Short answer: An HSA can pay tax-qualified LTC premiums tax-free up to the same age-based limits as the deduction (for 2026, from $500 to $6,200 per person). A health FSA cannot pay LTC premiums or LTC services. Most HRAs can reimburse LTC premiums within the limits, but not LTC services.
HSA money generally cannot pay insurance premiums, but long-term care insurance is one of the exceptions, along with COBRA, coverage while receiving unemployment, and Medicare at 65 or older. The LTC premium amount that counts is limited by age and adjusted annually: for 2026, $500 at 40 or under, $930 at 41 to 50, $1,860 at 51 to 60, $4,960 at 61 to 70 and $6,200 over 70. An HSA can also pay for qualified long-term care services.
A health FSA cannot reimburse long-term care insurance premiums or long-term care services. An HRA that counts as a flexible spending arrangement can reimburse LTC premiums within the age limits but cannot reimburse qualified long-term care services.
Owning LTC coverage does not affect HSA eligibility; long-term care is on the list of other coverage a person can have alongside an HDHP.