Because of the constant yearly rise of health services and health insurance premiums, healthcare has become a large portion of everyone’s personal budget. However, as these costs have increased over the last few decades, medical savings accounts have come into play to help offset them. There are a few different accounts you can choose from to help you save money towards your healthcare, but we’re only going to be looking at 2 of them: Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). Both HSAs and FSAs are savings accounts that allow you to save specifically for medical expenses. Aside from that fact, the two accounts differ in a number of significant ways. In this article we’re going to compare and contrast them so you get an idea of what they are, how they work, and if one of them would be beneficial to you.
Health Savings Accounts (HSAs)
Health Savings Accounts are not typical savings accounts, and they are only available to people with a high-deductible health plan (HDHP). As of 2023 an HDHP is defined as any plan with a minimum deductible of $1,500 for individual coverage or $3,000 for family coverage with an out-of-pocket maximum of $7,500 and $15,000 respectively. An HSA is a triple tax advantaged account that can be used to pay for qualifying medical expenses. It’s known as “triple tax-advantaged” because your contributions to your account are not taxed, the money in the account is never taxed while it’s in the account, even if it earns interest or investment returns.
Additionally, as long as you use your HSA funds for qualified medical expenses, your withdrawals will also never be taxed. However, if you use your HSA funds for anything besides qualified medical expenses you will have a 20% tax penalty. Another great thing about HSAs is that you can actually invest your funds as well, similar to the way you would a 401K. This lets your HSA actually make you money, if you invest properly you could end up with a nice health savings account keeping you from having to pay for little to any of your healthcare.
How HSAs Work
If you open an HSA with your HDHP, you will deposit money into the HSA that you can use to pay for qualified medical expenses that your health plan does not cover. Which are any services that the IRS recognizes as a eligible medical costs these expenses include:
- Acupuncture
- Ambulance services
- Birth control/contraceptive devices
- Blood pressure monitors
- Blood sugar test kits/test strips
- Chiropractic therapy/exams/adjustments
- Contact lenses
- Copayments
- Dental care
- Dermatological services
- Diagnostic services
- Eye exams
- Eye surgery
- Flu shots
- Gynecological care
- Incontinence supplies
- Infertility treatments
- Insulin and diabetic supplies
- Laboratory fees
- Lactation expenses
- Legal sterilization
- Laser eye surgery/ LASIK
- Menstrual care products
- Nasal strips
- Obstetric care
- Over the counter (OTC) treatments containing medicine (i.e., cold treatments, pain relievers, sinus medications, etc.)
- Physical exams
- Pregnancy test kits
- Smoking cessation programs
- Therapy or counseling
- Treatment for alcohol or drug dependency
- Vaccinations
- Vision care
- Wrist supports/elastic straps
- X-ray fees
You can use the HSA funds to pay all your medical bills until you reach your plan’s deductible, and then you can use them to cover your coinsurance or copayments until you reach your annual out-of-pocket maximum. Additionally, unlike other health spending accounts, HSA funds will never expire. Your funds roll over into the new year, every year so you don’t have to rush to spend the money in the account. One thing you should note though, is that HSAs do have a contribution limit, these limits change annually but as of 2023 if you have an individual plan you can only contribute up to $3,850 for the year. For family plans the limit is $7,750.
Flexible Spending Accounts (FSAs)
A Flexible Spending Account, sometimes called a Flexible Spending Arrangement, is a type of savings account that offers you specific tax advantages. You don’t actually set these accounts up, instead they are set up by your employer. FSAs let you contribute a portion of your pay into the account. Your employer can also choose to contribute to the FSA on your behalf, sort of like when your employer matches your 401K except the employer decides exactly how much they contribute. The FSA funds are then used to reimburse you for eligible medical and dental expenses.
How FSAs Work
An FSA is a voluntary plan that allows employees to contribute up to $3,050 a year (as of 2023) to pay for eligible medical expenses that are not covered by their health insurance plan such as:
- Health insurance copayments
- Doctor’s visits
- Coinsurance payments
- Dental work
- Vision expenses
- Prescriptions
- Therapy and counseling services
- Chiropractic care
- Acupuncture
- Hospital fees
- Surgery costs
- Diagnostic services
- Allergy testing
If your employer offers group health insurance they can also offer these FSA plans as an additional employment benefit. Your employer can choose to also contribute to your FSA, they can choose to match your contributions or decide to pay a smaller amount. They are not required to contribute though, so some employers might not add into your FSA at all. If your employer does choose to contribute, their contribution typically won’t count towards your yearly limit no matter how much they contribute.
