Yes, you can have an HRA and an FSA at the same time, but the IRS will not let both accounts reimburse the same medical expense. To keep the combination legal, at least one of the two accounts has to be designed with restricted coverage. Your employer decides which account is limited and how the two coordinate, and that design controls what you can spend where.
Why One Account Has To Be Limited
The core rule is simple: no expense can be reimbursed tax-free from two different accounts. IRS Publication 969 requires you to certify in writing that any expense you submit to your FSA has not already been paid or reimbursed by another health plan.1Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
Two general-purpose accounts sitting side by side would violate that rule the first time a bill could plausibly be sent to either one. So employers build the pairing in one of three ways: they narrow the FSA, they narrow the HRA, or they hold the HRA back until a spending threshold is met.
The Three Pairings the IRS Allows
General-Purpose HRA With a Limited-Purpose FSA
The HRA covers the full range of qualifying medical expenses: doctor visits, prescriptions, hospital bills. The FSA is walled off to dental and vision only. A cleaning goes to the FSA. A prescription goes to the HRA. Nothing can overlap because each account has a defined lane.
General-Purpose FSA With a Limited-Purpose HRA
Same idea, reversed. The FSA covers all qualifying medical costs, and the HRA is restricted to dental and vision (or, in some designs, preventive care only). Again, neither account can pay for what the other one covers.
General-Purpose FSA With a Post-Deductible HRA
A post-deductible HRA stays dormant until you have spent a set amount out of pocket. That threshold is usually pegged to the minimum annual deductible for a High Deductible Health Plan, which for 2026 is $1,700 for self-only coverage and $3,400 for family coverage.2Internal Revenue Service. IRS Notice 2026-05 Below the threshold you use the FSA. Above it, the HRA switches on and starts covering general medical costs. The staggering keeps the two accounts from competing for the same early-year bills.
Which Account Pays First
When both accounts can cover the same expense, the IRS default is that the HRA pays first. You draw the HRA down to zero, then move to the FSA for anything left over.3Internal Revenue Service. Health Reimbursement Arrangements Notice 2002-45
Your employer can flip that order in the plan document, telling the FSA to pay first.3Internal Revenue Service. Health Reimbursement Arrangements Notice 2002-45 There is a practical reason to do so. FSA money is generally use-it-or-lose-it, while HRA balances roll over. Spending the FSA first burns down the dollars that would otherwise be forfeited and leaves the HRA intact for later years.
With a limited-purpose FSA and a general-purpose HRA, ordering does not really apply. The category settles it. A $150 dental bill goes to the limited-purpose FSA because that is what the FSA is allowed to pay. A $40 specialist co-pay goes to the HRA because the FSA cannot touch it.
What This Does to HSA Eligibility
If you are on a High Deductible Health Plan and want to keep contributing to an HSA, the type of HRA or FSA you hold matters a great deal. A general-purpose HRA or general-purpose FSA that reimburses all qualifying medical expenses disqualifies you from making HSA contributions.1Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
You can preserve HSA eligibility by pairing the HDHP with accounts that have restricted coverage. The IRS allows HSA contributions alongside any of the following:
- A limited-purpose FSA or HRA that covers only dental, vision, and preventive care.
- A post-deductible FSA or HRA that reimburses nothing until the HDHP’s minimum annual deductible is met.
- A suspended HRA, where the employee elects to shut off HRA reimbursements for the coverage period except for preventive care.
For 2026, the HSA contribution cap is $4,400 for self-only coverage and $8,750 for family coverage.4Internal Revenue Service. Revenue Procedure 2025-19 Choose the right configuration and you can stack all three accounts: HSA, HRA, and FSA. Watch one trap: a general-purpose FSA with a grace period will disqualify you from HSA contributions unless the FSA balance was zero at the end of the prior plan year.1Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
2026 Limits and Rollover Rules
The 2026 health FSA salary reduction limit is $3,400.5Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026 HRAs have no IRS-imposed annual cap. Your employer decides how much to credit.
FSA money you do not spend by year-end is generally forfeited. Your employer’s plan may include one of two relief options, but not both:6Internal Revenue Service. Modification of Use-or-Lose Rule for Health Flexible Spending Arrangements
- A grace period of two months and 15 days after the plan year to keep spending down the balance.
- A carryover of up to $680 of unused FSA money into the next plan year for 2026.5Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026
HRA balances behave differently. Unused HRA funds automatically carry forward unless the plan document says otherwise, so the account can accumulate over time in a way an FSA cannot.
What Happens If You Leave Your Job
The two accounts part ways at termination.
For the FSA, you usually lose access on your last day of employment, or at the end of that month depending on plan terms. You can still submit claims for expenses incurred while you were covered, but not for anything new. Your employer may be required to offer COBRA continuation for the FSA, which lets you keep contributing and spending through the plan year. COBRA premiums for an FSA often cost more than the remaining benefit is worth, so it tends to pay off only if you have spent less than you elected.
For the HRA, the answer depends on how the plan is written. The employer can let you forfeit the balance, allow spend-down for eligible expenses incurred after you leave, or apply different rules to different groups of employees. What the employer cannot do is cash out the balance. Paying it to you in cash would make all HRA distributions taxable.3Internal Revenue Service. Health Reimbursement Arrangements Notice 2002-45 COBRA generally applies to HRAs as well, which can give you continued access to the balance regardless of the plan’s default forfeiture rule.