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Health Savings Accounts

 

Introduction

A High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) provides traditional medical coverage and a triple-tax advantaged way to help you build savings for future medical expenses while providing you greater flexibility and discretion over how you use your health care benefits.  The tax advantages are that you may contribute funds to your HSA for a tax-deduction, earn interest on the account tax-free, and withdrawals are not taxed for qualified medical expenses.

An HDHP may have higher annual deductibles than a traditional health plan. With the exception of preventive care, you must meet the annual deductible before the plan pays benefits. You pay nothing for preventive care services  received from an in-network provider.

When you enroll in an HDHP, the health plan will ask questions to determine if you are eligible for a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). If you are eligible for an HSA, the plan credits a portion of the health plan premium into your account each month.  You may also contribute to your HSA up to the IRS maximum amount. You choose whether to use your HSA funds to pay for your qualified medical expenses under your deductible or to leave in the account to continue to draw interest tax-free.  Even if you change plans, the HSA is yours to keep. Withdrawals from an HSA aren’t taxed as long as they are used to pay for qualified medical expenses. 

If you are enrolled in Medicare, you are not eligible for an HSA. The Plan will provide an HRA instead.   If you are provided an HRA, the plan will credit you a set amount at the beginning of the year. You are also protected by out-of-pocket maximums. The maximum out-of- pocket limits for HDHPs are based on IRS rules.

For more information please review our HDHP FastFacts.

Health Savings Account (HSA)

Health Savings Accounts (HSAs) are available to members who enroll in a high deductible health plan (HDHP), are not enrolled in Medicare or another health plan, and are not claimed as a dependent on someone else’s Federal tax return.   The health plan passes through a portion of the health plan premium as a deposit to the HSA each month.  The pass through contribution amount is different for a Self Only enrollment than for a Self Plus One or Self and Family enrollment.   You have the option to make additional, voluntary tax–free contributions to your account, up to the maximum established by law.    Federal employees who are enrolled in HDHPs can make pre–tax allotments to their HSAs through their payroll provider or through their health plan’s HSA trustee..   The funds in your HSA can be used to pay for your cost share for your deductible or other qualified medical expenses.

Features of an HSA include:

  • Your own HSA contributions are tax–deductible or pre–tax (if made by payroll deduction). See IRS Publication 969.
  • Interest earned on your account is tax–free
  • Withdrawals for qualified medical expenses are tax–free
  • Unused funds and interest are carried over, without limit, from year to year
  • You own the HSA and it is yours to keep — even when you change plans or retire
  • Your HSA is administered by a trustee/custodian

Health Reimbursement Arrangement (HRA)

If you select an HSA-qualified high deductible health plan (HDHP) and you are not eligible for an HSA, you will be given an HRA.  This is not a bank account, but a virtual fund that receives the premium pass through credits from your health plan.   The premium pass through credits are the same as the HSAs in the same plan.  Most health plans credit the funds to the HRA on an annual basis in January.  Funds in your account will help pay your qualified medical expenses, including Medicare premiums or other qualified medical expenses not covered by your health 

Features of an HRA include:

  • Tax-free withdrawals for qualified medical expenses
  • Carryover of unused credits, without limit, from year to year
  • You can have an HRA if you’re enrolled in Medicare or a healthcare flexible spending account (HCFSA)Credits in an HRA do not earn interest
  • Credits in an HRA are forfeited if you switch health plans, or if you leave federal employment other than to retire
  • Your HRA is administered by the health plan
  • You cannot make voluntary contributions to the HRA

Limited Expense Health Care Flexible Spending Account (LEX HCFSA)

FSAFEDS offers a Limited Expense Health Care Flexible Spending Account (LEX HCFSA) for eligible employees in FEHB high deductible health plans (HDHP) with a health savings account (HSA).  Under IRS rules, federal employees enrolled in high deductible health plans (HDHP) with health savings accounts (HSA) are unable to have a healthcare flexible spending account.  However, they are able to enroll in a limited expense health care flexible spending account (LEX HCFSA) to help cover their eligible dental and vision care expenses. .

WageWorks, Inc. (the third party administrator for FSAFEDS) administers the LEX HCFSA accounts.

To enroll in a LEX HCFSA (during the annual Federal Benefits Open Season or within 60 days after becoming a newly hired or newly eligible employee), go to www.FSAFEDS.com.

Comparison Chart

Comparison Chart for Health Savings Account, Health Reimbursement Arrangement, Health Care Flexible Spending Account, and Limited Expense Health Care Flexible Spending Account

Topic HSA HRA HCFSA LEX HCFSA
What does the acronym stand for? Health Savings Account Health Reimbursement Arrangement Health Care Flexible Spending Account under the FSAFEDS Program Limited Expense Health Care Flexible Spending Account under the FSAFEDS Program
Legal Authority Medicare Prescription Drug, Improvement, & Modernization Act of 2003 and supplemental guidance from the IRS IRS Guidance 2002-45 Internal Revenue Code Section 125 Same as HCFSA
Who is eligible? The FEHB member must be enrolled in a High Deductible Health Plan (HDHP). The member may not be enrolled in other general medical insurance coverage, an FSAFEDS Health Care Account, or Medicare and may not be claimed as a dependent on another person's tax return (but may be a spouse filing jointly). The FEHB member must be enrolled in an HDHP.  HDHP enrollees who are not eligible for an HSA are provided an HRA. Federal employees in executive branch agencies and other agencies offering FSAFEDS are eligible for an HCFSA.  Except for members of Congress and congressional staff members, employees must also be eligible to enroll in FEHB to be eligible for an HCFSA. The LEX HCFSA is designed for employees eligible for the  FSAFEDS Program who are enrolled in an HDHP with HSA.
Who "owns" it? FEHB member The health plan Employee Employee
Source of Funds The health plan's monthly "premium pass through" is deposited into the member's account. Individual voluntary contributions can be made directly to the account to bring the account to the maximum amount.  The health plan credits a portion of the premium to the HRA. FEHB health plans may credit the annual amount at the beginning of the plan year. Individual contributions are not allowed. The employee funds the account. The employee makes an annual election (up to $2,700 since 2019). The election is divided into allotments based on the number of pay dates in the plan year. Every pay date, an allotment is deposited directly into the employee's account.  Same as HCFSA.
Will my balance be forfeited after a certain amount of time? No.

