You’ve heard about HSAs and FSAs. And you think they are a good way to save money for and on medical expenses. And your employer offers both as part of its benefits plan.

You’re in luck. You get to choose the option best suited to your needs. And yes, you do have to choose. Because you can’t contribute to an HSA and a Healthcare FSA at the same time. Let’s discover which account type will win in HSA versus FSA.

So how do you choose? To make the best decision for you and your family, consider the details of each account. And compare those to the realities of your family’s medical and financial needs.

HSA vs. FSA Basics

There are some basic facts you need to know to understand the differences between FSAs and HSAs.

To start, let's look at what these accounts have in common.

Health Savings Accounts (HSA) and Healthcare Flexible Spending Accounts (FSA) are pre-tax accounts. And are both used to pay for qualified, out-of-pocket medical expenses. These include, but aren’t limited to, copays, deductibles, coinsurance, and prescriptions. Because contributions are pre-tax, you can save up to 30% on those out-of-pocket expenses. Depending on your tax bracket.

How are HSAs and FSAs different? The major difference they have is that an FSA is an employer owned account that pays for short-term expenses. You must use up the FSA funds you contributed by the end of the year.

HSAs are individually owned, and you can use them for short-term expenses, or long-term savings, like retirement. In addition, account functionality and account holder requirements are different for the two account types.

Let’s learn a little more about each account type.

What is a Health Savings Account?

A Health Savings Account is a kind of savings account that allows you to save for health care costs. And reduce your taxable income. In other words, HSAs are individually owned, tax-advantaged medical savings accounts. You can open one as an individual or as part of a family plan. As long as you and your family are enrolled in an HSA-eligible High Deductible Health Plan (HDHP).

What’s considered an HSA-eligible health plan?

HDHPs are health plans with a minimum deductible and maximum out-of-pocket expenses set by the IRS that differs for individuals and families.

The IRS adjusts its allowed annual HSA contribution limits annually for inflation, and has different limits for individual and family accounts. If you have a mid-year change – like moving from self-only coverage to family coverage, or vice versa, then your annual contribution limit becomes prorated.

How does an HSA work?

When you open your HSA, you choose how much you’d like to contribute annually. Then, your employer will deduct the appropriate amount from each paycheck. Your employer may choose to also contribute to your account. But they’re not required to.

If they do contribute, those contributions will count toward your maximum annual limit. Choose your individual contribution amount carefully. And keep in mind that contributions are cumulative. Otherwise, you could end up going over the annual contribution limit.

If you’re under the age of 65, you must use your contributions to pay for qualified medical expenses. These include, but are not limited to:

• Copays
• Coinsurance
• Deductibles
• Acupuncture
• Mental health treatment
• Prescriptions
• Medical supplies like bandages, crutches, joint braces, and more
• Hearing aids
• Dental health
• Vision tests

Want to see the full list of HSA-eligible expenses? Visit What’s Eligible?

How age affects HSA use and taxes

If you’re under the age of 65 and use your contributions for qualified medical expenses, those funds are not subject to federal income tax. But, your state tax liability for contributions depends on your state.

If you choose to use the money for something other than qualified medical expenses, you will incur a 20% tax penalty. And have to pay income taxes on the misused money. After age 65, you can use your health savings on anything you want provided income tax is paid on the amount of the non-qualified disbursement.

What is a Flexible Spending Account (FSA)?

There is only one type of HSA, and its main use is to pay for qualified medical costs at any age.

There are three types of FSAs:

• Healthcare FSA
• Dependent Care FSA
• Limited Purpose FSA

When people use the term “FSA,” they are most often talking about a Healthcare FSA, which is a spending account your employer makes available to pay for qualified medical expenses with pre-tax dollars. HDependent Care FSAs are for qualified care expenses, like child or adult daycare. Limited Purpose FSAs are only used for qualified dental and vision expenses.

The most important thing to remember is that you cannot contribute to a Healthcare FSA or Dependent Care FSA and an HSA at the same time. But you can have a Limited Purpose FSA and an HSA at the same time.

How does a Healthcare FSA work?

If you decide you would like to open an FSA, the good news is that you don’t have to purchase a specific health plan. In fact, you don’t have to purchase any health plan.

But you must elect to participate during your employer’s open enrollment period. Or within 30 days of starting employment if you begin your job mid-year. Then, you select the amount you would like to contribute to your account at that time. Your employer will then deduct the appropriate amount from each paycheck.

Your employer can choose to contribute to your FSA but is not required to do so. And their contributions don’t count toward your annual max. Unfortunately, you can’t change this election at any point outside of open enrollment. Unless you’ve experienced a qualifying life event like the birth of a child, death of a dependent, marriage, or divorce.

You also lose any unused money at the end of the year. Unless your employer offers either the option to rollover a small amount of funds to next year’s account or a 2.5 month grace period during which you can use leftover funds. So choose your contribution amount carefully.

Like with HSAs, the IRS imposes an annual limit on FSA contributions that adjusts annually for inflation. Unlike HSAs, FSAs are only opened on an individual basis, so there are no “family plan” increases for annual contribution limits. But if both you and your spouse are offered the opportunity to take part in an FSA at work, you can do so and each can contribute up to the maximum allowed amount.

FSA funds can be used to pay for out-of-pocket medical, vision, and dental expenses not covered by your health insurance plan. Including, but not limited to:

• Copays
• Coinsurance
• Deductibles
• Acupuncture
• Mental health treatment
• Prescriptions
• Medical supplies like bandages, crutches, joint braces, and more
• Hearing aids
• Dental health
• Vision tests

For a full list of medical expenses that you can use your FSA (or HSA funds) on, check out Publication 502 from the IRS. You can also visit the FSA Store.

