Do HRAs and HSAs work together? Health savings accounts and health reimbursement arrangements have been around for a while, but new laws bring more choices for business owners and their employees as they evaluate the best small business health insurance options. While these two tax-advantaged tools can work together alongside a high deductible plan, their relationship is complex. Here’s what to know about HRAs vs. HSAs before you choose.
Can you have an HRA and HSA?
Both Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) are tax advantaged accounts that help individuals pay for out-of-pocket health care expenses for themselves and their families through pre tax dollars in set aside funds. Figuring out how to stack these benefits and get the most out of them requires a little context and a lot of explanation. First, we will go over what HSAs and HRAs are intended to do. Then we will review HRA eligibility and HSA eligibility, explore the ways in which they can integrate while keeping the IRS happy, understand if you can use HRA and HSA at the same time, and bullet out the types of HRAs that play nice with HSAs.
Here we go!
Is an HRA the same as an HSA?
No, an HRA is not the same as an HSA. But we understand the confusion! They are both tax-advantaged tools that allow for individuals to pay for out of pocket medical expenses. We will jump into the difference between an HRA and HSA below.
What's the difference between an HRA and an HSA?
An HSA (aka Health Savings Account) is:
- Funded by both employer and employee
- Owned by Individual; employee takes funds with them when they leave
- Employee has immediate access to money in account
- Funds only for medical expenses that fall under the health plan’s deductible
- HSA funds cannot be used for insurance premiums
- HSA participants must have a High Deductible Health Plan (HDHP)
- Tax benefits: tax deductible contributions, tax free reimbursements, and tax free accumulation of interest and dividends
Now moving on.
An HRA (health reimbursement arrangement) is exactly how it sounds: the employer reimburses for premiums and medical expenses on a tax-free basis, and the employee chooses a plan that fits their needs. Employees are then reimbursed when they submit a claim. There are a few flavors you should be aware of, like ICHRA, QSEHRA and EBHRA, to name a few. Here's what to know about this crew. They all are:
- Funded entirely by Employer (no employee contributions)
- Account owned by Employer- funds stay with employer if employee leaves company
- Reimburses health insurance premiums and medical expenses
- Money is reimbursed for expenses/premiums after they are incurred and receipts are provided
- Employees must have qualifying health insurance to participate
- Tax benefits: Tax free for both employee and employer
HSA and HRA: what to know
Many individuals opt for high deductible plans for the lower premiums, especially if they don't have ongoing medical treatment, are relatively young and healthy, or don't expect any major medical episodes. Tax-free contributions through a health savings account (HSA) help individuals afford the higher deductibles if the unexpected happens, and the money continues to grow, much like an investment account. In 2023, there are IRS limits on HSA contributions.
The annual inflation-adjusted HSA contribution limit for 2023 for self-only coverage is $3,850, up from $3,650 in 2022. The HSA contribution limit for family coverage is $7,750, up from $7,300.
If you have a high deductible plan and want to benefit from the tax-advantaged HSA that goes along with it, you'll want to understand the full picture if your employer is offering you a health reimbursement arrangement at the same time.
While health reimbursement arrangements and health savings accounts are both tax-friendly tools to help cover the costs of medical expenses, they differ in design and their integration can be a little tricky.
First, you'll want to make sure you are eligible for the HSA in the first place before you consider using an HRA and HSA together.
Eligibility for HSAs
It’s important to remember that if you have any coverage in addition to your HDHP that provides first dollar coverage for medical care, you might be disqualified from opening or contributing to the HSA—and that would include employer contributions.
Reasons for disqualification include things coverage under your spouse’s group health plan that isn't considered high deductible, a spouse’s FSA (flexible spending account), Medicare, or HRAs that reimburse for medical expenses in addition to premiums.
You read that right: if you're covered by a spouse's qualified health plan that isn't a HDHP or if your spouse has an FSA or an HRA with medical expense reimbursement through their employer, you are disqualified from participating in an HSA.
→ Learn about the HRA IRS rules.
→ Learn about Health Reimbursement Arrangement Rules for ICHRA and QSEHRA.
→ Check out our top 5 Health Reimbursement Arrangement rules to remember here.
Can a health reimbursement arrangement and a health savings account be used at the same time?
The answer is yes, but there's a catch (isn't there always?). The IRS has some pretty specific rules about how these two tax-advantaged tools work together.
