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The Triple Tax Advantage: HSAs as a Complement to Retirement Accounts

A Health Savings Account (HSA) can serve as a powerful complement to retirement accounts like SEP‑IRAs and Solo 401(k)s, especially for self‑employed therapists who want both tax advantages and flexibility in managing healthcare costs.

Retirement Account Options

Self-employed therapists have several retirement account options, including SEP-IRAs, Solo 401(k)s, and Roth IRAs. Each plan offers different contribution limits, tax advantages, and administrative requirements, making it possible to tailor savings strategies to your practice size and income level.

Click into Accounts to see every account you've connected (bank, investment, retirement, credit card, and more) in one place. Your balances update automatically, so you don't have to chase down multiple logins.

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Next is Income, Expenses, and Savings, where your household's cash flow comes into focus: what's coming in, your estimated annual living expenses, and what's going toward retirement, college, and other goals.

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My Plan puts those pieces together to show where you stand: your probability of success, net worth, investments and asset allocation, and progress toward each of your goals.

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In Explore, you can run your own "what-if" scenarios anytime and see right away how a choice changes your probability of success.

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Want to see where the money's actually going? Your Spending page shows exactly that. Transactions are sorted automatically into categories you define, so your income, expenses, and net cash flow are always easy to read. You can add as many categories as you like.

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Vault is your secure filing cabinet. It has three folders: Shared Documents for sharing files with me, Advanced Scenarios for the deeper planning work I prepare for you, and My Private Documents for anything you'd rather keep to yourself.

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Finally, Reports is for clients who want to dig into the details. The Cash Flow report below is one example: it projects your inflows, outflows, and portfolio assets year by year for your entire planning horizon. Other reports include Investments, Savings and Income Tax.

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Disclaimer

All screenshots show a hypothetical client and are for illustration only; they do not represent an actual client or actual results. Projections, including probability of success, are based on assumptions about investment returns, inflation, income, and spending. The assumptions used, and their sources, are listed below. They are not guarantees and will change as those assumptions or your circumstances change. Probability of success is the percentage of Monte Carlo trials in which portfolio assets finish above zero dollars at the end of the plan. Projections were generated with eMoney Advisor financial planning software and reflect Thrive Investments' investment management fee; the annual planning fee is included in living expenses. Simulations cannot predict future market conditions or capture every possible outcome, and actual results will differ and may be better or worse. This illustration is not individualized advice; a plan for your household would be based on your own information. 

 

Assumptions

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Clients: Client 1, age 48, psychologist in private practice taxed as an S Corp. Client 2, age 48, W-2 employee. Children ages 15 and 13. Clinical and counseling psychologists average about 46 years old (Data USA, 2024), so this client is slightly older than average. The children were born when the clients were 33 and 35; parents with graduate degrees typically have their first child in their early 30s (NCFMR, 2023). About 90% of U.S. workers are employees (BLS).

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Income: Client 1: $100,000 practice net profit (before owner salary, payroll taxes and retirement contributions), paid as a $60,000 salary and the remainder as distributions. Client 2: $100,000 salary. About $100,000 of net profit is where S Corp savings begin to outweigh the costs (Heard). The 60% salary is an illustrative assumption; a reasonable salary depends on market wages and should be set with a tax professional. Full-time college graduates earn a median of about $92,000, and workers 45–54 earn about 14% more than average (BLS); Client 2's $100,000 is slightly conservative.

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Retirement age: Client 1 at 65; Client 2 at 62. About 19% of employed psychologists are 65 or older, versus 7% of all workers (BLS, 2025), and Medicare begins at 65. Retirees report a median actual retirement age of 62 (EBRI, 2026).

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Social Security: Both claim at 65. Annual benefits at 65, in today's dollars: Client 1 $22,836; Client 2 $32,928. Sixty-five is the median and average claiming age (Center for Retirement Research). Benefits use SSA's formula, assuming earnings grew with inflation from age 27. Client 1's benefit is lower because S Corp distributions don't count toward Social Security.

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Living expenses: $104,000 a year until Client 1 retires; $98,500 a year after.  Excludes the mortgage, property taxes and 529 and retirement contributions, which are entered separately. Thrive's monthly planning fee is included in Miscellaneous. Spending for four-person households with $200,000 income, adjusted to 2026 prices (BLS). In retirement, couples spend about 7% less than families of four at the same income, and households aged 65–74 spend about 22% more on healthcare than those aged 45–54 (BLS). 

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Health insurance: Family coverage through Client 2's employer until Client 2 retires at 62. From 62 to 65, coverage through Client 1's practice, with premiums paid from the health insurance budget already in living expenses. Medicare from 65. Coverage costs before Medicare may be higher than assumed.

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Home: Value: $615,000. Mortgage balance $168,312 at 3% (30-year, refinanced 2021), paid off in 2051. Property taxes $6,765 a year (1.1% of value). Median home value of $604,400 for homeowners aged 45–54 in the 80th–90th income percentile (Federal Reserve, 2025), plus about 2% price growth since (Case-Shiller). Purchased in 2013 with 20% down. The property tax rate is above the 0.9% national average (ATTOM, 2025), so conservative.

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Retirement accounts: $259,708 total, split equally between Client 1's SEP IRA and Client 2's 401(k); 78% stocks, 22% bonds. Annual contributions: SEP $14,400; 401(k) $14,400 ($9,600 from Client 2, $4,800 from the employer). Median retirement savings of $190,600 for this household group (Federal Reserve, 2025), plus recent market gains and about two years of contributions. Allocation is the average for this age group (Vanguard). Contributions equal 14.4% of pay, the average total savings rate in 401(k) plans (Fidelity).

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College: 529 balances of $101,111 and $89,007; contributions of $7,000 and $5,000 a year. Cost $30,990 per child per year for four years, in today's dollars, rising 1.7% a year faster than inflation. $30,990 is the average total cost (tuition, fees, housing, food and other expenses) for in-state students at public four-year colleges, before financial aid (College Board, 2025–26). College costs rise 1.7% a year faster than inflation, close to the 25-year average (BLS). Balances and contributions were set to give a little better than a 50% chance of fully funding college.

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Cash: $34,700 (four months of living expenses): $26,900 savings, $7,800 checking. Midpoint of the common 3–6 month guideline. Checking is about 29% of savings for similar households (Federal Reserve, 2025).

 

Taxes: 2026 federal tax law, married filing jointly. Massachusetts state income tax at its 5% flat rate.

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Investment asset class estimates and fees: All figures are in today's dollars, using returns after inflation. Stocks: 6.2% a year with 19.2% volatility (S&P 500, 1929–2024). Bonds: 1.5% a year with 7.9% volatility (10-year U.S. Treasury, 1929–2024). 1,000 simulations in eMoney. Projections reflect Thrive's 0.15% investment management fee. Long-run historical returns (Aswath Damodaran, NYU Stern). 

 

Planning horizon: Both to age 89. Life expectancy, averaged for men and women, plus 10% (SSA).

 

Sources

Sample Financial Planning Portal

Your Organizer is the foundation of your plan. It holds the details of your family, your home, your accounts, and your income, spending and savings.

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