Key Differences: FSA vs. HSA and HSA vs. HRA

It’s very easy to get confused when trying to decipher the differences between Flexible Spending Accounts (FSA) and Healthcare Saving Accounts (HSA).  While both are accounts one can contribute to tax-free to save for medical costs, they also have key unique characteristics which are important to understand to get the most bang for your buck.  In addition, let’s unwrap the variances in an HSA and a Healthcare Reimbursement Arrangement (HRA) to get the clearest picture of this often-foggy topic.


Both FSAs and HSAs allow people to set aside funds for health-related costs, also known as “qualified expenses”.  Qualified expenses can include deductibles, co-pays, and monthly prescription costs.  Some employers choose to contribute to these accounts.  Both types of accounts have tax benefits too, although the benefits are not the same.

The first key difference between FSAs and HSAs is qualification.  An employee is only eligible for an HSA if they have a high-deductible healthcare plan, not qualify for Medicare, and not be claimed as a dependent on someone else’s tax return.  It’s also important to remember that not all high-deductible plans qualify for an HSA so an employee should check with the insurer.

Second, HSAs and FSAs have different yearly contribution limits.  An employee can usually contribute more to an HSA and can also change the amount they’re contributing at any time, where an FSA can only be adjusted during the open enrollment period.  A big benefit of an FSA is that an employee has complete access to their annual election at any point in the year, even if they have not contributed that amount yet.  An HSA only provides access to what’s been deposited.  If an employee happens to switch jobs, the HSA can follow them unchanged.  FSAs will end with employment, unless there’s a continuation with COBRA.

The next key difference has to do with rollover – or what happens to the money at the end of the year if not all used.  With an HSA, all unused funds with roll over into the next year which means an HSA can grow tax-free and can accumulate to help with retirement.  Conversely, an FSA typically has the “use it or lose it” rule and the money that’s leftover gets forfeited.  This difference is due to the fact that FSAs are employer owned, and HSAs belong solely to the employee.  Due to this, an FSA does not work well as a long-term savings plan.  

Another variance is that FSAs can use after-tax dollars to pay for a wider variety of activities such as childcare expenses, but an HSA must be used for medical costs.  If HSA funds are used for something other than medical expenses before the owner is 65, taxes will be owed on the withdraw.  Using the funds in an HSA to pay for qualified expenses is tax-free.


Like an FSA, an HRA is employer-owned, so when an employee no longer works for that employer, the funds in an HRA are no longer accessible.  As opposed to an HSA and FSA which are funded by the employee, an HRA is 100% funded by the employer.  It is essentially free money provided to by employer to offset the cost of health-related expenses.  Since the employer provides the funds, they also set the rules for which the expenses are eligible for reimbursement.  The employer also sees all the tax benefits and reductions. While an HSA has an annual contribution limit, an HRA contribution is only limited by what the employer wants to provide.  Need more help understanding FSAs, HSAs, and HRAs, contact The Grigg Group!

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