HSA and FSA: How to Know the Difference

Finding Health Insurance, Health
3 Things to Consider Before Choosing a Health Insurance Plan with an HSA

Trying to choose between a health savings account (HSA) and a flexible spending arrangement (FSA) can be enough to make your eyes cross. In some ways, they’re very similar: they’re both accounts you can contribute to tax-free to save for medical costs. In other ways, they’re very different, and with several key differences between HSAs and FSAs, it literally pays to get this decision right.

Both HSAs and FSAs allow people with health insurance to set aside money for health care costs referred to as “qualified expenses,” including deductibles, copayments and coinsurance, and monthly prescription costs. Sometimes employers will also contribute funds to these accounts. In most cases, you receive a debit card for your account and can use it to pay for qualifying expenses throughout the year. Both types of accounts have tax benefits, too, although those benefits aren’t the same.

In general, electing to sign up for an HSA or FSA is smart. Knowing which one to select and how to get the most out of it will take some education.

Are you eligible for an HSA?

Health savings accounts are not available to everyone. This is the first key difference, and if you aren’t eligible for an HSA, it makes your decision much easier. Only people who have a high-deductible health plan, or HDHP, can select an HSA.

For 2018, an HDHP must have a deductible of $1,350 or more for an individual or $2,700 or more for a family. These plans also cap the amount you can spend in a year out-of-pocket for covered services at $6,550 for an individual and $13,100 for a family.

To qualify for an HSA, this HDHP must be your only health insurance plan, you must not be eligible for Medicare and you cannot be claimed as a dependent on someone else’s tax return. Not all plans with deductibles over these limits qualify for HSAs, so it’s important to check with the insurer before you buy.

Important differences between HSAs and FSAs

As you can see in the following table, there are several additional differences between these accounts. Things like your flexibility in contributing, the ability to keep your unused balance and additional tax benefits make HSAs the wisest choice if you have the option. Still, either account stands to save you money and make budgeting for medical costs easier.

 Health savings account (HSA)Flexible spending arrangement (FSA)
Eligibility requirementsEligibility requirements include having a high-deductible health plan (HDHP)No eligibility requirements
Contribution limit2018 contributions capped at $3,450 for individuals or $6,900 for families2018 contributions capped at $2,650
Changing contribution amount  You can change how much you contribute to the account at any point during the year.Contribution amounts can be adjusted only at open enrollment or with a change in employment or family status.
Rollover Unused balances roll over into the next year.With some exceptions, FSAs are “use it or lose it,” and you forfeit any unused balance.
Connection to employer Your HSA can follow you as you change employment.In most cases, you’ll lose your FSA with a job change. One exception: if you’re eligible for FSA continuation through COBRA.
Effect on taxes Contributions are tax-deductible, but can also be taken out of your pay pretax. Growth and distributions are tax-free.Contributions are pretax, and distributions are untaxed.

You cannot choose both, unless …

If you qualify for an HSA, you cannot elect to set up both an HSA and an FSA, unless the FSA is a “limited purpose” FSA. Your HR representative will be able to tell you if this is the case at your new job.

A limited purpose FSA works like a regular FSA but can be used only for vision care and dental expenses. If you expect to have high medical costs throughout the year, or want to maximize contributions to your HSA while minimizing your withdrawals, using a limited purpose FSA for expected vision and dental expenses could be a smart choice.

Which should you choose?

Both accounts have benefits that can make managing your out-of-pocket medical expenses easier throughout the year. But you should opt for an HSA if you qualify, if for no other reason than the limits are higher and you can carry over your contributions from year to year. If you don’t qualify, sign up for the FSA.

A good rule of thumb as you begin thinking about how much to contribute: Start with enough to cover your deductible, expected medication costs, anticipated doctor’s visits and any planned treatments or surgeries. Also, don’t be afraid to ask your HR representative as you come across questions; you can’t be expected to know all of the ins and outs of your new benefits.

Updated Oct. 24, 2017.