When you’re creating a competitive benefits plan for employees, good healthcare options should be a top priority. In addition to health, dental and vision insurance, many employers choose to offer employees supplemental tax-free accounts that can be used to pay for medical costs. Although the purposes of these accounts are similar, there are a few key distinctions that will determine which one is right for your company.
The primary differences between flexible spending accounts (FSAs) healthcare reimbursement arrangements (HRAs) and health savings accounts (HSAs) are based on their ownership, funding and legal requirements. Although each account type generally includes tax-free money, these funds are subject to different rules under the Internal Revenue Code.
Kathy Berger, certified employee benefits specialist (CEBS), said employers and their advisors should pay careful attention to all design, communication and administration requirements to avoid adverse tax consequences.
HSAs, FSAs and HRAs can be part of a competitive employee benefits package that helps attract skilled job candidates, retain your best employees, and maintain morale in your workplace.
A healthcare flexible spending account, also known as a flexible spending arrangement, is a type of savings account employers can set up for employees. These accounts are funded by employees through untaxed employee income contributions (up to $2,850 per year) and can be used to pay for qualifying medical, dental or vision expenses for themselves, their spouse and eligible dependents. The funds are relatively easy to access through a debit card.
Zane Dalal, executive vice president at Benefit Programs Administration, said that several different treatments, benefits and costs are considered qualifying expenses for today’s flexible spending accounts.
“FSA money can be used for acupuncture treatments, dental implants and even supplements if you receive a prescription from your doctor,” Dalal told Business News Daily. “Additionally, [it can be used to pay for medical costs that] insurance might not cover, like over-the-counter prescriptions, vaccines for travel or specific diagnostic tests. Some costs require reimbursement, like the purchase of frames for corrective glasses.”
FSAs have restrictions on when the money can be used. If an employee doesn’t spend the money in the account by the end of their plan year, they forfeit all remaining funds unless the employer determines otherwise. Employers can allow up to $570 of unused funds to roll over to the following year, or permit a grace period of up to 2.5 months. Employees who leave the company must forfeit all remaining funds, unless they are eligible for and choose COBRA continuation coverage.
FSAs are employer-owned savings accounts that employees fund (up to $2,850 annually) through tax-free contributions. They can be used to pay for eligible medical expenses for the employee, their spouse or their eligible dependents.
A health reimbursement account, also known as a health reimbursement arrangement, is a type of savings account that is set up and funded by employers for employees to use on eligible healthcare, dental, and vision expenses for themselves and their dependents. (Dependents must also be enrolled in the HRA.) Since the employer funds the HRA, they choose which expenses are eligible for reimbursement and how much of the account funds can roll over into the new year.
“If an HRA is offered along with an HDHP, lower premiums can result in reduced healthcare costs for employees,” said Dalal. “Individuals can typically use HRA funds to pay for deductibles, coinsurance, copayments and prescriptions, among other out-of-pocket healthcare expenses, depending on HRA plan details.”
Similar to FSA or HSA funds, the money in an HRA comes from tax-free contributions, but they are funded by the employer rather than the employee. Employers can claim a tax deduction for the reimbursements they make through these plans. The employer owns the account, so if an employee leaves the company, the HRA money stays with the employer.
Berger said the three basic types of HRAs are an original HRA, a qualified small employer HRA (QSEHRA) and an individual coverage HRA (ICHRA).
“With an original HRA, participating employees must also be enrolled in the employer’s traditional group medical plan,” said Berger. “A QSEHRA or ICHRA, on the other hand, is designed for situations where the employee does not have a group plan but purchases an individual insurance policy.”
HRAs are employer-owned accounts that employers fund with tax-free contributions. Employees can use their account to reimburse themselves for eligible medical expenses for themselves or their eligible dependents.
A health savings account is a type of personal savings account that is owned and funded by an employee through employee income contributions (up to $3,650 per year for individuals, up to $7,300 per year for families, and an additional $1,000 per year for employees 55 or older). HSA contributions are not taxed by the federal government or most states; however, there are some states — such as California and New Jersey — that do tax HSAs.
Since an HSA is funded and owned by the employee, they keep the money forever. That means there are no concerns for employees about spending all of the money before the end of the year or losing the money if they change employers. However, HSA accounts do have some limitations. For example, to be eligible for an HSA, an employee must be enrolled in an HDHP.
