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Both health savings accounts (HSAs) and health reimbursement accounts (HRAs) offer tax-advantaged ways to save for future medical expenses. But they work in very different ways.

An HSA allows you to set aside money for healthcare costs that are not covered by your health insurance plan on a pre-tax basis. You must have a high-deductible health plan (HDHP) to open an HSA. With this option, you own the account and can take it with you if you leave your job.

An HRA, on the other hand, is a type of account that is owned by your employer. The company puts money into the account on your behalf, and you can use your HRA funds, tax-free, to cover qualified medical costs throughout the year. However, you can’t take the account with you if you leave your job.

If you’re looking for a way to reduce your healthcare costs, it’s a good idea to understand HSAs vs. HRAs. Then, provided you are eligible, you can decide which is the best option for you and your family. There is also a chance you can opt into both types of accounts.

Differences Between an HSA and HRA

HSAs and HRAs work differently than other types of ​​savings accounts. Here’s how these two types of accounts compare at a glance.

What Is an HSA?

A health savings account (HSA) allows employees and freelancers to put away funds pretax to be used for future medical expenses. There is one major requirement for an HSA: You must be enrolled in a high-deductible health plan (HDHP). For 2024, a HDHP is defined as having deductible of at least $1,600 for an individual and $3,200 for a family. In addition, the plan’s cap on yearly out-of-pocket expenses can’t exceed $8,050 for an individual or $16,100 for a family.

Your employer may offer an HDHP with an HSA as a workplace benefit. Or, if you enroll in health insurance through the private marketplace and choose an HDHP, you can typically open an HSA with a brokerage firm or other financial institution.

There are limits on how much you can contribute to an HSA. In 2024, those limits are:

•   Up to $4,150 to an HSA for self-only coverage

•   Up to $8,300 for family coverage

•   People age 55 and over can contribute an additional $1,000 annually

Unlike a flexible spending account (FSA), which also allows you to set aside a certain amount of money pretax for medical costs, the money in the HSA isn’t a “use it or lose it” proposition. The funds roll over every year, so there’s no rush to spend the money. In addition, you can take HSA with you should you leave your job.

You can use your HSA to directly pay for qualified medical expenses (typically using a debit card or via online payment), or you can collect receipts and reimburse yourself later. Any expense that is considered a deductible medical expense by the IRS qualifies. This includes doctor visits, prescription medications, dental and orthodontic treatments, lab tests, surgeries, hospital stays, hearing aids, and eyeglasses.

While an HSA is designed to cover immediate healthcare costs, many HSA providers allow you to invest a portion of your HSA funds in various investment vehicles, such as mutual funds, stocks, bonds, and exchange-traded funds (ETFs). These investments grow tax-free. You can access unused HSA funds during retirement for nonmedical expenses, but you will pay taxes on the funds.

Pros of an HSA

Here’s a look at some of the benefits of using an HSA.

•   Lowers your taxable income: Contributions are made with pretax dollars, often through payroll deductions by your employer. That means the money is not included in your gross income and is not subject to federal (and in most cases, state) income taxes.

•   Tax-free withdrawals: Withdrawals from your HSA are not subject to federal (and in most cases, state) taxes if you use them for qualified medical expenses.

•   Lower premiums: To qualify for an HSA, you must be enrolled in a HDHP, which means your monthly payments are likely lower than other types of health insurance plans.

•   Annual rollover: HSAs aren’t “use it or lose it.” You keep your money even if you don’t spend it in the year you contributed it.

•   Money can be invested and grow tax-free: Once you reach a required minimum balance (which can range from $500 and $3,000), you can choose to invest your HSA dollars.

•   Can boost retirement savings: After the age of 65, you can withdraw the funds for any purpose, not just qualified medical expenses. Using the funds this way makes them taxable, but does not carry a penalty.

•   You own the account: The money in an HSA is yours; you don’t forfeit it if you change jobs or are let go.

Cons of an HSA

There are also some potential disadvantages to HSAs. Here are some to consider.

•   Only allowed with a high-deductible health plan: If you don’t enroll in an HDHP, you can’t open an HSA.

•   Contribution limits: You can only contribute up to $4,150 for individual coverage and up to $8,300 for family coverage in one year.

•   May come with fees: Some HSAs charge maintenance fees, investment fees, paper statement fees, and per-transaction charges. It’s a good idea to ask for a complete schedule of fees before you choose an HSA.

•   Penalties for nonqualified expenses: If you withdraw money from your HSA to pay for anything other than qualified medical expenses before you turn 65, the withdrawal will be subject to taxes and a 20% penalty.

•   Limited investment options: You may have a limited choice of investment options within your HSA, which limits the potential returns you can earn.

•   Investments can lose money: Any investments you make with HSA funds could cause your balance to fall if the market drops.

•   Requires careful record keeping: It’s crucial to maintain accurate records of your expenses and HSA transactions for tax purposes. Keeping track of the transactions can be a chore.

Recommended: How Many Savings Accounts Should I Have?

What Is an HRA?

A health reimbursement account (HRA), sometimes referred to as a health reimbursement arrangement, is a job perk that some companies offer to workers to help make healthcare more affordable. The employer owns and funds the account. You do not need (nor are you allowed) to make any contributions to the account.

