Current Situation

My wife currently has a general health FSA with her employer. The fiscal year started on October 1. We have spent about a third of the money in the account, but she obviously has not made all of her contributions.

I just started a new job on December 30, and I am in the 30 day benefits enrollment window. My wife and newborn son were on my previous employer's health insurance plan. My new employer offers a high deductible plan with an HSA. If I put the family on this plan, my employer will contribute $1,000 to the HSA. They also offer another health plan, but the premium is thousands higher for the year.

The benefits literature states that I cannot have an HSA and FSA simultaneously. Because my wife has an FSA, the situation is rather confusing. I'm posting a question here because I cannot get a clear picture of what my options are from any of the companies involved.

Possible Scenarios

  1. I put the whole family on my employer's HSA plan. In this scenario, I am certain that my wife needs to close her FSA and stop contributing. How would this affect her eligibility to use my HSA?
  2. I put myself and my son on my employer's HSA plan, and my wife uses her employer's plan. In this scenario, can she still use an FSA?
  3. I just use my employer's non-HSA plan, whether my family is on it or not, just to avoid any tax headaches.

Is there anything else I'm failing to consider?

  • 1
    Sam, what is your family/wife's expected out-of-pocket cost for the next year? If it is low, it is possible you will do well with the high-deductible plan. Do you expect that your out-of-pocket costs would exceed the new deductible on the high-deductible plan? Also, do you know if the FSA is a general health FSA (most common), or a limited-use FSA? It seems likely that if your wife joins the HSA, she may not be able to use the FSA, but perhaps she can spend some of that money now while you are deciding.
    – JAGAnalyst
    Commented Jan 9, 2015 at 16:50
  • Our expected out-of-pocket expenses are very low, which is why the HSA is so appealing to us. We do have a newborn, but he is very healthy so far and I don't expect major expenses (I could be very naive about this, though). The FSA is for general health. I am more interested in the technicalities of this situation, though. What does the IRS say I can and cannot do?
    – Sam Jones
    Commented Jan 9, 2015 at 17:35
  • Think it over long and hard before covering a child with a HDHP. Those well-baby visits won't be covered at 100% after the first year. Take a look at what you will pay if you need to go to the emergency room. Say something happens or there is some issue that requires multiple doctor visits. An example would be say you need to go to the dermatologist 12 times to get a wart removed. Instead of 12 co-pays you have to pay the full price 12 times. If you still feel like it would save you money then go for it. Commented Oct 25, 2016 at 13:40

5 Answers 5


Thanks for your additional comments Sam, that is helpful. Here is an overview of what you can and cannot do with an FSA as it applies to your situation.

The government intends that a general health FSA be used to cover expenses that are usually out-of-pocket when you are covered by a qualifying health plan. It is funded with pre-tax dollars and is on a use-it or lose-it basis.

However, an HSA is itself a form of health coverage that is tax-advantaged, and the balance can be invested. Because of this, an HSA is not considered by the government to be a health plan that "qualifies" for use with a general health FSA. However, this means that a given covered person cannot have both of these simultaneously. In your wife's case, if you have an HSA and she has traditional health benefits with an FSA, this is not considered a problem since she can only use the FSA money for expenses incurred by members of your family on her plan. However, if she were to join you on the HSA (which sounds like it could be a good idea overall), she would need to wind down her FSA and would not be able to fund it for the next year. This could be a problem if you have a lot of money in the FSA that she isn't able to spend prior to joining the HSA.

The reason why the government doesn't want one given person covered by both an HSA and given access to an FSA at the same time is that they are both tax-advantaged. What they intend is that people can set aside money pre-tax which they will use to pay their non-covered health expenses. If someone had both, there would be two potential problems:

  1. This person would be able to set aside twice as much money on a tax-advantaged basis as someone who had traditional health coverage rather than an HSA, and
  2. Someone could potentially abuse the system by funding their FSA and using it for health expenses, but not spending from their HSA. This would allow them to potentially keep investing in the HSA over a long period of time on a tax-advantaged basis instead of using this money for health expenses as intended.

If you do ultimately want your wife to be on the HSA, see if you can spend what is left in her FSA, as it will end when she ends her health coverage with her employer. If the amount you stand to lose is significant, you may need to wait another year until your next open enrollment period or life event (such as the birth of a child) to enroll her on your HSA. It is also likely that her premium on the HSA will be lower, which could impact the effect of ending her FSA.

Recently, there has also been a rule change regarding what is called a "Limited Use" FSA. These are FSAs that are used for qualifying non-"health" expenses such as dental and vision that can be used together with an HSA. This may be something that is helpful to you and/or your wife on the HSA if your employer offers this as a possibility. Please note that unlike retirement accounts, you cannot "rollover" funds between FSA plans offered by two different employers as each FSA is a separate benefit fund that is on a use-it or lose-it basis (again, because the government wants to restrict tax-advantaged contributions to what you are likely to spend).

You may also find the article here helpful to learn more about FSA/HSA combinations and Limited-Use FSAs.

I hope this helps!

