HSA savings.

Key Differences at a Glance Feature 

Feature                                            $500 Deductible Plan                             $10,000 Deductible Plan (HDHP)

 Annual Premium Cost                    $14,400 – $$21,600$                               $6,000 – $9,600

Monthly Premium                             $1,200 – $1,800                                       $500 – $800

Out-of-Pocket Risk                             Low ($500–$$1,500)                               High ($$10,000)

HSA Eligible?                                     No                                                              Yes

 Preventive Care                                  Usually $0 cost                                            Usually $0 cost (by law)

For exercise I was thinking of a health spa connected to a local clinic. VO Mac can improve the left ventricle of a 50 year-old to the level of a 30 year-old. Steam baths reduce all causes of mortality except for accidents. The gym could have a flat fee of say $35 a month for exercise including rebounders. For an additional $15 a month they could include steam baths. And for as needed they could offer HBOT therapy 2 hour sessions. That combined with my diet plans mentioned earlier should keep health costs low. What is your opinion. This has been very helpful. Thanks

Your instinct is correct: this model could dramatically reduce long-term health costs, but the specific modalities you are proposing (VO2 max training, steam baths, HBOT) carry different levels of evidence and risk.

Here is a breakdown of the science, safety, and business viability for each component of your $35–$50/month gym partnership model.

1. The Exercise Component ($35/mo): VO2 Max & ReboundersVerdict: Highly effective and scientifically sound.

VO2 Max & Aging: You are correct that cardiorespiratory fitness is the strongest predictor of all-cause mortality. Research confirms that high-intensity interval training (HIIT) can improve mitochondrial function and cardiac output in older adults, effectively "reversing" biological age markers in the heart. While reversing a 50-year-old's left ventricle to exactly match a 30-year-old's is an optimistic ceiling, significant functional reversal is well-documented.

  Yes, there is strong, established medical evidence for Hyperbaric Oxygen Therapy (HBOT) specifically for non-healing wounds and burn injuries. In fact, it is not just "alternative" medicine; it is a standard, FDA-approved treatment in hospital settings.

Here is the breakdown of the evidence for your specific use cases:

1. Diabetic Foot Ulcers and Chronic WoundsStatus: Strong Evidence / Standard of Care.

The Science: Many chronic wounds (especially in diabetics) fail to heal because the tissue is hypoxic (low oxygen). HBOT increases the partial pressure of oxygen in the blood by 10–15 times, forcing oxygen into tissues that are otherwise starved. This stimulates the growth of new blood vessels (angiogenesis) and enhances the ability of white blood cells to kill bacteria.

The Data: The Undersea and Hyperbaric Medical Society (UHMS) and the Department of Veterans Affairs include non-healing diabetic foot ulcers as a primary indication for HBOT. Studies show it can significantly reduce the risk of amputation and accelerate closure of wounds that have failed standard care.

2. Burn VictimsS tatus: Strong Evidence / Standard of Care.

The Science: Burns cause massive tissue damage and swelling (edema), which cuts off blood flow. HBOT reduces edema and provides high oxygen levels to the damaged tissue to prevent further cell death and fight infection.

The Data: HBOT is widely used for acute thermal burns, particularly if the burn is deep or involves the face/hands. It is also critical for Carbon Monoxide poisoning (often associated with house fires) and Cyanide poisoning.

3. The "2-Hour Session" Detail You mentioned 2-hour sessions. This is actually standard protocol for many therapeutic conditions.

A typical session involves: Compression: 10–15 minutes to equalize ear pressure.

Treatment: 60–90 minutes at 2.0–2.4 atmospheres absolute (ATA).

Air Breaks: Short breaks to reduce the risk of oxygen toxicity in the lungs.

Decompression: 10–15 minutes.

 Total time in the chamber is often 90 minutes to 2 hours. So, your timing is accurate for clinical settings.

Important Distinction: "Medical" vs. "Wellness" HBOTThis is the most critical point for your partnership with the clinic:

Feature Medical HBOT                                       (Hyperbaric Chamber)                            Wellness HBOT (Soft Chamber)

Pressure Hard Chamber:                                    2.0 – 3.0 ATA (High Pressure)                    Soft Chamber: ~1.3 ATA (Low Pressure, like a deep dive)

Evidence Strong:                                              Proven for wounds, burns, radiation necrosis, CO poisoning. 

scientific evidence.                                                                                                                    Weak/Controversial: Marketing claims often exceed

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 Recommendation for the Forum Post Y ou might add this context to your post:

"For a healthy family of 4 in rural Tennessee, a $10,000 deductible HDHP might cost only $6,000–$9,600/year in premiums, compared to $15,000+ for a $500 deductible plan. If they stay healthy and use preventive care (which is free), they save thousands annually. Those savings can be funneled into an HSA, creating a tax-free wealth-building tool that also covers future medical needs."