You can use the money in an HRA to pay for medical care you’d otherwise need to pay for out of pocket. The details, including how much is in the HRA and what type of medical expenses the funds can be used for, are determined by the employer.

In some cases, the HRA will reimburse the healthcare provider directly. In others, you might use a debit card associated with the HRA or pay for expenses out of pocket and then submit expenses and request reimbursement.

You are not taxed on the money your employer puts in your HRA, and you can withdraw the money for qualified medical expenses tax-free. However, you don’t own the account, can’t invest the money, and will lose the HRA if you leave your job (unless you choose COBRA continuing coverage).

In some cases, an employer might allow unused funds in an HRA to carry over from one year to the next, but they are not required to do so.

Pros of an HRA

Here’s a look at some of the key benefits of having an HRA.

•   Reduces your healthcare costs: You can withdraw money from the HRA to cover qualified medical expenses you’d otherwise have to pay for yourself. This may include deductibles, coinsurance, copayments, prescriptions, and more.

•   No high-deductible health plan requirement: You don’t need to enroll in a HDHP to have an HRA.

•   No contribution limits: There is no cap on how much money an employer can contribute to an HRA.

•   Some HRAs may cover insurance premiums: If you work for a small business that does not offer a group health plan, you may be able to use your HRA to purchase an individual health plan, as well as cover out-of-pocket expenses.

•   The HRA doesn’t count as income: Your employer’s contributions to an HRA do not count toward your gross income. And when you file a claim for a qualified medical expense, the reimbursement is tax-free.

•   Some HRA plans allow you to roll over unused funds to the next year. Your employer determines whether or not this option will be available.

Cons of an HRA

HRAs also have some downsides. Here are some to keep in mind.

•   You can’t contribute to an HRA: With this type of savings account, you are limited to whatever your employer contributes to the account.

•   Money in an HRA cannot be invested: This means that the funds will not grow over time.

•   You may lose the money if you don’t use it: In many cases, the money in the HRA must be spent the year it is contributed or you lose it. Employers can, but do not have to, allow some funds in your HRA to carry over to the next year.

•   You can’t take it with you. Your employer owns the account, and you lose your HRA money if you leave your job unless you elect COBRA coverage.

•   Inconsistent guidelines. HRAs are not standardized. As a result, an HRA offered by one company may have very different rules from an HRA offered at another company, which can lead to confusion.

•   Lack of availability. Not all companies offer HRAs. Also, self-employed people cannot participate in an HRA.

Which One Is Right for You?

When deciding if an HRA vs. HSA is better, the choice may be made for you. Many companies only offer one or the other. And if you’re self-employed, you won’t have access to an HRA.

If your employer offers both an HDHP and an HSA, as well as an HRA, you might be able to have both an HSA and an HRA. Generally, this is only possible if the employer’s HRA is limited in scope, such as one that only covers vision and dental expenses or just insurance premiums.

In this scenario, you may be able to contribute money into an HSA, where it can grow tax-free and potentially boost your retirement savings, while using the HRA to cover the cost of certain medical expenses. You can’t double dip, however, meaning you’re not allowed to get reimbursed by both accounts for the same expense.

In the end, whether to choose an HRA vs. an HSA will depend on which health saving plan (or plans) you are eligible to access and what type of health insurance you have.

The Takeaway

Health reimbursement accounts (HRAs) and health savings accounts (HSAs) can both reduce the cost of medical care that your health plan doesn’t cover, but they do so in different ways. The main difference between HRAs and HSAs is that you own and fund your HSA, while your employer owns and funds your HRA and can impose more limitations on it.
Whether your employer offers an HRA or an HSA, it’s a valuable workplace benefit. Both types of accounts help ensure you have funds you can tap to cover copays, high deductibles, and other out-of-pocket medical expenses.

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FAQ

Is it better to have an HRA or HSA?

It depends. Not everyone has access to a health reimbursement account (HRA); these accounts are created and funded by an employer as a workplace benefit. HRAs can cover a wide range of medical expenses, but funds are typically forfeited if you leave the company.

A health savings account (HSA), available with high-deductible health plans, allows you to contribute pretax dollars, grow the balance tax-free, and use the funds for qualified medical expenses. HSAs are portable and roll over annually.

The best option depends on your employment status, health insurance plan, and preference for control over the funds.

Can I use both an HRA and HSA?

Generally, having a health reimbursement account (HRA) disqualifies you from contributing to a health savings account (HSA). However, certain types of HRAs, such as limited-purpose HRAs, can be paired with an HSA. It’s essential to check with your employer and plan documents to understand the specific terms and ensure compliance with IRS guidelines.

Can I have an HSA if my husband has an HRA?

Not typically, but there are some exceptions. If you have a high-deductible health plan and your husband’s health reimbursement account (HRA) covers premiums-only or just certain types of medical expenses (such as only vision and dental), you may be eligible to contribute to a health saving account (HSA). You’ll want to verify the specific terms of the HRA to ensure compliance with HSA eligibility rules.

Photo credit: iStock/Nudphon Phuengsuwan

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