The differences between HSAs and FSAs

Eligibilty requirements

• FSA: Only employers can establish an FSA plan for employees to contribute. Employees can open an FSA regardless of if they have a HDHP or not. Self-employed individuals cannot open an account.
• HSA: Employees are eligible only if they have an HSA-eligible HDHP. Individuals are not dependent upon their employer to offer an HSA. And an HSA can be opened from the private market. Self-employed individuals can open an account.

Contribution sources and changes

• FSA: The contribution amount is chosen during open enrollment or at the time of a qualifying life event. And the contribution amount can not be changed outside of these two time periods.
• HSA: You can change your contribution amount at any time, no major life event required. This gives you the flexibility to increase or decrease your contribution at any time. Multiple contribution sources: You can grow your HSA in multiple ways. Not only can you add money to your HSA, but your employer, relatives, or anyone who would like to contribute can help your HSA grow.

Rollover rules

• FSA: Employers choose whether an employee can keep their unused funds or not. There are three options: Forfeit: Employee forfeits money, and employers get to keep it. Grace period: Employee has a 2.5 month grace period after the plan year ends to use on expenses. Any remaining money after the grace period is employer’s. Carryover: Employees can add a small amount of unsued funds, set each year by the IRS (in addition to contribution limit). Employers decide the carryover limit, and any funds over the limit are the employer’s.
• HSA: Funds do not expire from year-to-year. Rollover money is in addition to the contribution limits. Money in your HSA can be carried with you and is available even if you change health insurance plans, get a new job, or retire. And funds left in your account grow tax-free through interest or any investment gains.

Account ownership

• FSA: An FSA is owned by the employer. Unused funds belong to employers, not the employee.
• HSA: Funds stay with you. One of the best perks of an HSA is that the money you save always stays with you because you own the account. If money is left in your HSA at the end of the year, it stays put. No scrambling around trying to find ways to spend the money before the timer runs out.

Access to money

• FSA: Money available from day one. Every penny you contribute to your FSA is available at the beginning of the benefit year. Or shortly after the first contribution is made. Say you add $2,000 to your FSA for the year, you’ll likely contribute about $80 per paycheck. Yet, the entire $2,000 is available to use at any time even though you only make small contributions during the year. Another perk? If you leave a position before the year is over, the money spent from your FSA doesn’t have to be paid back.
• HSA: As the employee contributes to their plan. An employee only has access to what has actually been deposited into their HSA account.

HSA: A savings asset

• After the age of 65, your HSA functions like any other retirement account. And you can use your HSA money on anything you wish. How does it differ from other retirement accounts? You don’t pay income taxes on money used for medical expenses. You do, however pay income taxes on money used for anything else.
• HSAs are assets you can pass on to your kin: If your spouse inherits the HSA, it retains its status as a retirement-like account. With the same rules and allowances as it had when you were the account holder. If you pass it on to someone other than your spouse, it stops being an HSA, and inheritance laws apply.

Understand the pros and cons to find what’s best for you

While it’s likely you’ll only be eligible for either a Healthcare FSA or an HSA, it is still a good idea to take a look at the pros and cons of both types of accounts. This can help you understand how they align with your greater financial goals and help you decide what healthplan to choose.

HSA Advantages

• Portable account: means you own the account and don’t lose it if you change jobs
• Triple-tax advantage: Contribute funds pre-tax, funds grow pre-tax, withdraw funds pre-tax for qualified expenses
• No use-it-or-lose-it rules: Spend now or save for retirement.
• Anybody can contribute to your HSA: This includes your employer, spouse, family, or friends, as long as you don’t go over the annual contribution limit.

HSA Disadvantages

• Must enroll in a HDHP and meet other qualifications to have one
• May be subject to fees from the provider
• If you use your HSA for non-qualified expenses over age 65 you'll owe an additional 20% tax penalty on top of any taxes due

Healthcare FSA Advantages

• Double tax savings: Contribute funds pre-tax, withdraw funds pre-tax for qualified expenses
• Health plan agnostic: Can enroll in one if your employer offers it, do not need to have a specific type of health insurance plan

Healthcare FSA Disadvantages

• Only available from an employer, can’t have one if you are self-employed
• Employer owned, means you lose the account if you change jobs
• Subject to use-it-or-lose-it rules, meaning you lose funds if you they are not used during the plan year

Align Your Goals with Your Savings

Deciding between an HSA and FSA depends on your medical and financial needs. The principal requirement for an HSA is enrollment in an HDHP. And while preventative care is covered before the deductible under HDHPs, most other care is not. That means you will have to pay for your medical expenses for you and your family out-of-pocket until you reach your deductible.

An HSA-eligible HDHP makes the most sense in two cases. First, if you or one of your family members has a condition that needs managing by either a specialist or with speciality prescriptions or treatments. In this case, you’ll likely exceed the deductible and be able to use HSA funds to save up 30% on out-of-pocket medical costs.

Secondly, if you rarely use the medical system except for routine preventative care (that includes vaccines and well visits for children) and really want the ability to use your pre-tax account as an investment vehicle to save for retirement. Then, an HSA/HDHP arrangement may be the best choice for you.

To make the best decision for you and your family, start by assessing your past medical needs and those you can project. Then take a look at your finances. Choose the account and health insurance plan arrangement that sits at the nexus of best health coverage and account flexibility.