A few more details about medical expenses and taxes (to throw into your personal tax mix):
- The tax laws were changed so that medical expenses are deductible only to the extent that they exceed 10% (formerly 7.5%) of your AGI (Form 1040, line 37). That's net expenses, after ACA subsidies.
- There's a two year exception for people over age 65 (lasting through tax year 2016); for these folks, the floor remains at 7.5%.
- If you use a special tax account (e.g. HSA) to pay for some medical expenses, then you can't use those particular expenses in calculating your medical deduction.
- Insurance premiums (other than Medicare, COBRA, and LTC) can not be paid out of an HSA (so the only place they can be used is in calculating medical itemized deductions).
- A person under age 65 may not pay for their spouse's Medicare premiums out of their own HSA. (You must be over 65 to pay for Medicare premiums from your HSA.)

I agree with Desota - I would be quite surprised if you could get an R-class share outside of an employer-sponsored retirement plan.
When American Funds came out with class F shares (now called F-1), they were available not only through advisors, but through some offbeat discount brokers (e.g. Citicorp Investment Services - doesn't exist any more). Later, when American Funds added F-2 (same as F-1 but w/o 12b-1 fee), they seemed to tighten up on access to the F-1 shares.
Nevertheless, there appear to be a few access points remaining. I don't know how useful any of this will be, but here's what I know about those access points.
Several HSA (Health Savings Accounts) offer access to a limited number of mutual funds (i.e. they have a menu, like an employer's 401(k) plan does). Among these offerings one can often find one or two American Funds (class F-1). For example, here's the fund list from HSA Bank.
Some HSAs offer brokerage options, and these tend to be treated as retirement accounts or institutional accounts, rather than generic retail accounts. As such, they seem to offer greater access to some investments. Many of these HSA accounts use TDAmeritrade as the brokerage partner, and it looks like AMPFX (AMCAP F-1) may be available that way, NTF, despite a search on the brokerage site turning up a page saying the fund is not available for sale there.
Another back door is via a no load VA. What you get there are usually clones of the retail funds, but that's often close enough. You can access the American Funds Insurance Series VA funds through Jefferson National Monument Advisor VA. There isn't a clone for AMCAP, but there is one for Growth Fund of America.
Finally, there's the solution for the high rollers - dump $1M into American Funds, and you can get their A shares without a load. (Though there's a 1% redemption fee if you sell within a year.) If you're investing that much, you're probably not worrying about whether there's a transaction fee.

My portfolio is quite low on small-caps (and mid-caps to a lesser extent), and I'm thinking it's time to invest in a quality small cap fund.
I have a Fidelity 401k account, as well as an HSA. I'll list the HSA funds to help narrow it down a bit.
Delaware Small-cap Value: DEVLX
Schwab Small Cap Stock Index: SWSSX
Janus Triton: JGMAX
Robeco Small Cap Value II: BPSCX
Pimco Small Cap StocksPlus: PCKAX
Royce Dividend Value: RYDVX
Transamerica Small/Mid cap Value: IIVAX
Legg Mason ClearBridge Small Cap Growth: SASMX
Of course I'm leaning towards the Schwab index fund, though the Pimco fund has better returns at the price of a much higher expense ratio. Much of the rest seems to be average performance for higher expenses, but I'm listing them for sake of posterity.
Any suggestions for my HSA (and perhaps what would be a nice NTF for my Fidelity 401k)?