  • Wow, very thorough. I think the short answer is: If I put my wife on my plan with HSA, we need to cancel her FSA account, meaning we lose whatever money is still there. I think as long as her contributions to the account are not greater than the amount she has spent, it makes sense to do so.
    – Sam Jones
    Commented Jan 12, 2015 at 20:29
  • Your wife's FSA would be cancelled as soon as her coverage through her employer ends, that is part of the rules of how FSAs are administered. You likely won't have to take any steps to cancel it. Also, if you save money by putting her on the HSA, it could offset money lost in the FSA.
    – JAGAnalyst
    Commented Jan 12, 2015 at 23:33
  • You misunderstood. My wife does not currently have medical coverage through her employer, only the FSA. Regardless, we are going through the process of stopping her contributions.
    – Sam Jones
    Commented Jan 13, 2015 at 16:42
  • Ok no problem. If she did have medical coverage through her employer, the coverage and the FSA would end concurrently.
    – JAGAnalyst
    Commented Jan 13, 2015 at 19:19
  • 1
    An HSA is a form of health coverage!?!? No it isn't, it's a savings account.
    – quid
    Commented Aug 18, 2017 at 15:32

I believe the following statement by JAGAnalyst is incorrect:

In your wife's case, if you have an HSA and she has traditional health benefits with an FSA, this is not considered a problem since she can only use the FSA money for expenses incurred by members of your family on her plan.

Unless your FSA funds can only be used for your spouse's expenses and not yours (very few employer FSA plan documents state this), then the IRS will assume that the FSA funds are available to all family members, thus making you ineligible to contribute to an HSA.

According to the link cited above above by JAGAnalyst regarding Eligible Expenses:

You can use your account funds for numerous health care-related products and services — for yourself, your spouse, and your qualifying child or relative.

  • 1
    Almost everything in JAGAnalyst's answer is incorrect.
    – quid
    Commented Aug 18, 2017 at 17:20

I work in the FSA/HSA/HRA industry and just wanted to point out that if your wife has a medical FSA, you cannot contribute to an HSA whether or not you are covered by her medical insurance plan. The only exception to this per the rules is if your wife's employers plan limits the medical FSA benefit to the employee, your wife, which I can say from experience is extremely rare. It's possible, but I've never personally seen an employer with this in their plan document, so better check first to be sure the FSA is restricted to your wife only. You have to understand the FSA to know why this is true. Unless restricted, your wife can use her medical FSA for herself, her spouse, and any tax dependents. Meaning whether or not she uses the FSA for your eligible expenses you still have 1st dollar coverage from the FSA, making you in-eligible to open and contribute to an HSA until the end of the plan year and possibly grace period if her employer has one in place and she does not spend her funds by the end of the plan year. Hope this helps. If your still not sure, talk to a tax professional, which I am not, but do advise employers and participants on both HSAs and FSAs.


According to the IRS, it appears there is no issue in a spouse under EE or EE+Child(ren) coverage contributing to an FSA while you contribute to an HSA under an EE Only HDHP account:


"In Situation 1, H has HDHP self-only coverage and no other health coverage, is not enrolled in Medicare and may not be claimed as a dependent on another taxpayer’s return. Although W has non-HDHP family coverage, H is not covered under that health plan. H is therefore an eligible individual as defined in section 223(c)(1). The special rules for married individuals under section 223(b)(5) do not apply because W’s nonHDHP family coverage does not cover H. Thus, H remains an eligible individual and H may contribute up to $2,000 to an HSA (lesser of the HDHP deductible for self-only coverage or $2,650) for 2005. H may not make the catch-up contribution under section 223(b)(3) because H is not age 55 in 2005. W has non-HDHP coverage and is therefore not an eligible individual."

Some more information directly from IRS form 969 published for 2015 tax returns: https://www.irs.gov/pub/irs-pdf/p969.pdf

Qualifying for an HSA

To be an eligible individual and qualify for an HSA, you must meet the following requirements.

You must be covered under a high deductible health plan (HDHP), described later, on the first day of the month.

You have no other health coverage except what is permitted under Other health coverage, later.

You are not enrolled in Medicare.

You cannot be claimed as a dependent on someone else's 2015 tax return.

Under the last-month rule, you are considered to be an eligible individual for the entire year if you are an eligible individual on the first day of the last month of your tax year (December 1 for most taxpayers).

If you meet these requirements, you are an eligible individual even if your spouse has non-HDHP family coverage, provided your spouse's coverage does not cover you.


See IRS Revenue Ruling Rev. Rul. 2004-45 in Internal Revenue Bulletin IRB 2004-22:

Page 972:

Consequently, an individual who is covered by an HDHP and a health FSA or HRA that pays or reimburses section 213(d) medical expenses is generally not an eligible individual for the purpose of making contributions to an HSA.

Page 973:

The health FSA and HRA pay or reimburse medical expenses that are not limited to the exceptions for permitted insurance, permitted coverage or preventive care. As a result, the individual is not an eligible individual for the purpose of making contributions to an HSA. This result is the same if the individual is covered by a health FSA or HRA sponsored by the employer of the individual’s spouse.

I saw this ruling in The Complete HSA Guidebook (see page 31).

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