It’s open-enrollment season again, and at some companies, employees will need to choose whether they would like to sign up for a Health Savings Account (HSA), a Flexible Spending Account (FSA), or a Health Reimbursement Account (HRA). While it sounds like alphabet soup, it’s important to understand the differences. If you don’t, you could be leaving money on the table next year.

Here’s a quick breakdown on the three types of accounts, along with a few tips to find out whether they’re right for you:

Health Savings Account (HSA)

Health Savings Accounts, or HSAs, must be combined with a qualified high-deductible health insurance plan. This tax-advantaged account can be used to help pay your deductible, and any funds left in your savings account earn tax-deferred interest. Your contributions to your HSA are tax deductible, and withdrawals to pay for your qualified medical expenses are tax free. But here’s the best part: The money in your account is yours to keep – you don’t have to “use it or lose it” by the end of the year. I like to say that an HSA provides the benefit of a tax deduction AND lets you spend the funds on medical expenses tax-free. It’s like having your cake and eating it too!

How it Works

  • You decide how much to contribute, as long as the amount doesn’t exceed the maximum allowed by the government. (In 2022, for example, the limit is $3,650 for an individual and $7,300 for a family.)
  • Depending on your plan, you may receive either checks or a debit card for your HSA account to use for qualified medical expenses, including your deductible, any co-pays or co-insurance, or qualified medical expenses that your plan does not cover.
  • There are no deadlines for spending the money in your account.
  • If you are 55 or over you may make an additional contribution in the amount of $1,000 per year. If you are married and you are both55+, you can each contribute an additional $1,000.
  • Your HSA rolls over each year, unlike an FSA, which we’ll discuss later. If you reach the age of 65 and are on Medicare, you can still use your account to pay for out-of-pocket medical expenses, but you’ll no longer be allowed to contribute money to your account.
  • Once a year you may rollover the balance in your HSA account from your employer account to another, lower cost, better diversified HSA, and select and manage those investment options yourself.
  • If you change jobs, you can take your HSA with you.
  • You can also have an HSA if you are self-employed.

What to Check

  • Be sure to compare the coverage and the cost of your current plan with your high-deductible plan option to see which is less.
  • Since you can invest your HSA funds in mutual funds, stocks, or other types of investments, make sure your HSA offers low-cost funds that are reputable. Some companies require you to have a minimum balance in your account before you can invest (to ensure you’ll have the funds you need for a qualified medical expense). However, if you don’t anticipate needing the funds right away, it could be beneficial to look for an HSA that will let you invest right away, without a minimum.

Some employers contribute to their workers’ HSA accounts, so if yours does, a high-deductible insurance plan with an HSA could make better sense than a regular insurance plan.

Flexible Spending Account (FSA)

Also known as a Flexible Spending Arrangement, Flexible Spending Accounts may be offered by an employer in lieu of, or in addition to, a health insurance policy. As with an HSA, FSAs are funded pre-tax, by payroll deduction, which can lower the employee’s taxable income for the year. The contribution limit for FSAs in 2022 is $2,850, while the specified limit for dependent care accounts is $5,000 per year. Unlike HSAs, however, FSAs have a “use it or lose it” feature, meaning you forfeit any unused funds at the end of the year. Your employer may redirect your unused funds to administer the plan or credit the next year’s FSAs, but employers can also allow you to carry over a limited amount to the next year. (The 2022 carry-over amount is $570.)

How It Works

  • Employers fund the entire amount of an employee’s contribution at the beginning of the year, so the individual has funds to use for medical expenses. The employee then pays back the amount through payroll deductions.
  • At the end of the year, you may lose any remaining funds you haven’t spent.
  • As with an HSA, you may receive a debit card to pay for small medical expenses, such as co-pays, prescriptions and other fees. FSAs can be used to purchase certain non-prescription drugs, unlike other types of plans.
  • FSAs stay with the employer. They cannot move with you to another job.
  • Stand-alone FSAs (those without a major medical insurance plan) can only provide limited dental and vision benefits, and in certain cases may be used in conjunction with an HSA.

If you already have an HSA, you can’t also have a medical FSA. You can, however, use the dependent care feature with an HSA, and you may also use a limited FSA for eye and dental care.

What to Check

  • Some employers may offer “dependent care FSAs,” which enable individuals to pay for qualified child and dependent care expenses while lowering their taxable income.
  • Be sure you understand how your company’s FSA may be integrated with its HSA plan.

Health Reimbursement Account (HRA)

Many types of Health Reimbursement Accounts (also called Health Reimbursement Arrangements) exist, but we’ll focus on those that are linked with high-deductible health insurance plans. Employers may offer an HRA to employees and their families who enroll in the company’s group health insurance plan. An HRA differs from an HSA and FSA in that the employer is the only one who contributes, and, like an FSA, the employer owns the account.

How It Works

  • An employer determines how much to contribute to an HRA per employee.
  • The funds could be used to cover co-pays, deductibles, or insurance premiums.
  • Funds are available from the first day of coverage.
  • Unlike FSAs and HSAs, HRA funds do not accrue in a separate account. Employers reimburse employees after they have incurred an expense. Some HRAs are set up to pay only after an employee reaches his or her deductible. Reimbursements are not taxed.
  • Reimbursements to employees may be capped per individual for each year or for a total benefit.
  • Once the employer’s contribution is used up, employees must pay the balance of any expenses they incur. Depending on how the employer sets up the plan, someone who doesn’t spend the entire benefit may be able to roll the funds over to the next year.
  • HRAs stay with the employer.
  • Business owners are usually not eligible to participate in HRAs; however, employees (including spouses who are legitimate employees) can participate as long as they are receiving regular paychecks.

What to Check

  • Since HRAs can vary by employer, talk to your human resources department to learn more details about your company’s plan.

During this open enrollment period, take the time to study all of your options. In addition to protecting your health, you may also be able to improve your tax position and take advantage of funds contributed by your employer.

You should not assume that any discussion or information contained in this document serves as the receipt of, or as a substitute for, personalized investment advice from Savant. This is intended for informational purposes only.

Author Wayne B. Titus Financial Advisor / Managing Director

Wayne authored the book, "The Entrepreneur’s Guide to Financial Well-Being," and loves to educate others on financial, tax and investment topics by writing columns and through public speaking.

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