The health plan's credits must be used wfor qualified medical expenses while the member is covered by that plan. Unused credits are forfeited if the member terminates employment, (other than retirement) or changes health plans.

 Yes. Unused balances are forfeited except that qualifying employees may carry over up to $500 to an HCFSA in the next benefit year. Expenses must be incurred by the end of the 12 month benefit period (or by termination of employment, if before the end of the benefit period) and claims must be filed by the deadline. Otherwise, the employee loses unused funds in excess of $500, or all unused funds if the employee does not qualify for carryover. Same as HCFSA.
Can unused amounts carry over from year to year? Yes. The FEHB member owns the account and any contributions made to it, regardless of the source or timing of the contribution. Yes. Unused credits carry over year to year as long as the FEHB member remains in the sponsoring health plan. Employees can carry over up to $500 into another HCFSA in the next benefit year.  To qualify, employees must be employed by an FSAFEDS participating agency and making payroll contributions though December 31st.  Employees must also actively re-enroll in an HCFSA for the next benefit year. Claims for reimbursement must be submitted by April 30 following the end of the Plan Year. Same as HCFSA.
What type(s) of corresponding health plan is allowed?

HSAs are only available with an HDHP. An HDHP has:

  • a minimum annual deductible of $1,350 for Self and $2,700 for Self and Family coverage and
  • a maximum annual out of pocket limit of $6,650 for Self and $13,300 for Self and Family.
Amounts/limits are indexed for inflation.		 HRAs are available with an HDHP for those not eligible for an HSA.  Employees who are not enrolled in FEHB can still enroll in an HCFSA.  This account is designed for employees enrolled in an HDHP with an HSA.
Is the account portable? Yes. The FEHB member owns the account and keeps the account even if the member changes health plans or leaves Federal employment.  Credits in an HRA are forfeited if the member leaves Federal employment (except for retirement) or changes plans. Only if the employee transfers between agencies that both participate in FSAFEDS. Same as HCFSA.
Does interest accrue? Interest accrues on a tax-free basis in qualified HSAs. Credits in an HRA do not earn interest. Interest does not accrue. Same as HCFSA.
Who determines the contribution amount? The health plan determines the amount of the annual "premium pass through." Individual voluntary contributions plus the annual "premium pass through" may not exceed the total annual contributions allowed by the IRS.  For 2018, HSA holders can choose to save up to $3,500 for an individual and $7,000 for a family (including contributions from their health plan).   The health plan determines the portion of the health plan premium credited to the HRA. The credit to the HRA is not taxable income to the FEHB member. Individual contributions are not allowed. OPM determines the minimum and maximum annual amount each employee can contribute. Within these amounts, the employee decides how much to contribute. Since 2018, the minimum annual contribution is $100 and the maximum is $2,700. Same as HCFSA.
Is there a "catch up" contribution provision for older workers? Yes, an additional $1,000 contribution is allowed. These contributions "above the line" deductions on the member's Federal income tax. FEHB members from ages 55 up to age 65 may contribute the catch up contribution to their account per year, until they are enrolled in Medicare (age 65).  No. No. No.
Will my salary contributions be a pre-tax reduction to fund my account? Eligible Federal employees who are enrolled in HDHPs can make pre-tax allotments to their HSAs through their payroll self service system.   Your own voluntary HSA contributions are either tax- deductible or pre-tax (if made by payroll deduction).  See IRS Publication 969 Not applicable. Yes. Yes.
What is the tax treatment for FEHB members? An FEHB member's voluntary contributions are tax deductible, up to the annual maximum allowable amount. Account distributions are tax-free as long as funds are spent on qualified medical expenses. Reimbursements are limited to qualified medical expenses and are tax-free.  Employee contributions to an HCFSA are pre-tax and therefore reduce annual taxable income, including FICA taxes. Reimbursements are only allowed for eligible medical expenses. Same as HCFSA, except reimbursements are only allowed for eligible dental and vision expenses.
What expenses qualify for distribution? Qualified medical expenses defined under §213(d) of the Internal Revenue Code (IRC), except for amounts distributed to pay health insurance premiums. HSAs can be used to pay premiums for (1) Temporary Continuation of Coverage (TCC), (2) Long Term Care Insurance (3) retiree health insurance premiums including Medicare after age 65 (4) health insurance premiums while receiving unemployment compensation. Qualified medical expenses defined under §213(d) of the Internal Revenue Code (IRC) (including health care, Medicare insurance premiums and qualified Long Term Care Insurance premiums) except for medical expenses explicitly prohibited from reimbursement by FEHB law. Eligible medical expenses are listed on www.FSAFEDS.gov. Eligible dental and vision care expenses are listed on www.FSAFEDS.gov.
Can funds be used for non-medical expenses? Yes, but non-health care distributions are included in gross income and subject to a 20% penalty if under age 65. No. No. No.
Must a medical expense be incurred during the plan year that the contribution is made? No. However, reimbursements cannot be made for expenses incurred prior to the establishment of the account. No. However,  reimbursements cannot be made for expenses incurred prior the effective date of plan enrollment. Expenses must be incurred between the effective date of enrollment and December 31st and claims must be filed by April 30th following the end of the Plan Year to be eligible for reimbursement. Same as HCFSA.
Is the annual amount of the contribution available on the first day of coverage? No. Only the amount of the accumulating health plan monthly "premium pass through" and the individual's voluntary contributions to date are available for reimbursement. It depends on the way the health plan chooses to administer this benefit.  Please check your plan brochure for the full statement of benefits. Yes. The annual amount the employee elected is available on the first day of coverage regardless of the amount contributed by the date of the reimbursement request. Same as HCFSA.
Is proof of expenses required? No, however the member should be prepared to substantiate to the IRS the expense has been incurred, the amount of the expense, and its eligibility. Yes. IRS regulations governing HRAs require each claim be substantiated by an "explanation of benefits" statement or through itemized receipts. Yes. IRS regulations governing HCFSAs require each claim be substantiated by an "explanation of benefits" statement or through itemized receipts.  Same as HCFSA.
Can it be integrated with other accounts? Members are not eligible for an HSA if they have other health insurance that is not also a high deductible health plan, unless it is a limited expense HCFSA.  If the FEHB member is enrolled in an HDHP with an HSA, participation in a general HCFSA is not allowed.  Yes. If the FEHB member is enrolled in an HDHP with participation in an HCFSA is allowed. Also, if HSA eligibility is lost during the plan year, the member may then have an HRA. Yes. HCFSA enrollees can have HRAs, but not HSAs. Yes. LEX HCFSA enrollees can have HSAs.

