HSA vs FSA: Which is Better? [Comparison Chart Included]

Here’s the thing:

In light of past health care discussions on my blog and the fact that benefit re-enrollment period is up us, I thought I’d address a couple of tax-advantaged medical savings accounts:

Ready for a HSA vs FSA showdown? Strap in!

Who am I to offer up this comparison?

Well, I used a Flexible Spending Account for some time when I was employed and had a nice group health insurance plan.

Over the past couple of years, since becoming self-employed, I’ve learned a great deal about Health Savings Accounts.

Let’s look at what they are and how they can help you.

Save Money on Healthcare HSA vs FSA

Health Savings Account (HSA)

The Health Savings Account is like an IRA. You get to fund it with pre-tax dollars and it’s typically administered by a financial institution.

But unlike an IRA, you get to use the funds when you need them (not just in retirement) towards qualifying medical costs.

You also get to decide where the funds are invested. You get a lot of control with this account. Tax savings and growth.

Only certain people qualify. You must be enrolled in an HSA-eligible high-deductible health insurance plan. Unfortunately healthshare plans are not eligible.

Your annual contributions are limited. Check out this chart or visit my post on HSA contribution limits for more information.

Tax Year

Flexible Spending Account (FSA)

The Flexible Spending Account is a pre-tax dollars savings account your company administers where you’re allowed to save up a year’s worth of health care costs.

Most people use it to pay for deductibles, co-pays, and household health care items. It works like this:

At the beginning of the year (or during your benefit open enrollment) you must elect to open the account and save a specific dollar amount.

This account is funded automatically from your earnings at work. Your company will deduct the funds before taxes are calculated (pre-tax).

Throughout the year you’re allowed to spend the dollars you’ve accumulated in the account. The spending must be for qualifying health care costs.

Important: it’s a use-it-or-lose-it type plan. You must spend all the funds in the account or you lose them. Thus, people are normally very conservative with the amount they elect to fund the account.

The effect of using the account is big tax savings. If you normally spend $1,000 on “above coverage” health care costs in a year, you could save around $250 a year by using one of these accounts.

Things you might not have known were qualifying health care expenses (every plan is different, but these oddities are likely qualifying): Hand sanitizer, cold remedies (and other over the counter meds), sunscreen (like CoppertoneĀ®), and band aids.

Health Savings Account (HSA)
Flexible Spending Account (FSA)
Must be insured in order to use plan
May use funds toward qualifying medical costs only

Offered in conjunction with a high-deductible health insurance plans

Employers can deposit all or a portion of the deductible to use until the deductible is met
May contribute additional tax-free dollars taken from gross income
May transfer account if you switch jobs

Funds may be used in future years

Must declared fixed amount you would like your employer to deduct from your gross income
Must spend funds within tax year of contribution
Self-employed individuals do not qualify

Contribution limits
Use funds to pay for daycare
Can gain interest depending on the amount placed in the account and the length of time the funds go unused
Can not be receiving medicare or be claimed as a dependent

Contribute to an HSA and FSA at the Same Time?

You may also be able to contribute to an HSA in conjunction with an FSA if it is a limited purpose FSA. A limited purpose FSA only covers eligible dental and vision expenses, then allowing your HSA funds for medical expenses and savings.

What We Use: HSA vs FSA

Like I said above, we used to use an FSA, which we heavily funded each year for things like baby medical costs and prescription drugs.

However, we no longer qualify for an FSA because I’m now self-employed, Mrs PT is a stay at home Mom, and we can’t get on a low-deductible group health insurance plan.

So now we have an HSA through a local credit union.

Do you use these accounts? How have they worked out for you?

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  1. Avatar Liz@ChiefMomOfficer says:

    One minor update on the FSA – they’re no longer completely a “use it or lose it” plan. You can now roll over up to $500 in unused funds per year, if allowed by your employer. This was a change in just the past couple of years.

    Also one advantage to the FSA is that you get all the money upfront at the start of the year. With the HSA the balance grows as you contribute through your paychecks. This only matters if you either have a large expense at the start of the year or leave work mid-year.

    1. Avatar Philip Taylor says:

      Good catch, Liz. Our editors are currently working on getting this piece as up to date as possible. Appreciate your comment.

  2. Avatar Kim Russell Prato says:

    I know! Right? And they do the health screenings at work so there’s really no excuse for not getting the free money!

  3. I totally forgot to include info on the DCSA. Maybe I’ll do a whole post on that one. Hey, Kim Russell Prato, that’s pretty sweet about the $500. Not chump change.

  4. Avatar Kim Russell Prato says:

    Yes, I love using mine. I just started using them about 2 years ago and wish that I had started using them a lot earlier. The one for RP’s daycare expenses comes in so handy and the reimbursement that I get back after submitting a claim is like a fun payday for me! My employer has also started giving a “wellness credit” to employees who complete a 2-3 step physical. We get $500 that goes into our HSA!

  5. Avatar Joe Durika says:

    Love our HSA and our DCSA (dependent care spending account). The money is taken out pre-tax, so we have a $9,000 deduction right off the bat. Now if they would increase the DCSA limit to meet inflation, that would be awesome.

  6. We have used the FSA for years. It provides great tax savings and is available at any time….and we have never lost any money at the end of the year because we put in our prescription drug costs, deductibles and co-pays only.

    We are not able to use the FSA for OTC items. I think this was a change to the law? Not sure.

  7. Avatar Jenna, Adaptu Community Manager says:

    I didn’t use one last year, but I’m thinking about signing up for one this year. Know of any good calculators to do an estimate of how much one should be saving?

  8. Might want to double check me on this, but I think I read where OTC meds. will no longer qualify beginning 2012. At least for HSA.

  9. Avatar Jackie Walters says:

    Hi PT –

    We have an HSA and the long term idea behind them are great. We’ve never met our deductible which is a good thing but what money we have in the HSA account tends to get used up before we have a chance to actually save anything in it.


  10. Thanks for educating the general public about the health savings accounts and the flexible health savings account and how they differ and how they work. I was not even aware that these types of savings accounts were available. Now I do. It’s interesting way to save money for health related reasons.

  11. I have had an HSA with United Healthcare for 3 years now and I have and still am a huge fan of my HSA. I love the fact that the money in the account rolls over and that I can get an above the line tax deduction for everything I contribute into the account (up to the IRS limit).

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