Hi @mcmarasco
You noted: "Does anybody have any thoughts on Blackrock Healthcare (SHSAX) "Load Waived" at FIDO or Vanguard Healthcare (VGHCX) also at FIDO and GOLD rated by M*?
I like the idea a pairing with another fund such as FBIOX, any suggestions or comments?
FIDO shows PRHSX (TROWE) as "closed" to new investors even though it is "open" at TROWE. Any insight or suggestions?"
>>>For broadbased healthcare, I do not find an advantage to holding Vanguard or others when compared to FSPHX. The performance is similar looking backwards. There is and will be variances over other time frames depending on manager actions. As you are already "inside" of Fido with your account, I personally don't find a need to move outside of Fido offerings. I have not checked for overlap; but you could also consider a more directed play towards pharma with FPHAX or directed towards the delivery side of medical services with FSHCX.
With the exception of FBIOX, of which; FSPHX has a chunk of this action, over a 5 year time frame, FSPHX is a most suitable and able performing healthcare fund when compared to all other active managed funds.
We've considered mix and match with the several Fido medical area funds; but have remained with our monies in FSPHX.
Fido also has an etf (can't recall the ticker), either via I-shares or Fido for healthcare.
Lastly, I personally would not invest any less than 5% of a total portfolio in a given sector, in order to provide enough momentum to a portfolio. 'Course 5% can also go against the portfolio, too. :)
As others have also noted; your other equity fund holdings may alread have your portfolio at 5% of total holdings in healthcare. Many broadbased equity funds owe their YTD gains to healthcare holdings. I personally find no problem with adding to this sector, as dedicated holdings.
As always, just suggestions; eh?
Take care,
Catch

Thank you all for some great info, insight and suggestions!!
Does anybody have any thoughts on Blackrock Healthcare (SHSAX) "Load Waived" at FIDO or Vanguard Healthcare (VGHCX) also at FIDO and GOLD rated by M*?
I like the idea a pairing with another fund such as FBIOX, any suggestions or comments?
FIDO shows PRHSX (TROWE) as "closed" to new investors even though it is "open" at TROWE. Any insight or suggestions?
Thanks,
Matt

So, some links below to current ratings on long term top-tier performers. All notable. All struggling this past year...or more.
http://www.mutualfundobserver.com/fund-ratings/?symbol=TCWAX+OAKIX+UMBWX+TIGAX+SHSAX+PRHSX+VCHSX+MHNAX+UNHIX+HABDX+PTTRX+AMANX+YAFFX+BBTEX+FEVAX+FMIHX+GABEX+MPGFX+MVPFX+PIXAX+&submit=Submit
http://www.mutualfundobserver.com/fund-ratings/?symbol=CVGRX+FTQGX+MFCFX+SEQUX+PRGFX+WTEAX+AMRMX+ARDEX+AUXFX+FAIRX+BAEIX+FMIEX+IEF+PMHIX+VBLTX+ADAIX+BCMSX+ACRNX+MERDX+NBGNX+&submit=Submit
http://www.mutualfundobserver.com/fund-ratings/?symbol=RYSEX+ARTQX+DEFIX+FPPTX+PHO+FOBAX+MACSX+PVFAX+RYSEX+PRSVX+WEMMX+VVPSX+CCASX+WAAEX+WSCVX+WSTCX+UNSCX+WGRNX&submit=Submit
Broad category set.
This board especially should recognize a lot of familiar names:
Oakmark International I (OAKIX)
Waddell & Reed High-Income A (UNHIX)
PIMCO Total Return Instl (PTTRX)
AMG Yacktman Focused Service (YAFFX)
BbH Core Select N (BBTEX)
FMI Large Cap (FMIHX)
Mairs & Power Growth Inv (MPGFX)
PIMCO Fundamental IndexPLUS AR A (PIXAX)
The Cook & Bynum Fund (COBYX)
Sequoia (SEQUX)
T. Rowe Price Growth Stock (PRGFX)
American Funds American Mutual A (AMRMX)
ASTON/River Road Dividend All Cap Val N (ARDEX)
Auxier Focus Inv (AUXFX)
Fairholme (FAIRX)
iShares 7-10 Year Treasury Bond (IEF)
AQR Diversified Arbitrage I (ADAIX)
Meridian Growth Legacy (MERDX)
Neuberger Berman Genesis Inv (NBGNX)
Royce Premier Invmt (RYPRX)
Artisan Mid Cap Value Investor (ARTQX)
Delafield Fund (DEFIX)
FpA Capital (FPPTX)
Tributary Balanced Instl (FOBAX)
Matthews Asian Growth & Inc Investor (MACSX)
Royce Special Equity Invmt (RYSEX)
T. Rowe Price Small-Cap Value (PRSVX)
TETON Westwood Mighty Mites AAA (WEMMX)
Vulcan Value Partners Small Cap (VVPSX)
Wasatch Small Cap Growth (WAAEX)
Walthausen Small Cap Value (WSCVX)
Ivy Science & Technology C (WSTCX)
Wintergreen Investor (WGRNX)
SEQUX, arguably greatest mutual fund ever...no longer a Great Owl.
FAIRX, what a difference a decade makes...although, still top quintile across last two full cycles (through September anyway).
Perhaps somehow related to bond yield? IEF or TLH?
Valuations? Defensive funds not buying into current bull market?
Or, just the normal ebb and flow of investing styles across cycles?