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Health Savings Plan Worksheet

High Deductible Health Plans (HDHP) with a Health Savings Account (HSA) allow you to set up a savings account in which you can accumulate additional money on a tax deductible basis to pay for current or future medical expenses. Both the Government (through a pass-through by way of your health plan) and you can contribute.

While HDHPs with HSAs may seem similar to health care flexible spending accounts (FSAs) and traditional insurance, because both enable you to pay for eligible medical expenses with tax-free dollars, the funds in an HSA can accumulate without limit year after year, while the funds in a FSA must be used every year or else they are forfeited.

HDHPs provide you comprehensive health benefits coverage for major medical costs in a tax-advantaged way plus they help you build savings, through your HSA, for future medical expenses. After you meet the plan's annual high deductible, your HDHP pays benefits like traditional health benefits plans.

HDHPs with HSAs give you greater control over how your health care dollars are spent-both out-of-pocket and funds from your HSA. As with most health benefit plans, HDHPs provide more cost-effective coverage when you use network providers.

This is how an HDHP works -

  1. You enroll in an HDHP under the FEHBP.
  2. Your plan establishes an HSA with a fiduciary (each HDHP has more information on how this step works).
  3. Your plan contributes money into your HSA (the premium pass through).
  4. You can make additional tax-deductible contributions into your HSA, up to the maximum allowed for that plan, generally the plan's deductible.
  5. When you need preventive care, your plan will provide it without cost to you, subject to any limits outlined in the plan's brochure.
  6. When you need non-preventive health care, you pay the full cost of that care with funds from your HSA or out of pocket, up to your plan's high deductible.
  7. If you reach the catastrophic limit, your HDHP will provide needed care with no charge to you (assuming you use in-network providers).

With this framework in mind, you may wish to consider a few important points as you compare different HDHPs with each other and compare HDHPs with traditional health benefits plans. The accompanying worksheet walks you through several steps to help you decide if an HDHP is right for you.

  1. You should consider a plan's premium and your projected out-of-pocket costs before benefits begin under that plan, in conjunction with the plan's co-insurance (or co-payment) rates. This gives the true cost for that plan.
  2. It will be to your advantage to contribute as much of your own money into your HSA as is allowed, because you make those contributions with tax-deductible dollars (even if you don't itemize on your tax return). Thus, you save the money that you would have otherwise paid in taxes. Contributing the maximum amount with tax deductible dollars reduces your net out-of-pocket costs before plan benefits begin, as well as your maximum out-of-pocket expenses. Plus, funds in your HSA can accumulate year after year without limit or possibility of forfeiture.
  3. Remember that preventive care is NOT subject to the high deductible. Absent other health care needs, if you contribute a higher amount to your HSA, you get a higher tax deduction plus a higher balance in your HSA to use for future expenses. Since your out-of-pocket cost before plan benefits begin also defines the maximum amount of personal, tax-deductible, contributions you can make, contributing a larger amount isn't necessarily bad. If you use a relatively low amount of health care and you can afford to make the maximum contribution, you may be attracted to these aspects of HDHPs with HSAs.
  4. When reviewing how much you may have to pay out-of-pocket with an HDHP, remember that unlike traditional plans, HDHPs count ALL covered expenses toward your catastrophic limit. Once you reach that limit, the HDHP provides all covered benefits without requiring any payment from you (assuming you use network providers). In traditional health benefits plans, deductible amounts you pay generally do NOT count toward the plan's catastrophic limit and you may have to pay some types of co-payments without limit (e.g., for drugs). If you use a relatively large amount of health care, you may be attracted to this aspect of HDHPs.

Enter the annual premium _________ and coinsurance rate(s) ________

Enter the amount of the plan deductible ________

Subtract the Plan's Annual Premium Pass-Thru ________

Total ________

This is your out-of-pocket cost before plan benefits begin and also is the maximum amount of tax deductible personal contributions you can make (before catch-up contributions applicable to those age 55-65). Preventive care is not subject to the high deductible.

Enter the maximum amount of your personal contributions* ________

Multiply by 1.00 minus your marginal income tax rate ________

This is the after tax cost of your maximum personal contribution ________

Enter the plan's catastrophic limit ________

Subtract the Plan's Annual Premium Pass-Thru ________

Total out-of-pocket exposure** ________

*  Take .9167 (11/12ths) of this amount before calculating your maximum amount of personal contributions.

** Assumes you use in-network providers and don't use HSA funds for medical or other expenses not covered by your HDHP.

File Description
HSA Net Amounts & HDHP Benefits You can find monthly premiums, contributions to your HSA, and the amount you can contribute to your HSA, for each FEHB HDHP. You can also compare benefits information among HDHPs such as deductibles, catastrophic limits, coinsurance, copayments, and preventive services provided before the deductible.

