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HSA vs FSA (2026): Limits, Rules and Your Paycheck

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Updated October 25, 2026 · Sources linked in the text

An HSA (health savings account) and a health FSA (flexible spending arrangement) both pay medical costs with money taken from your pay before taxes. The big differences: you can have an HSA only with a high-deductible health plan, and HSA money is yours to keep from year to year, while most unused FSA money is lost at the end of the plan year. For 2026, you can put up to $4,400 in an HSA ($8,750 for a family) and up to $3,400 in a health FSA.

Choosing benefits for 2027? See HSA vs FSA 2027 for the new limits.

HSA vs FSA at a glance (2026)

HSAHealth FSA
Who can have oneOnly people covered by a high-deductible health plan (deductible at least $1,700, or $3,400 for a family), not enrolled in Medicare and not claimed as someone's dependentEmployees whose employer offers one; no special health plan needed
2026 limit$4,400 self-only, $8,750 family, plus $1,000 at age 55 or older$3,400 per employee
Who owns the moneyYou. It stays with you if you change employers or stop workingYour employer's plan
Unused moneyStays in the account from year to year; interest and other earnings are tax freeLost at the end of the plan year, except a carryover of up to $680 or a grace period of up to 2½ months, if the plan has one
When you can spend itAs money goes into the accountYour full yearly amount from the first day of the plan year
Taxes through payrollNo federal income tax, Social Security tax or Medicare tax on the money you put in
Money used for other thingsTaxed as income, plus a 20% additional tax; no additional tax after age 65Not allowed; the plan pays only medical costs

Sources: IRS Publication 969 Source; IRS 2026 inflation adjustments (Rev. Proc. 2025-32) Source.

What $100 a paycheck does to your take-home pay

Because the money comes out before taxes, putting $100 from each paycheck into either account lowers your take-home pay by less than $100. On a $60,000 salary paid every two weeks, a single filer in Texas gives up only $80.35 of take-home pay for each $100, and saves $19.65 of tax. Source

Take-home pay each paycheck, $60,000 a yearNothing put in$100 to an HSA$100 to a health FSA
Texas$1,938.07$1,857.72 (−$80.35)$1,857.72 (−$80.35)
California$1,838.71$1,759.66 (−$79.05)$1,766.26 (−$72.45)

Single filer, paid every two weeks, 2026 Form W-4 with no adjustments; California with 1 DE 4 allowance. Worked out with the same engine as our calculators.

California is the exception in the table: it does not exclude HSA contributions from state wages, so an HSA saves federal taxes there but not California income tax. A health FSA lowers California income tax too. A few other states also treat these accounts differently from the federal rules, so check your state's calculator.

At the 2026 maximums in Texas, putting $4,400 in an HSA ($169.23 a paycheck) costs about $3,535 of take-home pay over the year, and $3,400 in a health FSA ($130.77 a paycheck) costs about $2,732. The rest is tax you do not pay.

Try it with your own pay in the paycheck calculator: open "Deductions" and enter your HSA or FSA amount for each paycheck.

Which one fits you

Common questions

Can I have an HSA and an FSA at the same time?

Not a general health FSA. It counts as other health coverage and ends your HSA eligibility. A limited-purpose FSA, which pays only for items such as dental and vision care, is allowed with an HSA.

What happens to unused FSA money?

It is lost at the end of the plan year, unless your employer's plan lets you carry over up to $680 or gives a grace period of up to 2½ months.

Do HSA and FSA contributions lower Social Security and Medicare tax?

Yes, when they are taken from your pay through your employer's cafeteria plan. They lower federal income tax, Social Security tax and Medicare tax. Contributions you make to an HSA on your own are deducted on your tax return instead, and do not lower Social Security or Medicare.

How much can I put in an HSA in 2026?

$4,400 with self-only high-deductible coverage, or $8,750 with family coverage. If you are 55 or older by the end of the year, you can add $1,000. Employer contributions count toward the limit.

This guide is general information, not tax advice. Your plan documents decide the details, such as the plan year, carryover or grace period, and employer contributions.

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