I recently open an health svings account with The Bruce Fund. I will add to this hsa for the next 10 years (until age 65). The website leaves a lot to be desired, but I believe my occassional health care related reimbursements won't create too much of a hassle. It would be nice if Bruce accounts could be linked electronically to external bank accounts for dispursement. As mentioned by Mozart325, nice YTD performance.

I hold BRUFX as my singular HSA investment. I now afford my next box of band-aids.

My "plan" is to buy FBIOX whenever the so-called slow-sto goes below 20 and turns around as per this chart http://stockcharts.com/h-sc/ui?s=fbiox&p=D&yr=0&mn=6&dy=0&id=p08376940003 , an idea that is based on the logic supplied by this blog http://stockcharts.com/public/1107832 . basically, i'd be using an overbought / oversold indicator to DCA my way into the fund. historically, i'd be buying about 12 times a year, which would be just about right. who knows if i can stick to the plan, but it makes a kind of buy-low sense to me right at the moment.
In the meantime, I see nothing compelling about SHSAX whatsoever. Like many others, I do own a good bit of PRHSX.

Ted, FBIOX is "pure" biotech fund while prhsx and Shsax are more diversified health care funds which both have about 30% invested in biotech space and the rest spread among big pharma, medical device and research reagents/instruments areas. I personally use SHSAX and PRHSX as buy/hold funds and FBIOX as a trading vehicle.

Reply to @DavidMMP:
The numbers:

******* 1 yr 3 yr 5 yr 10 yr *****YTD
PRHSX 51.4***30.4***27.8***15.3******6.9
SHSAX 44.1***21.8***19.8***13.2 ******3.5
FBIOX 65.6***38.8***27***14.3******13.1
IBB 65.5***34.7***26.5***12.3******8.6

IBB: Industry Exposureas of 01/30/2014
Biotechnology 77.02%
Pharmaceuticals 15.82%
Life Sciences Tools & Services 7.09%
Health Care Equipment & Supplies 0.10%
(PRHSX is closed(WRONG), with the exception of existing holders or access through group plans.)
EDIT: I stand fully corrected per InformalEconomist's note below, PRHSX is open in spite of closed notations at some broker web sites.
If you hold SHSAX, hopefully it is load waived for the 5.75% upfront.
Take care,
Catch

prhsx and Shsax are better alternative to Fbiox if you want to get into hot biotech/health care area but worry about the huge run up of biotechs in the last two years.
Cancer immunology is red hot area in biotech space.

I established a hsa account with BRUFX at the start of 2014. Funded this with a one time transfer from a Tax Deferred IRA account. The Health Saving Account will distribute funds tax free for the purpose of paying health related expenses. As an individual over 55 years of age I was able to contribute (transfer) $4300 in 2014.
I am also setting up individual Roth conversion accounts for TY2014. I will have 5 small Roth accounts ($5-10K) and invest each account in a singular theme. Hopefuly one or more of these themes produce positive returns between Jan 2014 (account setup) and April 2015 (when taxes on the Roth conversion are due).
If the investment theme reaches my conversion period goal of "appreciating 'equal to or greater than' taxes due" (I am in the 15-20% tax bracket) than I will convert the account to permanent Roth status. If one or more themes fail to grow adequately I will recharacterize the accounts back to Self Directed IRA status.
One theme is PM Miners using USAGX / GDX / GDXJ. Another will be Japan-centric. A third will be Global Tech. A fourth will be Health Care related. The fifth will be invested according to a momentum based strategy.