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Frequently Asked Questions (FAQs)

Frequently Asked Questions for High Deductible Health Plans, Health Savings Accounts, and Health Reimbursement Arrangements

Thank your for your interest in learning more about High Deductible Health Plans (HDHP) with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). Each health plan has unique features. For complete details refer to the individual plan brochure, available on the Federal Employees Health Benefits Program (FEHB) website.

For a quick comparison chart showing the differences between an HSA, an HRA, and a Health Care Flexible Spending Account (HCFSA), use the Comparison Chart for HSA, HRA and HCFSA.

To view all plans available in your area, use the OPM Tool to Compare Plans by ZIP Code.

HDHP FastFacts

High Deductible Health Plans (HDHP)

A High Deductible Health Plan (HDHP) is a health plan product that combines a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) with traditional medical coverage. It provides insurance coverage and a tax-advantaged way to help save for future medical expenses.

The HDHP/HSA or HRA gives you greater flexibility and discretion over how you use your health care dollars, because the funds can be used to cover qualified medical expenses that are not covered by your health plan.

HDHPs may have a higher annual deductible than traditional health plans. For 2021, an HDHP in the FEHB Program has a minimum annual deductible of $1,400 for Self Only coverage and $2,800 for Self Plus One/Self and Family coverage (the deductible amount is indexed every year).

HDHPs in the FEHB Program have annual out-of-pocket limits which do not exceed $7,000for Self Only coverage and $14,000 for Self Plus One/Self and Family coverage.

Service delivery in the HDHP program within the FEHB Program may be offered with a: Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), or Point of Service (POS) plan. The health plan determines eligibility for a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA).

Depending on the HDHP you elect, you may have the choice of using either in-network and or out-of-network providers. Using in-network providers will save you money. With the exception of preventive care, the annual deductible must be met before the plan benefits are paid. In-network preventive care services are provided at no cost.

  • If your medical expenses are generally low, you should definitely consider an HDHP.
  • If you would benefit from reducing your taxable income by contributing to your HSA, you should consider an HDHP.
  • If you would like to save for medical expenses in the future or qualified medical expenses not covered by the health plan (Lasix, orthodontia), you should consider an HDHP.
  • If your in-network medical expenses would trigger the catastrophic limit, you may also want to consider an HDHP, if the nature of those expenses is such that you continue to pay out-of-pocket costs in your traditional plan even after you hit your traditional plan's lower catastrophic limit. This can happen because traditional plans may exclude drug and other costs from their catastrophic limits but an HDHP cannot. With an HDHP, once you hit the catastrophic limit, there is no out-of-pocket expense for covered in-network services.

There are a number of steps FEHB members should take to assist them in making an informed decision as to whether or not an HDHP/HSA or HRA is the right health program option for them.

  • Determine the premium you would pay out of your pay check.
  • Review the drug and other costs not applied to catastrophic limits under a traditional plan.
  • Review the plan design elements: deductible, out-of-pocket limits, the amount the plan contributes to your HSA, known as the "premium pass through," or the amount the plan credits to your HRA.
  • Subtract the annual plan contributions from the annual plan deductible to determine your true out-of-pocket cost (also known as your “net deductible”).
  • Review the eligibility considerations for an HSA. If you are not eligible for an HSA would you accept an HRA?
  • Ask yourself if you are in a financial position to be able to pay the annual net  deductible amount required (depending on Self Only deductible or Self and Family deductible) should you or a family member require a high medical cost service in the early months of the plan year,
  • Determine if you would benefit from making additional tax-deductible voluntary contributions reducing your overall taxable income.
  • If you are between the ages of 55 and 65, determine whether or not your financial situation will allow you to make "catch up contributions".  Currently, catch up contributions are allowed up to $1,000 over the IRS maximum contribution limit.
  • Review the listing of the new health care plans available where you live or work, at OPM Tool to Compare Plans by ZIP Code.

The premiums are similar to the premiums for many plans' lowest option but the plan contributes some money from the premium, the "premium pass through," to your HSA. For exact premium amounts you must contact the individual plans offering the HDHP option. Review OPM Tool to Compare Plans by ZIP Code to learn more about new health care plans available.

When you are enrolled in an HDHP, you will not have to pay more than the plan's annual catastrophic limit of no more than $7,000 for in-network Self Only coverage and $14,000 for in-network Self Plus One/Self and Family coverage, including the deductible.

It is important to remember once the catastrophic limit is met, you will not incur additional out-of-pocket covered medical expenses, including doctor visit co-payments and prescriptions which may be excluded from a traditional plan's catastrophic limit.

No, several HDHPs are offered through the FEHB Program.

GEHA and Mail Handlers are nation-wide indemnity type plans will offering an HDHP with both in-network and out-of-network benefits.

Your out-of-pocket expenses for covered medical services are limited to the catastrophic in-network limit of $7,000 for Self Only coverage and $14,000 for Self Plus One/Self and Family coverage. It is important to remember once the catastrophic limit is met, you will not incur additional out-of-pocket covered medical expenses, including doctor visit co-payments and prescriptions which may be excluded from traditional plans catastrophic limit.

HDHP: Obtaining Information

You can find a list of HDHP plans along with other plan options available in your area using OPM's Tool to Compare Plans by ZIP Code.

Health Savings Accounts (HSAs): The Basics

A Health Savings Account allows individuals to pay for current health expenses and save for future qualified medical expenses on a pre-­tax basis. Funds deposited into an HSA are not taxed, the balance in the HSA grows tax free, and that amount is available on a tax free basis to pay medical costs. Your voluntary contributions to your HSA reduce your taxable income. When you enroll in an HDHP, the health plan determines whether you are eligible for a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) based on the information you provide.

