Health Accounts

HSA vs. FSA vs. HRA

These arrangements can all help pay medical expenses, but they are not three versions of the same account. The durable way to compare them is ownership first, then funding, eligibility, access to funds, and what happens when employment ends.

Reviewed July 29, 2026 · Source-led practitioner reference

The comparison at a glance

Feature	HSA	Health FSA	HRA
Who owns or establishes it?	Individual-owned trust or custodial account	Employer-established cafeteria-plan arrangement	Employer-established reimbursement arrangement
Who funds it?	Employee, employer, or another person	Typically employee salary reduction; employer contributions may also apply	Employer only
Key eligibility condition	HSA-eligible individual with qualifying HDHP coverage and no disqualifying coverage	Eligibility under the employer’s written plan	Eligibility and integration rules depend on HRA design
Unused balance	Remains in the account	Plan may permit limited carryover or grace period; otherwise forfeiture rules apply	Plan may allow carryforward
Portable after employment?	Yes	Generally no, apart from applicable continuation or spend-down rules	Generally controlled by plan terms; not an employee-owned account

HSA: account plus eligibility rules

An HSA is a tax-exempt trust or custodial account. The individual must satisfy the HSA eligibility rules to contribute, including qualifying HDHP coverage. The HDHP is the health plan; the HSA is the account. Contributions can come from the individual, employer, or others, and qualified medical distributions are generally tax-free.

Health FSA: written-plan reimbursement arrangement

A health FSA is generally offered through a Section 125 cafeteria plan. The annual election is available for reimbursement under the uniform coverage rule even before the employee has contributed the full annual amount. Carryover and grace-period design are controlled by the plan and applicable guidance; a plan cannot simply promise both without checking the rules.

HRA: employer-funded by design

An HRA is funded solely by the employer. Employees cannot make HRA contributions through salary reduction. The plan sets the available reimbursement amount and eligible expense rules, and unused amounts may carry forward if the design permits. ICHRA, QSEHRA, excepted benefit HRA, and integrated HRA structures have additional rules—“HRA” alone does not identify the full design.

Administration trap: Before answering any account question, identify whether the fact pattern is about the health plan, the reimbursement arrangement, or the employee-owned account. Then apply that arrangement’s source and plan terms.

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Primary sources

Educational reference only. Plan documents, governing law, agency guidance, and plan-specific professional advice control.

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