Hi Guys,
Indeed, the equity markets have been double-digit generous to us so far this year. Given the historical December record boosted with the Santa Claus rally, I anticipate that these overly generous rewards will be slightly enhanced at year’s end. Regardless, it will be a memorable investor’s year.
Many respected market forecasters are becoming a bit more skeptical, some even pessimistic, about near-term prospects. Some of that skepticism is grounded in the belief that a few market indicators are shattering all-time high valuations or are crossing remarkable absolute even numbers. That numerical mysticism is sheer nonsense.
Remember that market gurus make successful forecasts slightly less than half the time. Since the markets can only go up or down, a fair coin toss would easily match the historical record of these unfortunate experts who are coerced into the realm of soothsayers.
It is not that these experts are not smart, well informed players; it is just that the Market is so complex with its unknown and non-linear feedback loops that accurate predicting is often compromised. That’s especially so when records and landmark numbers enter the emotional thought process.
These high-water mark numbers that seem to influence investors do not likely influence private business investment decisions. Eventually stock prices reflect business activity and profits. National landmark numbers are meaningless to business folks and entrepreneurs when they are making their investment decisions. So I’m more sanguine about market upcoming profits than the current band of dismal forecasters. I believe in making lemonade out of lemons.
What are the source lemons for my projection? The most fundamental factors that drive economic expansion are population growth rate and productivity growth rate. Demographics demonstrate the population aspects and GDP per capita growth data is a fair measure of productivity gain.
The US census data shows that our annual birth rate per woman hovers around the 2.1 value needed for population sustainability. With the entire world actively seeking to enter the USA, perpetual immigration augments a rising national population growth rate. Typically, that factor is responsible for one-third of our increasing prosperity.
The other accountable two-thirds is contributed by our productivity enhancements. As measured by our GDP per capita growth rate, recent data shows that the USA is delivering a GDP per capita growth rate in the plus 3 % neighborhood. That level is within the historical nominal range. Things aren’t great, but they aren’t so bad either.
Additionally, inflation seems under control, and Janet Yellen will work to keep it at those record lows. One fly in the ointment is that investor optimism is rising. I do not like that factor and consider it only a minor negative because sometimes the mob is on target and displays their “Wisdom of the Crowds”. This just might be one such instance.
In any case, I’ll take the optimistic side of the coin toss. I choose to make lemonade from lemons.
However, as the year ends, I’ll take my mandatory minimum withdrawals from my IRAs. I will make all those withdrawals from the equity parts of my portfolio. It is not that I fear a market meltdown, but my primary consideration is a rebalancing action. That segment of my portfolios has risen to a somewhat troublesome fraction. I remain a conservative, long time horizon investor.
I’m sure all this detail is more than you ever wanted to know. But some of the thoughts here might serve to guide or trigger your year end portfolio adjustments and reallocations. Have a Happy Holiday season everyone.
Best Wishes.

That's a good point about inheritance treatment...I hadn't considered that because I'm young and don't currently have any heirs, but my point was simply that debit or checking features should not generally be desirable for HSAs because, during one's lifetime, HSAs are basically just a kind of super IRA with which one can minimize taxes by avoiding withdrawals and contributing to in lieu of taxable accounts or other kinds of IRAs.
But you are right that when comparing withdrawals from a Roth IRAs vs HSAs specifically, the tax penalty incurred by the owner is equal between the two because there is no tax on withdrawal from either and the size of the tax shelter is equally reduced in both cases which leaves only secondary considerations like the tax burden on heirs to differentiate. So although it is better tax-wise for the owner to:
-contribute to an HSA instead of any other kind of IRA or any taxable account
-withdraw from taxable accounts instead of any kind of HSA or IRA
-withdraw from an HSA or Roth IRA instead of a Traditional IRA
, withdrawing from an HSA instead of a Roth IRA is worse for heirs even though it is neither better nor worse for the owner.
So upon consideration of secondary factors, HSAs are not universally superior to IRAs as I previously thought, but I think the point still remains that debit or checking features to aid in frequent withdrawals would not be a valuable for most prudent HSA usage just as they are not for IRAs.