Dalal said the minimum annual deductible for an HDHP in 2022 was $1,400 for individuals and $2,800 for families.
“Although employees may withdraw funds from an HSA for any reason, if the withdrawal is for an unqualified medical expense, the employee will be subject to both income tax and a 20 percent penalty,” Dalal said. “Like with IRAs and retirement distributions, if the employee is over 65, there is no tax penalty, but the withdrawal will still be subject to income tax.”
HSAs are employee-owned savings accounts that employees with HDHPs fund (up to $3,650 per individual annually and up to $7,300 per family annually) through generally tax-free contributions. They can be used to pay for eligible medical expenses for the employee, their spouse or eligible dependents.
Any employee, unless otherwise specified by the employer
Employees enrolled in an HDHP
Employee-funded (employers may contribute)
Employee-funded (employers may contribute)
Tax-free by the federal government and most states (with the exception of California and New Jersey)
Money usage allowances
Self-reimbursement for eligible healthcare, dental and vision expenses for you, your spouse,and eligible dependents
Employer-determined eligible healthcare, dental and vision expenses for you and your dependents (must be enrolled in the HRA)
Eligible healthcare, dental and vision expenses for you, your spouse and eligible dependents
Fund rollover into the new year
Yes (up to $570 rollover or up to 2.5-month grace period for unused balance, if allowed by employer)
Yes (if allowed by employer)
Yes (rollover at end of plan year)
Portability after termination
Yes (HSA stays with account holder)
No. Unlike health savings accounts, you do not have to report your FSA on your income tax return. Since FSA contributions are made with pretax dollars, you cannot claim them as a tax deduction either. Any leftover FSA money forfeited at the end of the year cannot be listed as a loss, since it was taken pretax. Additionally, if you paid for a qualified medical expense with pretax dollars from your FSA, you cannot list it as an itemized deduction on Schedule A (Form 1040).
Although you don’t need to have an FSA and an HRA at the same time, it can be beneficial, especially if you have several medical expenses. Sometimes employers offer both account types to employees for maximum healthcare expense savings. Keep in mind that you can’t be reimbursed for the same expense from both accounts, and unless otherwise specified by the employer, employees should use the HRA to cover medical expenses before using the FSA.
Yes, a debit card is one option for accessing HRA funds. There are several ways to receive reimbursement through an HRA, including automatic payment to the provider, automatic payment to the member (paper checks or direct deposit), personalized pay, manual paper claims and a debit card. The benefits administrator determines which of these methods are available with your specific FSA plan. If you have a debit card, you can use it to cover eligible expenses without paying out of pocket or filing forms.
You should put in as much as you can without exceeding the limit. Employees with HSAs can only contribute up to $3,650 per year for individuals and up to $7,300 per year for families. Employees 55 and older have the option of contributing an additional $1,000 per year as catch-up funds. Any contributed funds that exceed those amounts are not tax deductible and are typically subject to a 6 percent excise. HSAs are beneficial for covering eligible medical expenses; since the account and any unused funds stay with the employee indefinitely, it is wise to contribute as much as you can afford.
The type of healthcare expense account you offer employees will partially depend on the type of health insurance plans you offer. For example, if an employee wants to access a standard HRA, they also need to be provided with a traditional group medical plan, whereas HSAs are only eligible for employees who have access to HDHPs specifically.
It is also important to consider how much you can invest in your employees’ health benefits. If you have a hefty budget, an employer-funded HRA may be the way to go, but if you are tight on cash or want to give employees more freedom with savings amounts, you may want to go with a plan that requires the employee to make contributions instead.
The best type of account for an organization to offer also depends on the demographics and needs of its employees, according to Dalal.
“One way to choose is to survey your employees, asking what they need,” said Dalal. “Are their healthcare expenses unpredictable and fluctuate year to year, or are they fairly common and easy to plan for? Does your company want to offer a high-deductible health plan, where it may make more sense to include a health savings plan?”
Depending on the health insurance your business offers to your employees, FSAs, HRAs and HSAs can also be part of the picture. Review this guide thoroughly to help you understand which options are available and how they can benefit your team and your business. With your healthcare options in place, you might pay less to help employees cover medical costs, and your team will likely be healthier. A healthy team is more likely to do great work.