Can I Use My HSA and FSA Funds Together for Medical Expenses?

Only certain types of FSAs can be paired with an HSA. Here’s a simple chart to show you how to pair your HSA with an FSA so you can maximize savings without incurring any fees or penalties.

• HSAs have an annual limit set by the IRS. For 2026, you, your employer, your spouse or family members can contribute up to $4,400 into your HSA.
• If you or your spouse are over the age of 55, you can each contribute an additional $1,000 into your HSAs, known as a catch up contribution.
• Any contributions your employer makes into your HSA counts toward the annual IRS limit.

• FSAs also have an annual limit on the maximum amount you can contribute, however employers can set their own cap that is lower than the IRS limit. For 2026, the IRS contribution limit is $3,400 for FSAs and LPFSAs.
• If your employer chooses to contribute to your FSA, their contributions do not count toward the IRS limit. The IRS limit only applies to the pre-tax dollars you contribute from your paycheck—your employer may have a separate limit for how much they can contribute.
• Many FSAs are use-it-or-lose-it. If your plan allows, you may be able to either carryover some funds into the next plan year, or be given a grace period to spend your FSA dollars.

• Prioritize FSA funds. Since many FSAs are use-it-or-lose-it, spend your LPFSA dollars on eligible dental and vision expenses such as glasses, contacts, and Invisalign, along with eligible post-deductible medical expenses (Post-Deductible FSA) if your plan allows.
• You may want to use your HSA on bigger one-time expenses that are eligible, since HSA funds typically carry over each year. You may be eligible to use HSA funds on items such as fitness equipment, saunas, cold plunges, or smart watches to manage a specific health condition when supported by a Letter of Medical Necessity (LMN).
• Whether you’re spending your HSA or FSA/LPFSA funds, be sure to keep itemized receipts for items or services.

1. You may be able to pay for eligible expenses with a pre-paid debit card if your plan provides one, which could auto-approve purchases based on the merchant.

2. You may need a Letter of Medical Necessity for some items or services to be eligible to spend HSA/FSA funds on, when used to treat or manage a specific health condition.

3. For purchases that need documentation such as an LMN, pay out-of-pocket and be sure to keep itemized receipts so you can get reimbursed if eligible.

4. Submit your claims with the proper proof such as an LMN, itemized receipt, or Explanation of Benefits (EOB).

There are some rules to watch for with HSAs, General-Purpose FSAs, and LPFSAs. Here’s a breakdown of rules to look for so that you’re pairing and using these accounts correctly to avoid fees and penalties.

• If your spouse has a General-Purpose FSA, you cannot contribute to an HSA at the same time.
• This includes if your spouse has a GP-FSA that carries over into the new year—you still won’t be qualified to contribute to your HSA unless your spouse’s FSA is able to be converted into a Limited-Purpose FSA. Be sure to check what your individual plan allows.
• Mid-Year Changes & HSA: Changes to your HDHP plan, enrolling in Medicare (which is often retroactive), adding or removing FSA coverage, are all factors that may change your eligibility to contribute to an HSA.

One of the main differences between an HSA and FSA is if you leave your job, your FSA generally does not go with you. However, you may be able to continue using your FSA for eligible expenses through COBRA if your employer’s plan allows. HSAs are usually portable and go with you even when you leave a job.

You may be able to maximize your HSA and FSA funds by spending on eligible products and services used to treat or manage a specific health condition.

This typically requires a Letter of Medical Necessity (LMN), which Truemed* can help with.

• Truemed helps connect you with an independent licensed practitioner who reviews your health survey, and if appropriate, may issue a Letter of Medical Necessity.
• An LMN can help qualified individuals spend HSA or FSA/LPFSA money for eligible items related to a specific health condition. Note: An LMN does not increase your contribution limits or extend deadlines to spend HSA or FSA funds.
• Truemed can help streamline your documentation so you can submit claims for eligible HSA or FSA purchases with clear records.

*Truemed is for qualified customers. See terms at truemed.com/disclosures.