  • Your own HSA voluntary contributions are tax-deductible. Your own HSA contributions are either tax-deductible or pre-tax (if made by payroll deduction). See IRS Publication 969(external link)(PDF file).
  • Interest earned on your account is tax-free
  • Tax-free withdrawals may be made for qualified medical expenses
  • Unused funds and interest are carried over, without limit, from year to year
  • You own the HSA and it is yours to keep - even when you change plans or retire
  • Your HSA is administered by a trustee/custodian

An HSA plan may save you money through lower premiums, tax savings, and money deposited in your account which can be used to pay your deductible and other out-of-pocket medical expenses in the current year or in the future.

Generally qualified medical expenses will be determined by the plan in conformance with FEHB law and Section 213. See IRS Publication 502 for a list of qualified medical expenses. Please note some insurance premiums cannot be paid for by HSA funds.

The IRS defines qualified medical expenses. See IRS Publication 502 for a list of eligible expenses. However, not all insurance premiums are qualified medical expenses even though they are stated in the IRS Publication 502.

Yes. Your HSA funds are invested. Depending on which HSA plan you are enrolled in, the interest rate and payment of interest will vary.  Most HSA Trustees have higher earning investment opportunities once a threshold balance is accumulated. Your earnings are tax free.

Yes. Your funds will accumulate without a maximum cap. However, the annual limit you can contribute to the HSA may not exceed the maximum contribution amount set by the IRS , plus "catch up" contributions for those ages 55 to 65.

You own your account, so you keep your HSA, even if you change health plans or leave Federal Government. However, if your HSA was fully funded and you leave the HDHP during the year, then you will have to withdraw some of the contribution from the account. You must pay income tax on your excess contributions and income tax on any earnings of the excess contribution. There is no 20% penalty on excess contributions.

If you no longer are enrolled in an HDHP you are not eligible to make contributions to your HSA, but you may request withdrawals for qualified medical expenses.

Yes, there are administrative fees which vary by plan.  Most health plans pay for the monthly administrative charges for members, but other fees associated with banking may apply (e.g., cost of checks, transfers, overdraft fees).

First, you must elect a high deductible health plan. Generally, once the plan receives your enrollment, the plan will mail you an information packet which includes forms for you to complete and return to the plan. When the plan receives the completed forms, the plan will notify its administrator of the HSA. The HSA administrator will then set up your account and your health plan will deposit "premium pass through" payments into the account.

All plans offering an HDHP are required to have a financial trustee who can administer the HSA. However, you may choose to keep the funds with the health plan’s trustee or move to the financial institution of your choice.  The health plan does not pay for the monthly administrative fees or other fees when you use a different HSA trustee than your health plan has established.

Yes. A Federally chartered credit union qualifies under Treasury Regulations as a trustee/custodian. However, you will need to check with your specific credit union. If your credit union functions as an HSA trustee/custodian, you can work with them in two ways:
1) Submit your additional voluntary contributions, and 2) transfer funds from the trustee/custodian selected by your plan to the credit union.

You can invest the money in your HSA in bank accounts, annuities, certificates of deposits, stocks, bonds, mutual funds, certain types of Bullion or Coins (please see section 408(m)(3) of the IRS Code). However, your HSA custodian or trustee may offer only some of these types of investments.

The money market account portion of your HSA is normally insured by a Federal institution (e.g., FDIC, NCUA, etc.) Other types of investments, for instance, stocks, bonds and mutual funds, are subject to normal investment risk.

Your HSA would pass to your surviving spouse or named beneficiary tax free. If you are unmarried and do not have a named beneficiary, the money is disbursed to your estate and is subject to any applicable taxes.

HSA: Contributions

The IRS sets the maximum contribution limits. The maximum annual contribution limit for HDHPs in the FEHB Program are $3,600 for Self Only coverage and $7,200 for Self Plus One or Self and Family coverage.

If your HDHP is effective on January 1st, the total amount you can contribute to your account is the maximum contribution amount set by the IRS.

If your HDHP is effective after the first day of the month, you may make or receive a full year's contribution to your HSA for partial year coverage as long as you maintain your HDHP enrollment for 12 months. If enrollment is less than 12 months, the tax benefit is lost and a 10% penalty is imposed. There is an exception for death or disability. Previously, enrollees' contributions were pro-rated based on the number of full months their HDHP was in effect.

First, determine the maximum allowable contribution to your HSA (please see the question above). Second, subtract the amount the plan puts into your HSA through the plan's premium pass through. The remaining amount is what you can voluntarily contribute.

You may withdraw the excess amount and any earnings on the excess amount prior to April 15th of the following year. However, you must pay income tax on your excess contributions and income tax on any earnings of the excess contribution. There is no 20% penalty on excess contributions.

You must pay a 6% excise tax on the excess contribution and on any earnings of the excess contribution. If in the next year you decreased your maximum contribution by the amount of your excess contribution made the year before, you do not have to pay the 6% excise tax again. If, however, you leave the excess contribution in, and do not decrease your maximum contribution by the amount of your excess contribution made the year before, you will have to pay the 6% excise tax each year the excess contributions and earnings are in the HSA.

By statute, the annual HSA contribution cannot exceed the maximum contribution amount set by the IRS; however, additional contributions, called catch-up contributions, are available to those between the ages of 55 and 65.

Catch-up contributions are only available to those between the ages 55 and 65. If you are covered by your HSA for the entire year, you may deposit the entire catch-up amount starting with the year you turn 55. Currently, an additional $1,000 catch-up contribution is allowed.

You may contribute your own money to your account by making a lump sum contribution or periodic payments at any time, in any amount up to a maximum limit established by the IRS. However, your trustee/custodian can impose minimum deposit and balance requirements. You can claim your total amount contributed for the year as an "above the line" tax deduction when you file your income taxes. Your own HSA contributions are either tax-deductible or pre-tax (if made by payroll deduction). See IRS Publication 969. You have until April 15 of the following year to make HSA contributions for the prior year. If you are between the ages of 55 and 65, you can make additional catch-up contributions of up to $1,000.

Many Federal employees who are enrolled in HDHPs are eligible to make pre-tax allotments to their HSAs through their payroll office. Your own voluntary HSA contributions are either tax-deductible or pre-tax (if made by payroll deduction).  See IRS Publication 969(external link)(PDF file).

