一年一度的医疗保险开放申请期如期而至，很多已婚小伙伴会问: 「能否配偶一方使用健康储蓄账户(HSA)，另一方使用灵活支出账户(FSA)？」 答案是否定的。只要一方参与了 FSA，任何一方的 HSA 供款就不符合规定。证明如下：

第一步，根据税务局的鱼与熊掌不可兼得的定理，拥有其他医疗计划福利的人，不能向 HSA 账户缴款。税务局的原文如下：

Other employee health plans. An employee covered by an HDHP and a health FSA or an HRA that pays or reimburses qualified medical expenses can’t generally make contributions to an HSA.

From https://www.irs.gov/pub/irs-pdf/p969.pdf page 5.

第二步，根据 FSA 的定义，FSA 涵盖合规的医疗费用，包括账户持有人本人、配偶及至 26 岁的子女。合规医疗费用定义如下：

Qualified medical expenses are those incurred by the following persons.

  1. You and your spouse.
  2. All dependents you claim on your tax return.
  3. …

From https://www.irs.gov/pub/irs-pdf/p969.pdf page 17.

因此，配偶和子女均可持有附属卡，利用 FSA 资金支付医疗相关费用。

第三步，综合以上两点，一方参与 FSA, 双方都不能再向健康储蓄账户（HSA）缴款了，但已有的 HSA 仍可使用。证毕。

有人会问了，虽然法律允许配偶使用我的 FSA, 那配偶主动放弃使用，是不是就可以向健康储蓄账户（HSA）缴款了？ 这也不行，因为税务局还有一个「允许即视为使用」(allowed and allowable) 的定理。只要资格上允许，不管你实际有没有用，都按使用来看待。

这条定理最常用于房屋折旧的场合：

Depreciation allowed is depreciation you actually deducted (from which you received a tax benefit). Depreciation allowable is depreciation you are entitled to deduct.

If you do not claim depreciation you are entitled to deduct, you must still reduce the basis of the property by the full amount of depreciation allowable.

From https://www.irs.gov/pub/irs-pdf/p946.pdf, page 12-13.

也就是说，既然税务局允许您做折旧，不管您实际有没有做折旧减免，都当做做了来算。

这就犹如您订了江景房，不管您是否实际观看，都要按有江景来计费。既然支付了费用，自然应该多看看， 毕竟「看得越多，省得越多」（“the more you see, the more you save”).

the more you see the more you save

对于我们讨论的情况，税务局的用词是 “covered by FSA”, 而不是您是否真正 “paid by FSA”.

虽然一般性 FSA 和 HSA 不可兼得，但夫妻双方均可开设 Limited Purpose FSA (LPFSA), LPFSA 可以随时用于牙科和视力方面的开销，以及满足所有自付额后其他医疗费用。

如果你同时拥有 HSA 和 LPFSA，并且领取了与这两个账户相连的福利借记卡（Benefits Debit Card）， 当你产生涉及符合 LPFSA 使用范围的合规支出时，福利卡服务商的系统会优先自动从 LPFSA 账户扣款， 直到 LPFSA 用完为止。如果超过 LPFSA 可用额度，才会转而使用 HSA 资金。

这个图表提供了对应于夫妻两人保险情况的选项。如果不小心有了违规 HSA 的供款， 可以按照 HSA 供款超限的办法处理，具体步骤我的这篇博客里。

For readers who prefer English, here’s a summary of the key rules:

Under federal tax law, a Health Care FSA (flexible spending account) covers qualified medical expenses for the account holder, their spouse, and children up to age 26. Because this type of FSA can reimburse general medical expenses before the deductible is met, participation by either spouse disqualifies both from making new HSA contributions during the plan year - even if you don’t actually use the FSA to pay your spouse’s expenses. However, existing HSA balances may still be withdrawn to cover eligible expenses at any time.

On the other hand, both spouses can enroll in a Limited Purpose FSA (LPFSA) which only pays for dental and vision expenses, and other expenses after the medical deductible is met without jeopardizing HSA eligibility. When you have both an LPFSA and an HSA, your linked debit card will typically use available LPFSA funds first for qualified expenses before using HSA funds.