The Differences
You can’t have both of these plans at the same time, so if your employer offers an FSA but you’re also considering an HSA, you’ll want to keep these key differences in mind when you’re making your decision.
Qualifications
Compared to FSAs, HSAs have stricter eligibility requirements. To qualify for an HSA, you must have an HDHP. The HDHP has to be your only health insurance. Additionally if you are eligible for Medicare or are a claimed dependent on someone else’s taxes you can not open an HSA. On the other hand FSAs have to be set up by your employer, which automatically excludes self-employed or unemployed people. Your employer does have some qualifications they have to meet to be able to offer FSAs. For example they can only contribute to employee FSAs if they own less than 2% of the company. However, if they already offer these plans then there’s no other eligibility requirement on your end, all employees are eligible even ones without health insurance plans.
Annual contribution limits
Since contributions to these accounts are tax free they lower your taxable income. Because of this the IRS has placed limits on these plans. For FSAs the contribution limit is $3,050 as of 2023. For HSAs it’s $3,850 for individual plans and $7,750 for family plans.
Rollover rules
One of the biggest advantages of an HSA is that your funds roll over, meaning there are no time restrictions on using your funds. Since the account belongs to you, you get to decide when and how to use the funds. However for FSAs it’s not as simple. Unused funds are not automatically carried over into the new year. Since your employer owns the plan they decide what happens to the funds. Employers have 3 choices when it comes to rolling funds over:
- Forfeiture – This means any unused funds will not roll over. Instead, they will be transferred to the employer.
- Grace period – This is a 2 ½ month period after the plan year ends to use the last of the fund in the account, after this time frame, the funds then go to your employer.
- Carryover- This allows employees to take $500 of the unused money over to the new year’s plan. Any funds left in the account after the $500 is carried over goes to the employer.
Changing contribution amounts
This is another point where HSAs are simple. You can contribute any amount you want at any time, you don’t have to keep the same contribution every time. Whereas with FSAs your contribution amount stays the same through the year. You can only change your contribution amount 3 times. First at open enrollment, when the plan renews you can decide to change your contribution amount for the new year. Next is if there is a change to your family situation such as a marriage, death, or birth you will be allowed to adjust the amount. Lastly, if you change employers when you enroll in your new employer’s health plan, assuming they offer one, you can select your new contribution amount since it’s an entirely new FSA.
Keeping your account when changing jobs
Unlike FSAs, HSAs follow you no matter how many times you change jobs because your account belongs to you. With FSA’s, they belong to your employer so unless you qualify for COBRA, you will no longer have access to your FSA if you leave your job.
Which Is Better?
If you qualify, the higher contribution limits and contribution rollover of HSAs make it the better option overall. HSAs are more flexible than FSAs, allowing you to save money over time for potential medical expenses. However, unless your job allows you to roll over $500 annually, your FSA balance will not build up over time. Depending on your employer’s decisions, unused funds are generally forfeited to your employer at the end of this year, meaning if you didn’t have many medical expenses for that year you could be losing money.
However, most of the time choosing between them is more dependent on your situation rather than which one you actually prefer to have. This is because the decision will depend if your employer even offers an FSA and whether or not your health insurance plan is an HDHP.
Getting Help With EZ
Both of these options can be excellent tax-free ways to save, invest, and pay for medical expenses, and EZ can help if you’re interested in HSAs. If you choose an HDHP, open an HSA as soon as you are eligible and begin contributing. Since these accounts continue to be one of the most effective ways to reduce expenses and improve your overall financial standing. To begin saving immediately, enter your zip code in the box below to receive free instant quotes. Or, contact one of our licensed agents at 877-670-3557.
If you’re looking for a 
As mentioned above, if you choose a HDHP, you will have a plan with a high deductible. But lower monthly premiums. This means that if you know that you will most likely only use the plan for preventive care rather than more extensive medical treatment. You could save money by going with a HDHP. 
Having a plan with a low deductible means you’ll have less to pay out-of-pocket if you need to access healthcare services more frequently, or if you have a true emergency or a catastrophic illness or injury, both of which can be very expensive. People who are older or who have a medical history that includes chronic conditions or illnesses may find that selecting a plan with a low deductible is the better option for them. 
