A medical flexible spending account (FSA) is a tax-advantaged account maintained by employers where employees can set aside a portion of each paycheck to pay for out-of-pocket medical expenses. No payroll taxes are due on funds allocated to an FSA, and the employee can use the money, tax-free, to pay for qualified medical expenses throughout the year.
FSAs can be used in conjunction with any type of health plan (unlike HSAs, which can only be contributed to if the person has coverage under an HSA-qualified high-deductible health plan).
Employees have to decide before the start of the plan year (during open enrollment) whether they want to contribute to their FSA, and if so, how much they want to contribute. The amount is then divided out across the employee’s paychecks for the whole year, although the full amount is available for withdrawal as of the first day of the plan year.
Normally, employees cannot make changes to their FSA election during the plan year unless they have a qualifying event. But in response to the COVID-19 pandemic, employers were allowed (but not required) to relax these rules in 2020 and 2021. As of 2022, however, the normal rules are once again in place for all employers. So a qualifying event is necessary in order to make a mid-year FSA election change.
There is a “use-it-or-lose-it” requirement with FSAs: Any money left in the account at the end of the plan year (or by March 15th of the following year if the employer offers a grace period) is lost to the employee. So it’s important to only allocate for expenses that you know you’ll incur (instead of a grace period, employers can opt to allow employees to carry over up to $500 in unused FSA funds from one plan year to the next).
For 2020 and 2021, the rules were relaxed in response to the COVID pandemic. The 2021 Consolidated Appropriations Act allowed employers the option to let employees roll over any amount of unused FSA amounts from 2020 to 2021, and from 2021 to 2022, for use at any time during the year.
But as of 2022, the normal rules are once again in place. This means that funds that the “use it or lose it” rule will once again apply to funds that aren’t used up by the end of 2022. Employers can offer the normal 2.5-month grace period or a $500 rollover at the end of 2022, if they choose to do so.
FSA funds can be used for qualified medical expenses. As of 2011, the ACA prohibited the purchase of over-the-counter medications with FSA funds, unless a doctor wrote a prescription for them. But Section 4402 of the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act changed that. The CARES Act eliminated subsection (f) of Section 106 of the Internal Revenue Code. That section had previously prohibited the purchase of non-prescription over-the-counter medications with FSA money (it used to say “reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug (determined without regard to whether such drug is available without a prescription) or is insulin.” That provision was eliminated under the CARES Act).
Section 4402 of the CARES Act also changed the rules to allow menstrual products to be purchased with FSA funds. The new rules that allow FSA funds to be used for over-the-counter medications and menstrual products are retroactive to January 1, 2020, and are permanent changes (ie, they will remain in place even after the COVID-19 emergency period ends).
A health savings account is a tax-advantaged savings account combined with a high-deductible health insurance policy to provide an investment and health coverage.
HSA-qualified high deductible plans fit easily within the guidelines established by the ACA.