Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) both help families pay for healthcare, but IRS rules can make it difficult to take advantage of both at the same time. Members covered by a traditional HRA generally can't contribute to an HSA or receive employer HSA contributions. The same restriction applies to spouses whose medical expenses are covered by the HRA, even if they have their own HSA.
That matters because both accounts offer meaningful financial benefits. HSAs come with strong federal tax advantages. Contributions are tax-deductible or made with pre-tax dollars, the money grows tax-free, and withdrawals for qualified medical expenses are tax-free too. Unlike some other healthcare spending accounts, unused HSA funds roll over year after year, making them useful for paying today's medical bills while building savings for the future.
HRAs have their own advantages. They're funded by employers and reimburse eligible healthcare expenses tax-free, helping families pay less out of pocket for medical care. Together, HSAs and HRAs can offer families a powerful combination of immediate financial support and long-term savings.
So, how can families get the benefits of both an HRA and an HSA?
Enter the Post-Deductible HRA.
A Post-Deductible HRA addresses the IRS restriction by delaying reimbursements until members meet the IRS minimum deductible for a high-deductible health plan. That allows otherwise eligible members to keep contributing to their HSAs while receiving reimbursement support later in the year.
How does a Post-Deductible HRA work?
To contribute to an HSA, members generally need to be covered by an HSA-qualified high-deductible health plan (HDHP) and meet other IRS eligibility requirements. With a Post-Deductible HRA, members pay medical expenses themselves, or with existing HSA funds, until they've met the IRS minimum deductible for an HDHP. For 2026, that's $1,700 for self-only coverage and $3,400 for family coverage. In 2027, those amounts increase to $1,750 and $3,500, respectively.
Healia's Total Care Option (TCO) is a spousal HRA available in two versions: First-Dollar and Post-Deductible. The Post-Deductible version, also known as a Post-Deductible HRA (PDHRA), allows eligible members to maintain their HSA contribution eligibility. Once members meet the required deductible, the Post-Deductible TCO can start reimbursing eligible healthcare expenses.
The biggest advantage? Members can continue making their own HSA contributions and receiving contributions from their employers. For families whose employers contribute generously to their HSAs, or those who want to invest their HSA funds, take advantage of the tax benefits and build savings for future healthcare expenses, a Post-Deductible HRA may be the better financial choice.
For example, in 2027, a family enrolled in an HDHP with a $5,000 deductible would generally need to meet the $3,500 IRS minimum before the Post-Deductible TCO could start reimbursing eligible expenses. The family could keep making eligible HSA contributions throughout the year while receiving reimbursements through the TCO.
Households enrolled in the Post-Deductible TCO don't have to figure out when they've met the required deductible on their own. Healia helps with that. Enrollees upload an Explanation of Benefits (EOB), a statement from their insurance company showing how claims have been processed and what counts toward their deductible. Healia reviews the EOB to verify when the required deductible has been met. From there, members can submit eligible expenses through the Healia portal or mobile app and receive reimbursements by direct deposit in a matter of days.
More options for the whole household
Some families want to lower healthcare costs today. Others want to build long-term savings through an HSA. Many want both, especially when they're comparing health coverage from 2 different employers. The most cost-effective setup depends on the household's healthcare needs, available benefits and financial priorities.
Healia helps enrollees compare their household's coverage options and understand how each could affect their healthcare spending. With both First-Dollar and Post-Deductible versions of the TCO available, eligible families have more flexibility to choose the approach that makes the most sense for them.
Frequently asked questions
Can I enroll in the TCO and a high-deductible health plan (HDHP)?
Yes! Members can choose between 2 versions of the TCO:
First-Dollar TCO: Reimbursements through the TCO can start with the first eligible expense. However, members covered by this version, including spouses, generally can't make or receive HSA contributions while enrolled. Any money already saved in an HSA can stay in the account and still be used for qualified medical expenses.
Post-Deductible TCO: Members can keep making or receiving HSA contributions, as long as they meet the other IRS eligibility requirements. TCO reimbursements start once they've met the IRS minimum deductible for an HDHP.
Can members still use money already in their HSA?
Yes. With either option, members can generally keep using existing HSA funds for qualified medical expenses, even if they can't make new contributions. With the Post-Deductible TCO, members can also use those funds to pay medical expenses before meeting the required deductible.
Can the same medical expense be paid with both an HSA and the TCO?
No. The IRS doesn't allow the same medical expense to be reimbursed tax-free twice. Members can't use HSA funds for a medical expense and then get a tax-free reimbursement for that same expense through the TCO. The same restriction applies to expenses reimbursed through a Flexible Spending Account (FSA).
Do members need to change their health insurance plan?
No. A Post-Deductible HRA is a reimbursement benefit and doesn't replace medical coverage. Members stay enrolled in their health plan. To contribute to an HSA, they need qualifying HDHP coverage and must meet the other IRS eligibility requirements.
Can I contribute to my HSA if my spouse and kids are enrolled in the TCO, but I'm not?
Yes! If you're not covered by the TCO, you can generally continue making and receiving HSA contributions, even if your spouse and children are enrolled. You just need to have an HSA-eligible health plan and meet the other IRS eligibility requirements.
The reverse is also true. If you're enrolled in the TCO but your spouse isn't covered, they may still be able to contribute to their own HSA.
HSA eligibility is determined individually, not for the household as a whole. However, employers may have different rules about which family members are covered by the TCO, so check your specific plan details.
Are employer HSA contributions allowed?
Yes, but the same restrictions apply to both employee and employer contributions. If you're enrolled in the First-Dollar TCO, neither you nor your employer can contribute to your HSA while you're covered.
However, if your employer offers the Post-Deductible TCO, you may still be eligible to make and receive HSA contributions. Unlike the First-Dollar version, the Post-Deductible TCO only reimburses eligible medical expenses after you've met the IRS minimum deductible, allowing you to maintain HSA eligibility.
I've already contributed to my HSA this year. Can I still enroll in the TCO mid-year?
Yes! You can enroll in the TCO even if you've already contributed to your HSA this year.
If you choose the First-Dollar TCO, you generally can't make or receive additional HSA contributions once your coverage begins. With the Post-Deductible TCO, you can continue making and receiving contributions as long as you meet the other IRS eligibility requirements. Either way, the money already in your HSA is still yours to use for qualified medical expenses.
One thing to keep in mind: Your annual HSA contribution limit generally depends on how many months you were eligible to contribute. If you've already contributed more than your adjusted limit, you may need to withdraw the excess to avoid tax penalties. A tax advisor can help you determine your limit and next steps.