Max HSA, pay medical out-of-pocket, invest the balance, reimburse decades later.
HSA contributions deductible, growth tax-free, withdrawals for medical tax-free — the only triple-tax-advantaged account. Trick: pay current medical bills out-of-pocket, save the receipts, invest the HSA (Fidelity, Lively) in index funds, then reimburse yourself decades later — tax-free — from receipts you've been hoarding. $4,300 single / $8,550 family (2025) cap; +$1K age 55+.
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Reimburse employees for individual health premiums — tax-free, no group plan needed.
Reimburse up to $6,350 single / $12,800 family in premiums + medical, tax-free.
$75/mo DPC subscription + high-deductible catastrophic plan = better care at half the cost.
Hire your spouse, deduct 100% of family medical expenses through a §105 HRA.
Travel and $50/night lodging for medical care count toward the medical deduction.
Time elective procedures to clear the 7.5%-AGI floor in one big year.
Manage MAGI to avoid Medicare's income-based premium surcharges (up to $6K/yr extra).
$200–$450/mo cost-sharing plans (Medi-Share, CHM, Samaritan, Sedera).