Saving for a Longer Life in Bitcoin: My Interview With Stuart Lackey of SOUND HSA
The short version: Stuart Lackey is co-founder and CEO of SOUND HSA, a health savings account that holds real bitcoin instead of cash while keeping the HSA’s triple tax advantage. We talk about direct primary care, why so many Bitcoiners take their health seriously, and paying for a longer life. If you’re over 65 and on Medicare, you can’t add new money to an HSA, but you can keep one and spend it tax-free on qualified medical costs.
If you plan to live a very long time, you need a plan to pay for it. Healthcare is one of the biggest costs of getting older, and most people save for it in dollars that buy less every year.
That is why I wanted to talk to Stuart Lackey. He is the co-founder and CEO of SOUND HSA, a health savings account that holds real bitcoin instead of cash. It sits right where the two halves of my life meet, which I wrote about in why Bitcoiners chase longevity. I met Stu at BitBlockBoom, the Bitcoin conference I founded in 2018, and knew right away he would be a great guest.
Who Stuart Lackey Is
Stu came out of medical technology. He held leadership roles at surgical device and med-tech companies, two of which went public, SI-Bone and TranS1. He first learned about bitcoin in 2016, finished a master’s degree in healthcare informatics in 2018, and co-founded SOUND HSA with Jon Gordon.
What SOUND HSA Actually Is
A health savings account has what people call a triple tax advantage. The money goes in tax-deductible, it grows tax-free, and it comes out tax-free when you spend it on qualified medical expenses. Most HSAs keep that money in cash or a savings account.
SOUND HSA keeps the same tax structure but holds actual bitcoin in your name, in cold storage with regulated trust companies. Their app also runs health and wellness challenges that pay small bitcoin rewards, like walking a set number of steps.
One honest note. Bitcoin’s price swings hard. Money you may need for a medical bill next year is not the same as money you are saving for twenty years from now, and that difference matters a lot more with bitcoin than with cash.
What We Talked About
Direct Primary Care
Stu started with something I did not know by its initials: direct primary care, or DPC. You pay a doctor a monthly or yearly fee, with no insurance involved, and in return you get real access to them, often their cell phone number, plus a yearly physical with the blood panels you and the doctor choose. He has used it himself for about 15 years.
The reason it works is time. A busy insurance-based doctor can carry 700 to 1,000 patients. A DPC doctor carries far fewer, so they can actually advocate for you. To find one, search “direct primary care” plus your city. MDVIP is one national network. This caught my attention because we are already ordering our own blood panels and I have a full-body MRI coming up, and I would rather have a doctor look those over than just ask Claude.
Why So Many Bitcoiners Care About Their Health
Stu went to his first Bitcoin meetup in Nashville in 2016. He planned to stay five minutes and stayed two hours. What he noticed is the same thing I noticed: the rooms were full of very smart people, and a lot of them took fitness and metabolic health seriously.
The link is what Bitcoiners call low time preference, which just means choosing a better future over an easy now. It is the same habit whether you are holding an asset for years or skipping the dessert. His rule for anyone thinking about buying bitcoin: don’t, unless you plan to hold it for at least four years.
Paying for a Longer Life
A viewer, GrumpyOldGuy777, asked how people will afford to live past 95 when most retirement plans are not built for it. Stu pointed to Fidelity’s numbers. Fidelity estimates a 65-year-old couple retiring in 2025 needs about $345,000, after tax, for healthcare in retirement, and that is before any long-term care. Add another 20 years of life and that number only grows.
How the Account Works
To put money into any HSA, you need a high-deductible health plan. Through an employer, contributions come out of your paycheck before tax. On your own, they are tax-deductible. Stu says opening a SOUND HSA takes under five minutes. You fund it with cash or move over an existing HSA, then decide yourself when to buy bitcoin.
It is real bitcoin, not an ETF. The keys are split among three separate institutions, Unchained, an affiliated trust company, and Horizon Trust, the HSA custodian, so no single company can move it, and nobody can pressure you into handing it over because you do not hold the keys. For people who want to hold one of the three keys themselves, that option is on their roadmap. They charge a flat annual fee.
Two Things I Did Not Know
First, after 65 an HSA works like a traditional IRA for non-medical spending. You pay ordinary income tax on it, but there is no penalty, and unlike an IRA there are no required minimum distributions.
Second, keep your receipts. You can reimburse yourself tax-free, years later, for qualified medical expenses you paid out of pocket after you opened your HSA. If the account has grown in the meantime, that can add up to real money. SOUND HSA helps you organize those receipts in the app.
Earning Bitcoin for Walking
Their app has a feature they call Move to Earn. You join weekly step challenges, like 50,000 steps in a week, and earn bitcoin for finishing. A direct primary care group in Houston with 58 clinicians and staff uses it as a workplace wellness program, and Stu says a lot of people earned their very first bitcoin by moving. I walk three and a half miles a day, so Stu promised to let us know when the next public challenge opens.
Stu was clear about this, and so am I: nobody can promise what bitcoin’s price will do, and none of this is financial advice.
If You Are Over 65, Read This First
Once you enroll in any part of Medicare, including Part A, you can no longer put new money into an HSA. That is an IRS rule, not a SOUND HSA rule, and it covers most people who read this site. One trap if you sign up for Medicare after 65: Part A coverage usually backdates up to six months, so stop HSA contributions six months before you enroll or you may owe a tax penalty.
What you can still do is keep an existing HSA and spend it tax-free on qualified medical expenses, including Medicare Part B and Part D premiums. After 65 you can also take money out for anything else without the 20 percent penalty. You just pay income tax on it, the same as a traditional IRA.
So if you are on Medicare, this is mostly about moving an HSA you already have, or telling your kids and grandkids about it while they can still contribute.
How to Open an Account
Open a SOUND HSA account with my code (affiliate link).
If you want the rest of what I do, my full daily regimen is in my protocols, the training side is under fitness, every number I track is in test and stats, and the products I actually use are on my discount codes page.
Affiliate disclosure: the SOUND HSA link in this post is an affiliate link. If you open an account through it, I earn a commission at no extra cost to you. SOUND HSA also had a booth at BitBlockBoom, the Bitcoin conference I founded.
Live long and prosper,
Gary
A note from Gary: I am not a doctor, and I am definitely not your doctor. I am not a financial or tax advisor either. I am a 71-year-old man running a 129-year experiment on himself in public. Nothing here is medical, financial or tax advice. Talk to your physician, and to a tax professional, before changing anything.
These are products I use on my push to 200. I only put something on this list after I’ve tested it on myself. The links are affiliate links, which means I may earn a small commission at no cost to you.
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