Before you can move your money into the stock market, you must establish a "Cash Target." This is a specific dollar amount that you keep in your HSA’s cash settlement account to cover near-term medical expenses . Think of it as an emergency fund specifically for your health. Without a cash target, you might find yourself in a situation where you have a $1,000 dental bill but all your HSA money is invested in a mutual fund that just dropped 10% in value. Selling those shares to pay the bill would "lock in" your losses. A well-calculated cash target prevents this "forced selling" and gives you the peace of mind to invest the rest of your balance for the long term.

Calculating Your Personal Cash Target

There is no one-size-fits-all number for a cash target because everyone’s health needs and financial capacities are different. To find your number, you should follow a structured three-step process .

Step 1: Historical Expense Analysis

The best predictor of future spending is past spending. You should gather information on what you spent on qualified medical expenses over the last 12 to 24 months. This includes:

Doctor’s Visits: Co-pays, co-insurance, and out-of-pocket costs for specialists.
Prescriptions: Monthly maintenance medications or one-off antibiotics.
Ancillary Care: Mental health therapy, physical therapy, or chiropractic sessions.
Vision and Dental: Eye exams, new glasses, contact lenses, and dental cleanings .

Tip: If you don't keep a spreadsheet of these costs, log in to your health insurance portal. Most providers have a "Year-End Summary" or a "Claims" section that totals your out-of-pocket responsibility.

Step 2: Future Expense Forecasting

Once you have your baseline, adjust it for the upcoming year. Are you planning to start a family? Do your children need braces? Are you scheduled for a knee surgery?

If you expect a typical year: Use 100% of last year's expenses as your guide.
If you expect higher expenses: Add the estimated out-of-pocket maximum of your insurance plan to your target.
If you expect lower expenses: (For example, if you had a one-time surgery last year), subtract that specific cost from your total .

Step 3: Applying the Financial Capacity Multiplier

Fidelity suggests that your "Financial Capacity"—your ability to handle a sudden, large bill using other savings—should dictate how much extra cushion you keep in your HSA .

Financial Capacity	Description	Suggested Cash Target Multiplier
High Capacity	You have a robust emergency fund and high monthly cash flow. You can pay a $4,000 bill out of your checking account if needed.	0.5x to 1x of monthly expected expenses.
Moderate Capacity	You have some savings but a large medical bill would be a significant strain.	4x of monthly expected expenses.
Lower Capacity	You live paycheck to paycheck or have minimal emergency savings.	10x of monthly expected expenses.

Example Scenario:
Imagine "The Miller Family." They spent $2,400 on medical costs last year ($200/month). They have a moderate financial capacity.

Monthly Expense: $200
Multiplier: 4x
Cash Target: $800

The Millers should keep $800 in their HSA cash account. Every dollar they contribute above that $800 threshold can be safely moved into the "Brokerage Link" to be invested in stocks or index funds .

The "Rolling Total" Concept

It is important to remember that a cash target is a rolling total, not a static pot of money that you never touch. You will use the cash in your HSA to pay for current expenses, and then you will replenish it with your ongoing contributions .

If your cash balance falls below your target (e.g., you had a $500 emergency and your balance dropped to $300), your next few payroll contributions should stay in the cash account until you hit your $800 target again. Only once the target is met do you resume "sweeping" the excess into your investments.

Frequently Asked Questions: Cash Targets

Q: Can I change my cash target during the year?
A: Yes. If your financial situation improves or your health needs change, you can adjust your target at any time. If you find you are contributing more than you spend, you might lower your target to get more money into the market .

Q: What if I have a massive expense that exceeds my cash target?
A: You have two choices. First, you can pay the bill using non-HSA savings (which is often the best strategy for long-term growth). Second, you can liquidate (sell) some of your HSA investments. The money from the sale usually settles in a few business days, at which point it becomes cash available for withdrawal .

Q: Does my employer contribution count toward my target?
A: Absolutely. Any money that enters the account—whether from you or your employer—contributes to reaching that cash threshold .