Because the HSA money is deducted from your pay before taxes are calculated, which is nice. The only catch is that if you don't use it ALL by the end of the year (or whatever set time period) you lose it. It can be a bit of a gamble if you're not sure you're going to need it. I used to have one through my husband's employer and I would choose an amount that I expected to run out in September, just to be on the safe side. It really helps especially if you don't itemize on you taxes. Prior to reading this thread, I did not even know there was such a thing as a HSA that charges maintenance fees. I think fees like that are ridiculous. It's mostly done by computer! They send you a card that looks and works just like a debit card but it won't work for any medical expenses that do not qualify. Simple and convenient! If they must charge fees, they (morally) ought to be very small. Sheesh! Everybody's trying to get into the pockets of sick people. It's disgusting.