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HSA vs FSA: what is the difference?
Both let you pay medical expenses with pre-tax money. An HSA requires an HSA-eligible high deductible health plan and the funds stay yours to use at any time. An FSA is set up by your employer, which sets your limit, and unused money can be lost unless the plan allows a carryover or grace period.
Facts only, from 3 cited sources, checked October 23, 2026. This page does not recommend either option.
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HSA vs FSA side by side
| Health savings account | Flexible spending account | Source | |
|---|---|---|---|
| Who sets it up | You open it with a bank or other financial institution | Your employer | HealthCare.gov glossary: Health Savings Account (HSA) |
| Plan required | An HSA-eligible high deductible health plan | None in the HealthCare.gov definition | HealthCare.gov glossary: Health Savings Account (HSA) |
| Contribution limit | 2026: $4,400 self-only, $8,750 family; $1,000 extra at 55+ | 2025: $3,300 salary reduction limit | IRS Publication 969 (2025) |
| Unused money | Stays in the account; can be used any time for qualified expenses | Can be lost; 2025 carryover up to $660 if the plan allows it | IRS Publication 969 (2025) |
| Earnings | Interest and other earnings are not taxable | Not an investment account | HealthCare.gov glossary: Health Savings Account (HSA) |
| Paying premiums | Generally not allowed | Not listed among allowed expenses | HealthCare.gov glossary: Flexible Spending Account (FSA) |
| After Medicare enrollment | Contribution limit is zero | No Medicare rule in Publication 969's FSA section | IRS Publication 969 (2025) |
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Questions
What is the difference between HSA and FSA?
Both let you pay medical expenses with pre-tax money. An HSA requires an HSA-eligible high deductible health plan and the funds stay yours to use at any time. An FSA is set up by your employer, which sets your limit, and unused money can be lost unless the plan allows a carryover or grace period.
Can you have an HSA and an FSA at the same time?
Generally not with a general-purpose health FSA. IRS Publication 969 says an employee covered by an HDHP and a health FSA that pays qualified medical expenses generally can't contribute to an HSA; limited-purpose and post-deductible FSAs are exceptions.
What are the 2026 HSA limits?
$4,400 for self-only HDHP coverage and $8,750 for family coverage, plus $1,000 if you are 55 or older, per IRS Publication 969.