Mike has explained the difference between an HSA and a health care spending account. The latter is often a "Health FSA" (Flexible Spending Account) which operates generally as Mike said (money is set aside by your employer and if not used, might be forfeited).
On the whole, an HSA is preferable (if you have the choice) because it is nearly the best tax benefit available: you pay no tax on dollars as they go into the HSA, and when spent on qualified medical expenses, there is no tax on the dollars as they come out of the HSA. Even better, the dollars are persistent and once you hit 65 years of age, it operates similar to an IRA (when you withdraw dollars, you just pay income tax on them, no matter what they were used for).
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