Quick answer: Both let you use pre-tax money for health expenses, but they work differently. An HSA is yours forever and rolls over every year (requires a high-deductible health plan). An FSA is tied to your employer and mostly use-it-or-lose-it. Crates Health works with both.
The Basics
HSA (Health Savings Account)
You own it. It's your account, like a bank account. It stays with you even if you change jobs.
Rolls over forever. Money you don't spend stays in your account indefinitely. No deadlines.
Requires a high-deductible health plan (HDHP). You need to be on an HDHP to contribute. In 2026, that means a deductible of at least $1,700 (individual) or $3,400 (family).
Triple tax advantage. Contributions are pre-tax, growth is tax-free, and withdrawals for eligible expenses are tax-free.
2026 contribution limits: $4,400 (individual) or $8,750 (family). If you're 55+, you can add another $1,000.
You can invest it. Many HSA admins let you invest your balance in index funds, ETFs, and more.
No time limit on reimbursement. You can pay for something today and reimburse yourself from your HSA years from now, as long as the expense happened after your HSA was opened.
FSA (Flexible Spending Account)
Your employer sets it up. You can only get an FSA through your employer's benefits plan.
Use it or lose it (mostly). Unspent funds are generally forfeited at the end of the plan year. Your employer might offer a grace period (up to 2.5 extra months) or a carryover (up to $680 in 2026), but not both.
No HDHP required. Anyone with employer-sponsored benefits can use an FSA.
Pre-tax contributions. Like an HSA, you fund it with pre-tax dollars from your paycheck.
2026 contribution limit: $3,400/year.
Full balance available Day 1. Unlike an HSA, your full annual election is available at the start of the plan year, even if you haven't contributed it all yet.
Stricter documentation. FSA admins are required to verify (substantiate) your claims. They'll check itemized receipts and may ask for additional documentation.
Side-by-Side Comparison
Feature | HSA | FSA |
Who owns it | You | Your employer |
Rolls over | Yes, forever | Limited (grace period or small carryover) |
Health plan required | HDHP only | Any employer plan |
2026 contribution limit | $4,400 / $8,750 | $3,400 |
Can invest the balance | Yes | No |
Portability | Stays with you | Tied to job |
Documentation requirements | You keep records for IRS — they can audit up to 10 years | Admin verifies every claim |
Reimbursement deadline | None - reimburse anytime | Plan year deadline |
Which One Do I Have?
Not sure? Here's how to find out:
Check your benefits portal. Your employer's HR or benefits site will show which accounts you have.
Look at your health plan. If you're on a high-deductible health plan, you likely have (or are eligible for) an HSA. If you're on a PPO or HMO with a lower deductible, you probably have an FSA.
Check your cards. HSA cards usually say the name of the HSA admin (HealthEquity, Fidelity, Optum, etc.). FSA cards usually reference your employer's benefits admin.
Can I Have Both?
Generally, no - you can't have a regular HSA and a regular FSA at the same time. However, you CAN pair an HSA with a Limited Purpose FSA (LPFSA), which only covers dental and vision expenses. You can also have a Dependent Care FSA alongside an HSA since it covers different expenses (childcare, not medical).
How Crates Works with Both
Crates Health works the same way regardless of whether you have an HSA or FSA:
Take your health assessment
Get your LMN from our licensed healthcare providers
Purchase your wellness product normally (Crates is not a store — you buy where you normally would)
Upload your itemized receipt to Crates
Submit for reimbursement through your HSA or FSA
The only differences are in how your admin processes the claim: - HSA: Most HSA admins don't require documentation to process a withdrawal. You just transfer the money and keep itemized receipts for your records in case the IRS audits you, which they have the right to do up to 10 years post-transaction. - FSA: Your FSA admin will review your documentation (itemized receipt + LMN) before approving the reimbursement.
Frequently Asked Questions
Does Crates work with my specific HSA/FSA admin? We can issue Letters of Medical Necessity for any HSA or FSA admin. For reimbursement support directly through our platform, we currently support 8 admins: HealthEquity, Fidelity, Optum, HSA Bank, Bank of America, WEX, Navia, and FSAFEDS. If your admin isn't one of these, you can still get your LMN through Crates — you'll just need to download your LMN, get your itemized receipt, and submit both to your admin's portal yourself.
My FSA expires soon. Can I still use Crates? Yes, and you should! FSA funds that aren't spent before your plan deadline are forfeited. Getting an LMN through Crates and reimbursing wellness expenses is a great way to use those funds before they expire.
Which is better, HSA or FSA? If you have the choice, most financial advisors recommend an HSA for its triple tax advantage, investment options, and no-expiration rollover. But it depends on your health plan options and personal situation. Crates works great with either one.
Still Need Help?
Not sure how Crates works with your specific account? Chat with us or email [email protected] and we'll help you figure it out.