The amount each plan contributes to your HSA varies. Please consult the plan's brochure or use OPM’s Plan Comparison Tool.

The Office of Personnel Management (OPM) and the FEHB carrier have agreed on a premium rate for the HDHP. This premium is comparable in amount to the premium for many plans' standard option. The FEHB carriers will allot a specified portion of the premium to be "passed through" on a monthly basis to the FEHB member's HSA.

No. You are not required to contribute to your account. However, there may be a minimum balance required to maintain your HSA.

Yes, anyone can contribute to an HSA. However, the tax benefit from such a contribution is gained by the person receiving the contribution, not to the person giving the contribution.

HSA: Coverage

Your HSA can be used to pay for "qualified medical expenses," as defined by IRS Code 213(d). These expenses include, but are not limited to, medical plan deductibles, diagnostic services covered by your plan, Medicare Part B and long-term care insurance premiums, and other health insurance premiums if you are receiving Federal unemployment compensation, LASIK surgery and some nursing services. Please note only some insurance premiums are considered "qualified medical expenses."

When you become Medicare enrolled you can use the account to purchase any health insurance other than a Medigap policy. You may not, however, continue to make contributions to your HSA once you are Medicare enrolled.

For the complete list of IRS-allowable expenses, you can request a copy of IRS Publication 502 by calling 1-800-829-3676, or visit the IRS website at www.irs.gov(external link) and select "Forms and Publications." Please note, however, while health insurance premiums are listed as an allowable expense they are not reimbursable from HSAs, unless you are receiving Federal unemployment compensation.

Yes. You may withdraw money from your HSA for items other than qualified health expenses, but it will be subject to income tax and, if you are under 65 years old, an additional 20 percent tax penalty on the amount withdrawn.

Health plans negotiate provider fees that are often less than the billed charges.  We recommend receipt of the health plan’s Explanation of Benefits (EoB) explaining your liability before you pay the provider.

Yes, money from your HSA can be used to pay for all qualified medical expenses. You will usually save money, however, if you use network providers. See IRS Publication 502 for a list of eligible expenses.

Yes, you may use the money in your HSA to pay your spouse's or other covered dependent’s uncovered medical expenses. However, you are not allowed to have both an HSA and a Health Care FSA at the same time unless it is a Limited Healthcare FSA (LEX HCFSA).

You will be able to continue contributing to your HSA. The amount you are permitted to contribute will change from the Self Only to Self and Family contribution or vice versa, prorated appropriately for the year.

HSA: Eligibility

You must participate in a High Deductible Health Plan, have no other insurance coverage other than those specifically allowed, and not be claimed as a dependent on someone else's tax return in order to be eligible for an HSA. Some examples of other coverage that would cause ineligibility are: a health care flexible spending account (HCFSA), a spouse's FSA, a spouse's family enrollment in an HMO, other non-high deductible health insurance coverage, TRICARE, Medicare, or receipt of VA or IHS healthcare benefits within the previous three months. You can still have other disability, dental, vision and long-term care insurance policies.

Correct. You may, however, join an HDHP and have an HRA while also covered by other health insurance.

It is important to review eligibility requirements before you enroll. If you have not used any benefits or received a plan contribution to your HSA, you may cancel your enrollment no later than 60 days after the effective date of your enrollment, and you may enroll in another plan with a retroactive effective date.

You are eligible. Filing jointly as a spouse does not mean you are a dependent on your husband's tax return.

No, you cannot open separate HSA accounts for your minor dependent children.

HSA: Withdrawal

You can use the money in your account for qualified medical expenses. See IRS Publication 502 for a full list. Keep in mind health insurance premiums, which are listed, are generally not reimbursable.

You can use the money in your HSA immediately, or you can allow the money to accumulate for future use. However, you can only use the amount currently in your account.

It depends. Please see the health plan's brochure for specific information about receiving medical care.  For participating health plan providers, it is recommended payment be made after the health plan’s negotiated provider discount has been applied.  The Explanation of Benefits (EoB) describes your liability after the health plan’s negotiated discount has been applied.

It depends on the arrangements your health plan has with its providers. Usually, you can access your account in one of three ways: debit card, check, or withdrawal request.

Yes. Funds will not be disbursed until your reimbursement totals at least $25 or a higher amount based on the rules of the trustee administering the HSA.

No. In-network preventive care is covered at 100%.

Yes.

You will pay any difference between the balance of your HSA and the plan's deductible. Please consult the plan's brochure for more information.  However, if you continue under an HSA-qualified HDHP, you can pay yourself back with future HSA deposits.

For example, if you have surgery in January and need $1,000 for your deductible, are you able to pay the deductible then (as in the case of a health care flexible spending account, HC FSA) or do you have to wait until your account has accumulated $1,000?

You have to wait until $1,000 is accumulated. Just like a checking account, you can only draw out what is in your account. Your health plan will contribute its share on a monthly basis and you can contribute additional funds up to the maximum amount.

You can return the money to the HSA if there is clear and convincing evidence the withdrawal was a mistake of fact. You must repay this money before April 15th of the year following when you knew or should have known that the withdrawal was a mistake.

Yes, you should keep your receipts. If you exceed your deductible, you may need the receipts to send to your HDHP. If you are audited by the IRS, you may need to explain your HSA expenditures.

HSA: IRS Tax Questions

Tax benefits are three-fold: your additional voluntary contributions are pre-tax or tax-deductible*, interest earned is tax-free, and HSA distributions are tax-free if they are used to pay for qualified medical expenses.

* Contributions are tax-deductible on your Federal tax return. Some states do not recognize contributions to an HSA as deduction. Your own HSA contributions are either tax-deductible or pre-tax (if made by payroll deduction). See IRS Publication 969(external link)(PDF file). You should consult your tax advisor.

