Compare HSAs to FSAs to HRAs

Account Structure

Tax-exempt custodial account (usually checking) used for qualified medical, dental, or vision expenses for the owner of the account (primary insured), their spouse, or dependent children.

A cafeteria plan to reimburse qualified medical expenses, dental or vision expenses, and expenses related to child care. Funds revert to the employer if not used during a specified time period.

An employer funded account used to reimburse employees for qualified medical expenses.

Eligibility

The four rules of eligibility apply.

Eligible exclusively through an employer-sponsored arrangement.

Available to employees by their employer exclusively.

Funding

Funding can be done through payroll deduction, by an employer as a "gift" of dollars, and from other external sources. Election amount can be changed or stopped. Funds are not available until they are deposited.

Funding is an election for payroll deduction at the beginning of a calendar year, or when the plan is effective. Once the amount is established by the employee, it may not be changed. Funds are available to be borrowed against prior to deposit by the employee.

Employer only - employees do not own or control funds.

Health Plan Requirements

Corresponding health plan requirement is an HSA qualified HDHP.

No corresponding health plan requirements.

No corresponding health plan requirements.

Contribution Limits:

Contributions for the current year can be made until April 15 of the next year. 

Contribution information provided by the IRS.

Individuals age 55 or older can make an additional $1,000 per year catch-up contribution to their HSA.

Both employers and employees may contribute, but not in excess of the Annual Contribution Limit.

Only the employer may contribute to the HRA. There are no limits to the amount.

Employer Monitoring

Employer is not obligated to verify that expenses paid from an HSA are qualified.

The employer needs to verify that expenses are qualified, and provide reimbursement for the FSA. In order to do this, most employers hire an external TPA where employees submit claims for reimbursement.

The employer is obligated to ensure that expenses are qualified medical expenses, and most hire an external TPA to administer.

Portability

HSAs are portable.

FSAs are not portable. They can, however, have balances transferred into an HSA if the employer will allow. Otherwise the employee forfeits the dollars at the end of the FSA term.

HRA accounts are portable at the discretion or the employer.

Beneficiary Eligibility

A Health Savings Account can be left to a beneficiary.

FSAs are not eligible to be given to a beneficiary; employees forfeit balances.

An HRA may be passed to a beneficiary at the employer's discretion.

Tax Status

Employee contributions to an HSA are tax deductible, and any funds directly from the employer deposited on the employees' behalf are not taxed as income for the employee.

With FSAs, there are no federal, Social Security, or state taxes (in most states) for employees. No FICA or unemployment taxes for employees.

Employer contributions to an HRA are generally excluded from an employee's gross income. In the event an employer distributes funds as a death, severance, or termination benefit, the funds do not qualify as an expense deduction.

Interest Earnings

Interest accrues tax-free in an HSA

No interest paid for FSA funds

No interest paid on HRA funds