If you have an HSA account, it works like a Traditional IRA account. The earnings on the account are not taxable until you cash them out at age 59. Some states did not like the HSA settings and therefore, contributions are not tax deductible and earning are taxable. Check with your state.

I have an HSA account but I pay my medical bills using a traditional point earning credit card and then just wire the money from the HSA to my checking account. The earnings are negligible for me to consider deferring them for tax purposes.