If you’re a business owner or an HR leader, you’ve probably sat through insurance provider meetings. Unfortunately, many of those meetings feel like you’re sitting through a lecture in the movie A Beautiful Mind.
The information is overwhelming and the stakes feel high, especially because you’re trying to make the best decisions for your company and people. One such decision is whether to offer FSAs or HSAs (or both), and you’ll need to understand how each impacts flexibility, eligibility, and your benefits plan strategy.
How are FSAs and HSAs Different?
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) both help employees save for medical expenses, but they differ in key ways.
FSAs are employer-owned, and funds are typically “use-it-or-lose-it,” meaning employees must spend the money within the plan year.
HSAs, on the other hand, are employee-owned, and unused funds roll over from year to year, allowing long-term savings. HSAs are only available to those with high-deductible health plans (HDHPs), while FSAs are more widely accessible.
What is an FSA?
A Flexible Spending Account (FSA) is a tax-advantaged account that allows employees to set aside pre-tax dollars to pay for eligible medical expenses, such as copayments, prescriptions, and certain over-the-counter items.
Unlike an HSA, an FSA is owned and managed by the employer. Funds are typically subject to a “use-it-or-lose-it” rule, meaning they must be spent within the plan year. However, some employers may offer a grace period or allow a small amount (up to $660 for 2025) to roll over into the following year.
FSAs are more widely accessible than HSAs because they don’t require enrollment in a specific type of health plan. However, they don’t provide the long-term savings benefits that HSAs offer since funds are tied to the current plan year.
Employer Contributions to FSAs
Employers can also contribute to employees’ FSAs to provide additional funds to help offset medical expenses. Note that these contributions are tax-deductible for the employer and excluded from the employee’s taxable income.
Consider offering FSA contributions to enhance your company’s benefits package to:
- Make healthcare more manageable for employees, particularly for those without access to an HSA.
- Demonstrate your investment in employee well-being.
- Attract and retain top talent.
TIP: Regularly remind employees that they need to use their FSA funds by the end of the year. They’ll appreciate the nudge: According to the Employee Benefit Research Institute (EBRI), $4 billion is lost yearly nationwide because funds aren’t used.
What is an HSA?
A Health Savings Account (HSA) is a tax-advantaged account designed to help individuals with high-deductible health plans (HDHPs) save for qualified medical expenses. Employees, employers, or both can make contributions to an HSA, which offers a triple tax advantage: contributions are pre-tax, funds grow tax-free, and withdrawals for eligible expenses are also tax-free.
Unlike FSAs, HSA funds roll over annually and remain the employee’s property, even if they change jobs. HSAs can also act as a long-term savings tool since unused funds can be invested, offering the potential for growth over time.
However, HSAs are only available to individuals enrolled in an HDHP, and the IRS sets annual contribution limits. For 2025, those limits are $4,300 for individuals and $8,550 for families.
Employer Contributions to HSAs
Employers can also contribute to employees’ HSAs to offer additional financial support for healthcare expenses and make HDHPs more appealing. These contributions are tax-deductible for the employer and tax-free for the employee, making them an attractive benefit for both parties.
Because Americans continue spending more each year on health care, employees will appreciate additional contributions and see it as an investment in their personal and professional futures.
TIP: Clearly communicate to employees that your employer deductions count toward their HSA contribution limits. You don’t want employees to miss out or hit their cap because of misinformation or wrong calculations!
What are Eligible Expenses for FSA and HSA?
FSAs and HSAs are designed to cover a wide range of healthcare-related expenses, but the specifics depend on IRS guidelines. Eligible expenses typically include costs like doctor visits, prescriptions, and medical supplies, but there are a few key differences to keep in mind.
- Eligible expenses for FSAs include medical, dental, and vision care, certain over-the-counter medications, and products like bandages and thermometers. If tied to a dependent care FSA, FSAs may also cover dependent care expenses, such as daycare or elder care costs.
- HSAs cover many of the same medical, dental, and vision expenses as FSAs but offer greater flexibility for long-term needs. For example, if you leave your job, HSA funds can be used for Medicare premiums, long-term care insurance, and even COBRA coverage. Additionally, if HSA funds are used after age 65 for non-medical expenses, they are subject to income tax but avoid the 20% penalty applied before that age.
Both accounts exclude expenses like cosmetic surgery or health club memberships.
TIP: Provide clear guidance to employees about eligible expenses and remind them to keep receipts for substantiation if needed. Often, employees can easily upload their receipts (if necessary) into their insurance app for quick turn-around and better organization.
FSA vs. HSA: Which Should Your Business Offer?
Deciding whether to offer an FSA, HSA, or both depends on your business’s goals, the needs of your workforce, and the type of health insurance plans you provide.
Note that age plays a major role in FSA and HSA utilization, so it’s critical to consider your multigenerational workforce as you build out your benefits plans. Make sure you’re building a benefits menu and collecting feedback to ensure all employees’ needs are met.
Here’s a breakdown to help guide your FSA and HSA decision:
- Health plan compatibility: If you offer high-deductible health plans (HDHPs), an HSA is a natural fit, as employees must have an HDHP to qualify. For businesses with other types of health plans, FSAs are a more flexible option since they aren’t tied to specific plan requirements.
- Employee financial needs: HSAs are ideal for employees who want a long-term savings tool and can afford to set aside larger contributions. FSAs, with their annual spending limits and use-it-or-lose-it features, are better suited for employees focused on short-term healthcare expenses.
- Employer contributions: Both accounts allow for employer contributions, but HSAs may offer a higher perceived value since funds roll over and grow tax-free. This feature can attract and retain employees who prioritize long-term financial planning.
- Administrative considerations: FSAs require more active management due to the annual reset and the potential for rollovers or grace periods. HSAs, on the other hand, are owned by employees and typically require less administrative oversight.
Ultimately, offering one or both options can enhance your benefits package and appeal to a broader range of employee needs. If you’re unsure which option is right for your business, consider surveying employees to understand their healthcare priorities or consulting with a benefits advisor to align your offerings with your company’s goals.