"Premium pass through" payments are not considered income, and you cannot deduct them on your income tax return.

Many Federal employees who are enrolled in HDHPs are eligible to make pre-tax allotments to their HSAs through their payroll office.

You do not have to itemize to receive the tax deduction. However, you need to complete IRS form 8889 with your income tax return. This form communicates to the IRS what your total withdrawals and deposits were from your account during the year.

"Above the line" means you will reduce your taxable income regardless of whether you itemize or use the standard deduction on your income tax form. The voluntary contributions are a tax deduction, not a tax credit. The distributions from your HSA are tax-free. The IRS will set rules and reporting requirements. Check with the IRS or your tax advisor.

Health Reimbursement Arrangements (HRAs): The Basics

An HRA is an employer-funded tax-sheltered fund to reimburse allowable medical expenses. HDHP members who do not qualify for an HSA, will be provided an HRA. There is no additional paperwork needed for enrollment into the HRA.

  1. Tax-free withdrawals for qualified medical expenses 
  2. Carryover of unused credits from year to year as long as you remain enrolled in the same health plan
  3. Credits in an HRA do not earn interest 
  4. Credits in an HRA are forfeited if you leave Federal employment or switch health insurance plans 
  5. Your HRA may be administered by the health plan.

First, you must enroll in a High Deductible Health Plan. Depending on which HDHP you choose, the HDHP may send you an enrollment questionnaire. You must complete the questionnaire and return in to the plan. The plan will then set up the fund and contribute your deposits for each month you are enrolled. In most cases, plans credit the full annual amount at the beginning of the year.

An HRA may save you money through both lower premiums and tax-free medical reimbursements.

If you retire and remain in your health plan, you may continue to use and accumulate credits in your HRA. If you terminate employment or change health plans, only eligible expenses incurred while covered under that health plan will be eligible for reimbursement, subject to timely filing requirements. Unused credits are forfeited.

Yes. Your credits accumulate without a maximum cap as long as you remain enrolled in the same health plan.

Technically, this isn't money in an account, but a health reimbursement arrangement you use to reimburse qualified medical expenses for yourself and your enrolled dependents.

Generally, there are no set-up or administrative fees but you need to check with your individual plan for detailed information on possible costs.

You may apply for reimbursement from your HRA for any qualified medical expenses incurred during the period of time you were enrolled in the HDHP and HRA. Your requests for reimbursement are subject to timely filing requirements. Any remaining funds will be forfeited. Please note if the plan credited the entire HRA funds at the beginning of the year, you will be responsible for returning the overpayment for the number of months remaining in the plan year.

HRA: Contributions

Your health plan will credit a portion of the health premium. The credit will be the same as the plan's HSA deposit for a Self Only, Self Plus One or Self and Family enrollment.

You cannot contribute any money to your HRA. Your HDHP will contribute a certain amount of premium into your HRA. This entire amount is credited to the HRA at the beginning of the plan year, allowing for immediate access to funds. However, if you end your enrollment in your HDHP, you will not be entitled to the entire contribution. The amount will be prorated for the months you are enrolled in the plan. If you leave during the plan year after using the entire plan allotment, you will be responsible for returning the overpayment for the number of months remaining in the plan year.

No. Your HRA will not earn interest.

Is the major benefit over the FSA one of convenience in record keeping by the health benefit provider?

Premiums are based on expected plan experience including the credits to an HRA. A major difference between a Health Care Flexible Spending Account (HCFSA) and an HRA is that unused credits in an HRA "roll over" from year to year. In an FSA, HCFSA or Dependent Care Flexible Spending Account (DCFSA), unused money is forfeited.

HRA: Coverage

You can use funds in your account to pay:
  • qualified medical expenses that do not count toward the deductible
  • your health plan's deductible
  • your Medicare premiums

HRA: Eligibility

You are eligible for an HRA if you are enrolled in an HDHP and:
  • You are enrolled in Medicare,
  • You are covered by another non-HDHP health plan, or
  • You are not otherwise eligible for an HSA.

HRA: Withdrawal

You can use funds as available to reimburse yourself for your deductible or other out-of-pocket medical expenses.  Most plans with HRAs use funds from the HRA first, until the deductible is met.

Please refer to IRS Publication 502 for more details about qualified medical expenses.

You would pay any difference between the balance in your HRA and the deductible.

No. Preventive care is covered at 100% when an in-network provider is used.

Please consult your plan brochure.

HRA: IRS Tax Questions

Credits to your HRA are made through your HDHP's premium pass through. The money you receive for reimbursements of qualify medical expenses are free of federal, state, and FICA taxes.

Nothing. Your HRA is a health benefit.

Limited Expense Health Care Flexible Spending Accounts (LEX HCFSAs)

A Limited Expense Health Care Flexible Savings Account (LEX HCFSA) is a type of flexible spending account under the FSAFEDS Program. It is an account where you contribute money from your salary before taxes are withheld, incur eligible dental and vision care expenses and get reimbursed. It is available to employees eligible for FSAFEDS who are enrolled in a Federal Employees Health Benefits (FEHB) Program high deductible health plan (HDHP) with a health savings account (HSA). Go to Health Savings Accounts Page to learn more about HDHPs and HSAs. Go to www.FSAFEDS.com(external link) to learn more about LEX HCFSAs.

Expenses are limited to eligible dental and vision care services/products that meet the IRS definition of medical care. Eligible expenses include your out-of-pocket costs for such services/products as:

Dental Care Vision Care

Cleanings

Refractions

Fillings

Eyeglasses

Crowns

Contact lenses

Orthodontics

Vision correction procedures

Dental and vision care expenses are the only reimbursable expenses covered under the FSAFEDS LEX HCFSA. Cosmetic services – even if dental or vision related – are not eligible expenses. All of the other expenses normally eligible under a "general" health care flexible spending account are NOT eligible under a LEX HCFSA.

