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1. They Treat the HSA Like a Stealth Retirement Account Most Americans use HSAs to pay for yearly medical expenses. Rich individuals don’t. They pay out-of-pocket for medical bills and let their HSA money grow untouched for decades , because: • Contributions are tax-deductible • Growth is tax-free • Withdrawals for medical expenses are tax-free This is the only account in America with triple tax advantages. No 401(k). No IRA. Not even a Roth IRA comes close in flexibility.