Comparing HSAs, HRAs, and FSAs

If you are interested in health spending accounts, this chart can help you learn the differences between an HSA, HRA, and FSA. For additional information on HSAs, HRAs, and FSAs, please view our Educational Videos.

  Health Savings Account (HSA)
(Member Owned)
Health Reimbursement
Arrangement (HRA)

(Employer Owned)
Flexible Spending Account (FSA)
(Employer Owned)
Who "owns" account? Individual (Member) Employer Employer
Account overview Member-owned bank account that allows members to pay for IRS-qualified, out-of-pocket medical expenses. Employer-funded, tax-advantaged arrangement which reimburses employees for IRS-qualified, out-of-pocket medical expenses. Tax-advantaged account established through an employer to pay for IRS-qualified, out-of-pocket medical expenses.
Who can contribute to account? Member, Employer, Third Party (i.e., spouse, parent, etc.) Employer only Employee, Employer
How are funds accessed? Distributions for IRS-qualified medical expenses are not taxable.*
  • Debit Card**
  • Request for distribution (paper)
  • Online bill-pay
Limited to IRS-qualified medical expenses per plan design
  • Debit Card**
  • "Claim" - Request for reimbursement or bill-pay
Limited to IRS-qualified medical expenses per plan design
  • Debit Card**
  • "Claim" - Request for reimbursement or bill-pay
Substantiation of expenses Member (not required for payment*) Third Party (required for payment unless auto-substantiated) Third Party (required for payment unless auto-substantiated)
Must have health plan? Yes, qualified High Deductible Health Plan (HDHP) whether through employer or not Yes, an HRA must be integrated unless limited to specific purpose benefits such as vision and dental. Yes, other group health plan coverage, not limited to excepted benefits, must be made available to employees.
Other health plan allowed? Only certain permissible coverage such as dental or limited purpose plan(s)*** Yes Yes
Tax Benefits? Deposits, earnings, and distributions for IRS-qualified medical expenses are tax-free Employer contributions and claim reimbursements are tax-free Contributions and claim reimbursements are tax-free
Can unused dollars rollover? Yes. Funds always belong to the member. If allowed per employer plan rules. Up to $500, if allowed per employer plan rules.
Access to funds after termination? Yes. When a member terminates or retires, they continue to maintain ownership of their HSA. When an employee terminates, they do not typically retain access to an HRA unless they elect COBRA continuation coverage. When an employee terminates, they do not remain eligible for an FSA, though limited COBRA rights may be available.
Can account be used for retirement income? Yes. After age 65, funds can be withdrawn for any reason without penalty, but will be taxed as income if not used for IRS-qualified medical expenses. No No

* HSA distributions for purposes other than IRS-qualified medical expenses defined in IRC § 213(d) may be subject to income and penalty taxes.

** HSA debit card restricted to IRC § 213(d).

*** Dental, vision, accident, disability, long-term care, workers' compensation, specified disease or illness, fixed dollar hospitalization, certain deductible plans.

This chart is intended to provide general information, but it is only a summary of the rules that apply and does not constitute legal or tax advice.