If your employer offers both an HRA and an FSA, figuring out which account covers what can feel like solving a puzzle. Understanding HRA/FSA-eligible items helps you coordinate these benefits to get the maximum tax savings on your healthcare spending. While both accounts draw from the same IRS definition of qualified medical expenses, the practical differences in how they are funded and administered affect your spending strategy.
The key insight is that HRAs and FSAs can overlap, complement, or substitute for each other depending on how your employer has designed the plans. Getting the most from both requires understanding what each covers and spending in the right order.
The Shared Eligible Expense List
Both HRAs and FSAs define eligible expenses based on IRS Section 213(d). The core list is identical for both accounts: medical services including doctor visits, specialist appointments, hospital care, and emergency services are covered. Prescription medications are eligible at any pharmacy. Over-the-counter medications qualify without a prescription since the CARES Act of 2020. Dental care from cleanings to implants is covered. Vision care including exams, glasses, and contacts qualifies. Mental health services, physical therapy, and medical equipment are all eligible.
Menstrual care products, sunscreen, first aid supplies, and the full range of CARES Act additions apply to both HRAs and FSAs. The underlying IRS rules do not differentiate between account types when defining what qualifies as a medical expense. For a complete FSA overview, see our FSA guide.
How HRAs and FSAs Differ in Practice
Despite sharing the same eligible expense definition, HRAs and FSAs work very differently. FSAs are funded by your pre-tax payroll deductions — you choose how much to contribute. HRAs are funded entirely by your employer — you contribute nothing. FSAs give you the full annual election on day one. HRA availability depends on your employer’s funding schedule.
The most important practical difference is that your employer can restrict which expenses the HRA covers. While the IRS allows HRAs to reimburse any Section 213(d) expense, employers frequently limit HRA coverage to a subset. Some HRAs only cover the health plan deductible. Others are limited to dental and vision. A few cover only prescription drugs. Your Summary Plan Description (SPD) defines what your specific HRA covers — it may be narrower than the full IRS-allowed list.
Coordinating HRA and FSA Spending
When you have both accounts, spend them in the right order. Use your HRA first for expenses it covers, since HRA funds are employer money that may not roll over. Then use your FSA for expenses the HRA does not cover or for expenses exceeding the HRA limit. This approach ensures you use employer-funded benefits before dipping into your own pre-tax contributions.
If your HRA rolls over and your FSA does not (or has limited carryover), the calculus changes slightly. Spend the FSA first to avoid forfeiture, then rely on the HRA for expenses later in the year. The optimal order depends on your specific plan designs — check both plan documents to understand rollover rules, coverage limits, and any coordination requirements.
Common HRA/FSA-Eligible Items by Category
Medical Services
Doctor visit copays, specialist copays, urgent care and ER visits, lab work, imaging, hospital stays, ambulance services, physical therapy, mental health counseling, and chiropractic care. These are standard qualified medical expenses eligible under both accounts.
Medications
Prescription drugs, OTC pain relievers, allergy medications, cold and flu remedies, digestive aids, anti-itch creams, first aid ointments, and smoking cessation products. Since the CARES Act, no prescription is needed for OTC medication claims.
Dental
Cleanings, exams, X-rays, fillings, crowns, root canals, extractions, implants, dentures, orthodontics, and dental sedation. Cosmetic dental work like whitening is excluded.
Vision
Eye exams, prescription glasses, prescription sunglasses, contacts, contact solution, LASIK, and reading glasses. Non-prescription sunglasses are not eligible.
Medical Equipment
Blood pressure monitors, thermometers, CPAP supplies, hearing aids, crutches, breast pumps, and home diagnostic tests. These are durable medical equipment and supply purchases eligible under both account types.
Items Ineligible Under Both Accounts
Certain expenses are never eligible regardless of account type. Cosmetic procedures (teeth whitening, cosmetic surgery), gym memberships, general wellness supplements, personal care items (toothbrushes, shampoo, deodorant), health insurance premiums, and childcare are excluded under both HRAs and FSAs. These exclusions come from IRS rules that apply across all tax-advantaged healthcare accounts.
Special HRA Considerations
Different HRA types have different coverage scopes. An Individual Coverage HRA (ICHRA) can reimburse individual health insurance premiums and medical expenses. An Excepted Benefit HRA (EBHRA) covers expenses not covered by your group plan, up to $2,150 in 2025. A traditional integrated HRA covers out-of-pocket costs under your employer’s group plan. Know which type you have, as it directly affects what HRA/FSA-eligible items your HRA can actually reimburse.
If your HRA has a narrow scope (deductible-only, for example), your FSA becomes more important for covering the expenses the HRA does not reach. If your HRA has broad coverage and generous funding, you may need a smaller FSA election since the HRA covers many of the same expenses.
Frequently Asked Questions
Can I use both my HRA and FSA for the same expense?
No. You cannot double-reimburse the same expense from two tax-advantaged accounts. Each medical expense can be reimbursed from one account only. If your HRA covers a portion of an expense, your FSA can cover the remainder, but the same dollar amount cannot be claimed from both.
Which should I spend first, HRA or FSA?
It depends on rollover rules. If your FSA has a use-it-or-lose-it deadline and your HRA rolls over, spend the FSA first. If your HRA does not roll over and your FSA has a carryover provision, spend the HRA first. The general principle is to spend the most-at-risk-of-forfeiture funds first.
Can my HRA cover expenses my FSA won’t?
Both accounts use the same IRS definition of eligible expenses, so in theory, neither covers more types of expenses than the other. However, HRAs can cover insurance premiums in certain configurations (like ICHRAs), which FSAs cannot. Conversely, your employer may restrict HRA coverage to fewer categories than the FSA covers.
Do I need to submit separate claims for each account?
Yes. HRA and FSA claims are typically processed through separate systems even if they use the same administrator. Submit claims to the appropriate account based on which one should cover the expense. Some administrators offer automatic coordination that routes claims to the appropriate account.
The Bottom Line
The list of HRA/FSA-eligible items is fundamentally the same because both accounts rely on the IRS Section 213(d) definition. The practical differences lie in funding (employer vs employee), rollover rules, and any employer restrictions on HRA coverage. Coordinate your spending to maximize the use of both accounts: spend the account most at risk of forfeiture first, use the HRA for expenses it specifically covers, and fill gaps with your FSA. Together, these accounts can cover a significant portion of your annual healthcare spending with tax-advantaged dollars.