在美国参加工作后，每年年底都会有一个Open Enrollment，给大家选择下一年的医保、401k、人寿保险等等。关于401k的讨论已经很多了，基本上无脑把公司match的部分放满，如果收入较高的话，直接放到IRS允许的上限。FSA和HSA就要稍许复杂一些，不过不用担心，这类东西都是一旦懂了背后的逻辑就很容易理解，希望本文可以为您理清这些逻辑。
FSA和HSA简介
HSA，全称health savings account
FSA，全称flexible spending arrangement/account
这两种账户有两个最大的共同点。
第一，tax-free，放到这类账户的收入不用交税。
第二，专款专用，这类账户里的钱只能用于与医疗相关的支出，通常包括看病、牙医和眼科。
区别
这两种账户区别还是挺大的，适用的医保计划就不一样，必须high-deductible的计划才能存HSA。high-deductible的意思是看病的支出中自付的金额比较高，以$3000 deductible的计划为例，只有在自付满$3000之后，保险公司才会来支付剩余的费用，在满$3000之前，虽然看in-network的医生还是可以享受保险内协议价，但保险公司一般是不承担费用的。那为什么还会有人选择high-deductible的计划呢？道理很简单，high-deductible的计划每个月从工资中扣除的保险月费少。
| ————— | Health savings account (HSA) | Flexible spending arrangement (FSA) |
|---|---|---|
| 开户要求 | 医保计划必须是HDHP (high-deductible health plan ) | 不要求，但如果存了HSA就不能存FSA |
| 存款上限 | 2018年个人最多存$3450，家庭最多$6900 | 2018年最多存$2650 |
| 更改数额 | 任何时候都可以更改，存多少用多少 | 只能在Open Enrollment阶段更改，一旦确定，不能更改 |
| 存款有效期 | 存款随时有效，当年存款用不完的可以留到以后用 | 必须当年用完，有些计划允许延迟后后一年三月，用不完则作废 |
| 与雇主关系 | 与雇主/公司无关 | 绝大部分情况下，一旦离职，没用完的FSA自动作废 |
综合上述的几点，给大家的建议是：
年轻人，除了每年体检外不怎么看病的，可以选择high-deductible health plan，存HSA。如果工资高（意味着marginal tax rate也高），HSA可以存满。
有家庭的，根据家庭成员的健康情况和具体计划来决定，有时候公司为了鼓励员工选择HDHP，会往这类员工的HSA存一些钱用来帮助支付deductible，总之大家可以把保险月费、deductible、HSA省的税等等加起来并结合家庭具体情况简单计算一下，找到适合自己的方案。
常见问题
1、我存了HSA，真的不能再存点FSA用了吗？
有些公司支持Limited Purpose FSA，顾名思义，这类FSA能支付的医疗类别很受限制，主要用于支付牙科和眼科的费用。如果你明年准备看牙或者配眼镜，并且已经存了HSA，不妨预估一下费用并存一些LPFSA，这部分钱也是免税的，而且可以减少HSA的开支，毕竟HSA可以留着以后慢慢用。LPFSA不要存太多，因为用不完会作废的。
2、快到年底了，我的FSA还没用完，怎么办？
FSA虽然限制较多，但这些钱要花光还是不难的，下面我罗列了一些FSA eligible的常见支出。
- Chiropractic office visit or treatment
- Eyeglasses (over-the-counter)
- First aid kits (over-the-counter)
- Flu shots
- Monitors and test kits (over-the-counter)
- Over-the-counter bandages and related items
- Physical therapy
- Pregnancy tests (over-the-counter)
- X-ray fees (medical)
完整的列表大家可以看wageworks的这个页面。
（除非特别注明，这个博客的文章都由我原创，谢绝转载）
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