While HRAs, HSAs, and FSAs all help employees save on out-of-pocket healthcare costs, they differ in who owns them, who can contribute, and how funds are accessed.
Hereās a quick comparison:
| Feature | HRA | HSA | FSA |
|---|---|---|---|
| Who Owns the Account | Employer | Employee | Employer (but funds are for employee use) |
| Who Can Contribute | Employer only | Employer and/or employee | Employee (employer can contribute, with limits) |
| Portability | Generally not portable (stays with employer) | Fully portable (stays with employee) | Not portable (use it or lose it) |
| Fund Availability | Set by employer; reimbursement-based | Grows over time; used as needed | Full annual amount available Day 1 |
| Rollover of Funds | Employer decides if unused funds roll over | Yes, funds roll over from year to year | Limited rollover or grace period allowed |
| Eligible Expenses | Set by employer (within IRS rules) | Set by IRS | Set by IRS |
| Must Be Paired with Health Plan? | Often, yes | Yes (must have HDHP) | No |
| Can Reimburse Premiums? | Sometimes (especially ICHRA/QSEHRA) | Only in limited situations | No |
š§ In Summary:
-
HRAs are employer-controlled and very flexible in design.
-
HSAs are employee-owned and come with long-term savings and tax advantagesābut require enrollment in a high-deductible health plan (HDHP).
-
FSAs are use-it-or-lose-it accounts with full access to funds upfront, but limited flexibility.