Normally, someone enrolled in an HDHP with a HSA cannot also have a general purpose health care FSA. IRS rules prohibit it. However, with a LIMITED expense HCFSA, you can have both accounts. Therefore, you can pay for your eligible out-of-pocket dental and vision care expenses with pre-tax salary dollars. You pay less in taxes and therefore save money. By using a LEX HCFSA, you can preserve the funds in your health savings account to use/save for other purposes.

You enroll in a LEX HCFSA during the Federal Benefits Open Season at www.FSAFEDS.com(external link) or by calling FSAFEDS Benefits Counselor, toll-free, at 1-877-372-3337, TTY: 1866-353-8058, Monday through Friday, 9:00 A.M. until 9:00 P.M., Eastern Time.

You can enroll in a LEX HCFSA during the Federal Benefits Open Season, or within 60 days after becoming a newly hired or newly eligible employee.

You can set aside anywhere from a minimum of $100 up to a maximum of $2,700 per year.

Yes, all dependents you claim on your Federal Income Tax return, or with whom you jointly file your taxes.

By establishing an LEX HCFSA, you can enjoy the benefits of an FSA (paying less in taxes and therefore saving money) while preserving your HSA funds for other purposes, including simply saving those funds for the future.

Questions relating to HDHPs, HSA, HRA, and Health Care Flexible Spending Account (HC FSA)

Yes. The amount you pay for allowed prescription expenses is applied to the catastrophic limit includes the deductible and coinsurance.

An HDHP/HSA or HRA provides insurance coverage and catastrophic coverage and a tax-advantaged way to help save for future medical expenses. It provides greater flexibility and discretion over how to use your health care dollars.

This occurs under certain HDHPs. Please consult the plan brochure.

The process is different between an HSA and HRA. Access to an HSA or an HRA depends on the individual health plan's administrative procedures. Some plans will offer a debit card or checks for the HSA. If you use a network physician, the provider will first bill the health plan for his or her services. The provider will then bill you for any amounts you owe after your health plan has paid what it owes under the terms of your plan benefits. It's best to allow your plan to process your claim and send the Explanation of Benefits (EoB) to understand your liability under the claim.

If you are not covered by your spouse's health plan, you are eligible for an HSA. You are ineligible when you are covered by another health plan.

If the benefit is not covered by your plan, you can use the money in your HSA to pay dental and vision claims for services by a provider of your own choosing.

Employees are responsible for making sure they are not enrolled in an FSA or other type of health benefit disqualifying for an HSA. OPM and the HDHP health plans will provide guidance and advice to help enrollees make accurate decisions; however, it is ultimately the enrollee's responsibility to follow IRS rules. No action is needed by either the Human Resources Office or payroll office.

With an HSA only the amount of the health plan monthly "premium pass through" and the individual's voluntary contribution accumulated to date is available for reimbursements. Of course, you can wait to file for a reimbursement until after the account has had a chance to build up to the needed amount. However, HRAs of some plans will be credited with the annual amount at the beginning of the plan year and others will accumulate monthly.

No.

Yes, as long as the employees is eligible for FSAFEDS. Enrollment in an HDHP/HSA does not affect eligibility for a dependent care FSA.

Questions Relating to Retirees and Military Veterans - 
Retiree and Early Retiree

Yes. You are eligible for an HSA after age 65 unless you are enrolled in Medicare Part A or Part B.

If you use your HSA for non-medical withdrawals prior to age 65, the amount will be included in your gross income and you will pay a 20% penalty.

You are eligible for an HSA if you enroll in an HDHP, even if your spouse is enrolled in Medicare, and you may contribute the amount permitted for a Self and Family enrollment. You may pay for your spouse's non-reimbursable medical expenses from your HSA.

As long as you are not enrolled in Medicare or another health insurance plan and enrolled in an HDHP, you may continue contributing to the HSA.

People with TRICARE cannot have an HSA because TRICARE does not qualify as an HDHP.  Whether you are retired or active, you are eligible for an HRA.  In addition, if you are an employee (not retired) and eligible for FEHB coverage, you can also have an HCFSA.

The HSA is still the FEHB member's account. As long as the retiree remains enrolled in his HDHP and is not covered by another health plan or Medicare, he is eligible to continue making contributions to the HSA. Voluntary contributions may also be made.

There is no single answer as to what option is best. You need to review the following before making your choice: your medical expenses and those of your family, the benefits offered by an HDHP for which you are eligible, the amount you can contribute to the HSA, and your tax information. Please keep in mind that your Medicare Part B premium may be higher if you do not enroll when you first become eligible. It may not be in your financial interest to turn down Medicare coverage.

The remaining HRA credit "rolls over" if not used in the current year. You can use it to pay for Part B or Part D Medicare premium.

An HDHP is not a Medigap policy. To be eligible to enroll in an HDHP with an HSA, you must not be enrolled in Medicare Part A or Part B. However, please note a number of the current fee-for-service health plans do waive or reduce deductibles and co-payments, if you are enrolled in both Medicare A and B. HDHP members enrolled in Medicare are provided an HRA instead of an HSA. An HRA can be used to help pay for Medicare Part B premiums. You may also consider suspending your FEHB enrollment if you enroll in a Medicare managed care plan.

You are not eligible for an HSA if you have TRICARE For Life. You may, however, have an HRA.

The HSA will be available for qualified medical expenses including premiums. Your health plan will discontinue making contributions to your HSA and will open and begin crediting funds to an HRA for you.

Military Veteran

IRS guidance states you are not eligible to make contributions to your HSA for three months after each use of VA medical or prescription drug services.  A physical to maintain your VA benefits will not cause you to be ineligible for an HSA.

If so, should the couple choose Self Only coverages and choose an HDHP/HSA?

Individuals receiving a VA disability benefit are entitled to enroll in an HDHP and establish an HSA. However, IRS guidance states they cannot make a contribution to their HSA for 3 months after each use of VA medical or prescription drug services.

VA benefit refers to any medical services and prescription drug benefits.
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