Once money is placed in an FSA or HSA, it may be used to pay for out of pocket medical expenses for the account owner, their spouse or their dependents.
- The only expenses that can't be paid from an HSA are medical insurance premiums, except that premiums for long term care and Medicare (but not "Medigap" insurance premiums) can be paid from an HSA if the person is 65 or older.
- The only expenses that can't be paid from an FSA are medical insurance premiums (including long term care).
- Neither type of plan can be used to pay for expenses that were also covered by some other type of insurance.
The restrictions really fall on contributions— you can't contribute to an HSA if you are covered by Medicare or by your own or a spouse's FSA. But once money is in the account, the rules on spending it are not that much different.
