With the MSA you can add up to the deductible each year; and if you don’t spend the money on medical expenses you get to “keep” it, or like an IRA. All contributions to the MSA are deductible, and the as of this year, the full amount of the fixed premiums are also 100% deductible. (Finally).

The MSA route is probably a viable way to go, especially for younger workers without families who may not use the deductible. For us middle-aged folks, it is less attractive, as we are finding that we are spending close to the full deductible amounts each year for both of us.

I also have a State Farm disability policy, and a Mutual of Omaha accident policy. which pay (partial) salary replacement and hospitalization for accidents respectively. This adds another several hundred in premiums each year.

Dental and eye doctors are paid from the MSA.

The whole system is absurd. We pay almost double our mortgage payments each month, with the cost rising each year. Any transaction causes piles of paperwork, often months after treatment. When I lived in Canada and Europe, I experienced their more socialized systems, which far superior for routine treatment and which included things like free rides home from the hospital after treatment, and even house calls (!)