Health Savings, Medical Savings, and Flexible Spending Accounts

The government offers several programs based on tax breaks that are designed to help you pay for you and your family's medical expenses. The IRS calls them "tax-favored health plans".

You may be able to enroll in a Health Savings Account, a Medical Savings Account, a Flexible Spending Arrangement, and/or a Health Reimbursement Arrangement. This page contains a general overview of those 4 programs.

(Also, remember that you can itemize and deduct medical expenses that are not covered by one of these health plans.)

What Is a Health Savings Account (HSA)?

A Health Savings Account (HSA) is a tax-exempt account used to pay or reimburse you and your family's medical expenses if you are covered by a high-deductible health insurance plan. You or anyone else can contribute money to your HSA. You can take a tax deduction for money contributed to your HSA by anyone except your employer. The money you take out of the account is tax-free if you use it for qualified medical expenses (see a list of qualified medical expenses).

You can set up a Health Savings Account through your employer, a bank, an insurance company, or another approved trustee. Health Savings Accounts are portable, so you can keep the account even if you change employers. The money in an HSA remains in the account until you spend it.

The requirements to qualify for an HSA are:

  • You must be covered by a high-deductible health plan (HDHP) on the first day of the month.
  • You cannot have any other general health coverage except a high-deductible health plan (there are exceptions for specific coverage, such as for vision, dental, diability, or long-term care insurance).
  • You may not be enrolled in Medicare.
  • You must not be claimed as a dependent on someone's 2013 tax return.

For 2013, the contribution limit for Health Savings Accounts is $3,250 for individuals and $6,450 for families (plus $1,000 if you are 55 or older at the end of the year). Beginning in 2013, the contribution limits will be adjusted for inflation. You generally cannot make contributions to an HSA if you are covered by a Flexible Spending Account or a Health Reimbursement Account (discussed below).

Your gross (total) distributions from an HSA are reported to you on Form 1099-SA. When you file your tax return, you are required to report HSA contributions and HSA distributions on Form 8889  efile it , attached to Form 1040  efile it . If you prepare your return on efile.com, the online software will select the proper forms for you and help you to fill them out correctly.


What Is a Medical Savings Account (Archer MSA)?

An Archer Medical Savings Account (MSA) helps those employees of small businesses and self-employed people who are covered by a high-deductible health plan to pay the health care costs of themselves, their spouses, and their dependents. If you are employed, either you or your employer may contribute to your Archer MSA in any given year, but not both. If you are self-employed, only you can make contributions to your MSA.

You can set up an Archer MSA through your employer, a bank, an insurance company, or another financial institution. Medical Savings Accounts are portable, so you can keep the account even if you change employers, and the funds in an MSA remain in the account until you spend them.

You qualify for an Archer MSA if all of the following are true:

  • You are employed by a "small employer" (an employer with an average of 50 or fewer employees over the last 2 years) at the time you start the MSA, or you are self-employed.
  • You are covered by a high-deductible health plan (HDHP).
  • You do not have any other general health care coverage except a high-deductible health plan (there are exceptions for specific coverage, such as for vision, dental, disability, etc.)

If you are eligible to be covered by Medicare, then you cannot enroll in an Archer MSA, but you can enroll in a Medicare Advantage MSA. This is like an Archer MSA, but you can only use the funds from a Medicare Advantage MSA to pay your own qualified medical expenses.

If you make contributions to your MSA, you can deduct the contributions on your tax return even if you don't itemize deductions, unless you are eligible to be claimed as someone else's dependent for the year. Distributions from an MSA are tax-free if the money is spent on qualified medical expenses--such as expenses not covered by your health plan because you have not yet met the high deductible (see a list of qualified medical expenses).

The maximum annual contribution to an MSA is 75% of your family health plan's annual deductible amount, or 65% of the deductible if you have a self-only plan. If you were not covered for the whole year by a high-deductible health plan, the maximum allowable contribution to your MSA is reduced by 1/12 per month in which you were not covered.

You may be able to carry forward excess contributions to an MSA and deduct them in a future year. Generally, you can also roll over funds from an MSA to a Health Savings Account tax-free. There are no HSA contribution limits for rollovers, but you can only make one rollover contribution per 1-year period.

Your total (gross) Archer or Medicare Advantage MSA distributions for the year will be reported to you on Form 1099-SA. When you file your tax return, you must report all distributions from your HSA--and contributions to your HSA--on Form 8853 efile it , which can only be attached to Form 1040 (Learn how to file Form 1040). If you prepare your return on efile.com, the online software will select the right forms for you and make sure they are filled out correctly.


What Is a Flexible Spending Account or Arrangement (FSA)?

A Flexible Spending Arrangement or Account (FSA) is an employer-sponsored account that helps you pay for you and your family's medical expenses. An FSA is funded by voluntary paycheck withholding and by employer contributions. All money contributed to an FSA is completely tax-free for you. No payroll or income taxes are withheld from your contributions to an FSA, and contributions by your employer are excluded from your taxable income. Withdrawals from a Flexible Spending Account are tax-free if the money is spent on qualified medical expenses (see a list of qualified medical expenses).

You can only establish an FSA through your employer. Self-employed people are not eligible. You do not have to be covered by a high-deductible plan or by any other health plan to qualify for an FSA.

The maximum amount you can contribute to an FSA through paycheck withholding is $2,500 for 2013. There is no IRS-imposed limit on the amount your employer can contribute. There may be other limits if you are considered a "highly compensated employee".

At the beginning of each year in which you have a Flexible Spending Account, you must decide the amount that you will contribute to it over the course of the year. It is important not to contribute too much to an FSA, because FSAs are "use-it-or-lose-it". This means that you must spend the money in the account by the end of the year or else any remaining amount is forfeited. However, your employer can provide up to a 2 and 1/2 month grace period for you to spend the money in the following year.

It is also possible to roll over funds from an FSA to a Health Savings Account, tax-free. Rollover contributions to HSAs have no dollar amount limit, but you may only make one rollover contribution per 1-year period.

You do not report Flexible Spending Account contributions nor distributions on your tax return.


What Is a Health Reimbursement Arrangement (HRA)?

A Health Reimbursement Arrangement (HRA) is an employer-sponsored plan that reimburses you for the health care costs of you and your family. Your employer is the only one who can contribute to your HRA.

An HRA is established by your employer, so self-employed individuals are not eligible. There is no requirement to be covered (or not covered) by any other type of health plan, so you can enroll in an HRA if it is offered by your employer, no matter what other health coverage you have (or do not have).

Health Reimbursement Arrangements are solely funded by your employer, and your employer can set the maximum coverage amount. Employer contributions are tax-free income to you. Reimbursements are excluded from your taxable income if the money was spent on qualified health costs and medical expenses (see a list of qualified medical expenses). There may be some exceptions if you are considered a "highly compensated employee".

Unlike FSA funds, unused funds in an HRA at the end of the year are not forfeited and can be carried forward to later years.

Information about a Health Reimbursement Arrangement is not reported on your tax return.


For more details on any of the accounts and arrangements described above, please see Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans.

Find out about deducting medical expenses that are not covered by one of these plans.

See a general overview of tax deductions available for 2013.

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