Can I have a HRA, HSA, and FSA at the same time? If so, which one does the employer fund?

Yes, an HRA and FSA may co-exist. Employers fund the HRA and employees fund the FSA for qualified medical expenses beyond what the employer-funded HRA will pay for.

May an FSA, HRA, and HSA co-exist?  Yes, all three healthcare account structures may co-exist, although there are “ordering rules” that must be followed.  The employer may offer a QHDHP and establish an HSA for each of its eligible employees. The employer may also establish a post-deductible HRA to pay for qualified medical expenses beyond the IRS minimum deductible requirements. At the same time, the employer can make a limited-purpose FSA (LPFSA) available to employees, so that they can set aside tax-preferred money to pay for qualified vision and dental expenses. This triple-tier healthcare account strategy is called “healthcare account stacking”, and is an advanced CDHP solution.

Coaches' Takeaway

Yes, all three healthcare account structures may co-exist, as long as the flexible spending account is a limited-purpose flexible spending account that can be used to pay only for dental and vision expenses. There are also healthcare account “ordering rules” that must be followed.

Tools & Resources

CDHPCoach’s Storage Facility, where the Coach has organized and compiled a vast amount of tools and resources for you to access.


Housed here are key components and information within the book, Bend the Healthcare Trend which was the impetus behind the CDHPCoach.