Here are the main rules to remember.
You can use HSA funds any time to cover medical expenses, as long as you don't submit for reimbursement of the same expenses from your employer. No double dipping.
You can contribute tax-free to your HSA and use the funds alongside your company's HRA:
- If you are enrolled in a high deductible plan.
- If your HRA reimburses premiums only.
- If you don't double dip. That means you can't enjoy the benefits of tax free reimbursement through your HRA when you've paid for the medical expenses with your HSA.
Let's go over which HRAs can play well with HSAs.
HRA and HSA together: Types of HRAs that work with HSAs
There are a few HRAs that will work with an HSA, if certain conditions are met. Here is the full lineup.
- Individual Coverage HRA:The Individual Coverage HRA, ICHRA plan (ICHRA) allows employers of any size to reimburse any amount to employees for qualified medical expenses and premiums. While HSA funds can be used for medical expenses at any time, as long as employees don't submit the same expenses for reimbursement through ICHRA, it's a bit more complicated when it comes to contributing to an HSA while also participating in an HRA. To allow for employee contributions to an HSA, the ICHRA must give employees an option to opt out of medical expense reimbursement on a yearly basis. More details on this integration below.
- Qualified Small Employer HRA: The Qualified Small Employer HRA (QSEHRA) allows companies with less than 50 employees to reimburse for medical expenses. Like an ICHRA, medical expenses can't be reimbursed through the QSEHRA if the employee wants to continue to contribute to an HSA. For QSEHRA, if the employer allows expenses, then employees are not able to contribute to an HSA. If it's their spouse's HSA, the spouse can contribute based on the employee not being eligible. For a spouse and employee, the spouse can contribute the single amount. If they have kids, then the spouse could contribute the family rate. 2023 QSEHRA contribution limits can be found here.
- Limited Purpose HRA: This type of HRA covers certain things, like preventive care, dental and vision procedures. Your expenses won’t reduce your deductible, but this type of HRA can be used in conjunction with your high deductible plan.
- Post-Deductible HRA: This type of HRA is basically an HRA that has its own deductible, covering qualified medical expenses after you pay off your deductible. This is compatible with an HSA. Even if you use a post deductible HRA, you can still reimburse for certain things like dental expenses or 5 other things before deductible and everything else you can reimburse after deductible.
- Retirement HRA: This type of HRA covers qualified medical expenses for retirees. You can use your HSA up until the point in time before you lose eligibility for an HSA. After that, you can use your HRA.
Creating an HSA-friendly class for ICHRA
One of ICHRA’s hallmark features, aside from the tax-friendly reimbursement for medical expenses, is the ability to divide employees into different ICHRA classes and offer different levels of benefits to each class. This is one of the top pros when you consider ICHRA pros and cons.
With ICHRA, there’s a provision that allows employers to offer an entire class the option of medical expenses. They can choose to opt out of the medical expense reimbursement on a year to year basis, but keep the reimbursement for premiums through ICHRA. If they opt out of the medical expense reimbursement for the year, then they can participate in their HSA.
The only time this would make sense is if the maximum contribution for your HSA or whatever you are saving on taxes is greater than what you are offered through the HRA.
2023 HSA limits are slightly higher than last year, with $3,850 for individuals and self-only HDHP coverage and $7,750 for family HDHP coverage. As an example, if you estimate your tax savings at a 25% tax rate for your family, you would be saving $1,775 a year or about $148 per month. If your monthly HRA reimbursement rate falls short of that figure, opt for the HSA. It’s a better deal.
Take Command is here to help
There are some other more complicated ways to structure your HRA and allow your employees to still contribute to their HSAs, but it's best to consult with a tax professional if you'd like to go that route.
Need help making sense of how to get the most out of these two great tax-friendly tools? Our team of HRA experts is at the ready to chat with you on our website. You can also check out our guide on small business tax strategies for more ideas on how to play it smart.
This post was originally published in 2020 and has been updated with new information and insights for 2023.
I wrote this blog because I care about ideas (big and little) that can help fix our healthcare system. I used to work on projects for Kaiser Permanente and the Parkland Health & Hospital System so I've seen the system inside and out. It's so important that consumers keep up with industry shifts and changing health insurance regulations. I'm also Take Command Health's Content Editor and a busy mom. Learn more about me and connect with me on our about us page. Thanks!