Reply to @BannedfromBogleheads:
#1. Aren't HSA contributions tax deductible going in?
Also, why would it be more beneficial to "raid your Roth" to pay medical expenses? A spouse can roll over an inherited HSA tax free, but a non-spouse (kids) have to take a full distribution and this distribution is considered income. Conversely, kids can spread out the distributions of an inherited Roth IRA over their lifetime tax free.
If you have kids as beneficairies the Roth account seem like the one not to raid.

Reply to @bee:
Neither BRUFX nor Saturna Brokerage are good custodians for using your HSA to pay medical expenses directly as neither offer debit card or checking features, but that's not a problem if you're making the most of your HSA because it's not to your advantage to be making direct payments from an HSA anyway because reimbursing yourself for medical expenses is also a qualified withdrawal and there is no time limit for doing this; The longer you wait to withdraw the more your investments compound tax free, so:
1. I strongly feel that HSA owners should make it their highest priority to take no distributions until retirement or beyond because HSAs are the best tax shelter around: no tax going in, no tax on returns, and no tax going out...so if you can't afford to pay your medical bills with taxable savings then raid your Roth if you have to but LEAVE THAT HSA ALONE.
2. I'm also of the opinion that, even when interest rates are high, cash portfolio allocations should NOT be located in tax shelters as is sometimes advocated with the argument that one can withdraw from riskier, more tax-efficient investments in taxable accounts and rebalance in the tax shelter. If you know you'll always be able to withdraw from the riskier investments without running out then that means you're not at risk and you don't need a cash allocation, but if you do in fact need a cash allocation then it needs to be where you can spend it without any dubious predictions about the ability to rebalance. Additionally, (not to mention that cash yields are currently extremely low) to minimize tax bill you need to consider which investments maximize all future cash flows with compounding and that's not necessarily going to be the investments which have lower tax efficiency in any single isolated year.
P.S. Yeah BRUFX doesn't allow online transactions, but IMO that's exactly why they have a liquidity edge vs other mutual funds. If you don't need daily liquidity then why would you invest in funds which pay a premium in the market to get it?

Just spoke with a Bruce fund representative...using the Bruce fund requires mail in requests for withdrawals and deposits...no online transactions. There is no "debit card" option for making medical payments as part of your account with Bruce making it a little more complicated paying for medical expenses. Other HSAs offer an "HSA checking" account and a debit card. Finally, HSA funds are always fully invested with Bruce...no cash position.

Reply to @BannedfromBogleheads: Thanks BFB, I was in the process of setting up an account before year's end.
Also, For those that are eligible to fund a HSA account funding is tax deductible. Qualified withdrawals from the HSA are tax free. Also, a one time trustee to trustee transfer can be made from a traditional IRA to a HSA which, once in the HSA account, can be withdrawn tax free when used for qualified medical costs.
kiplinger.com/article/insurance/T027-C001-S003-rules-for-ira-to-hsa-rollovers.html

Also The Bruce Fund (BRUFX) is a fund that's available for direct purchase only (ie not through brokerages) and they charge the same custodial fee for HSAs as they do for IRAs (which is the $15/year that I believe all IRA custodians must pay to the IRS even though most are willing to subsidize it). So if you're interested in their management (which has an excellent track record and is the only microcap balanced fund I'm aware of), their HSA is a relatively good value and they even told me I could pay the custodial fee with outside funds if I wanted.
So unless other custodians start lowering their fees, I personally wouldn't consider any except either Saturna Brokerage or The Bruce Fund. Although given my ringing endorsement I feel I should disclose that I do not have a position in the Bruce Fund, but that might change if bond rates keep rising and if Obamacare somehow allows me to become HSA contribution eligible again.
EDIT: fixed ticker to BRUFX