Tax-Advantaged Health Care Accounts (Open Enrollment 2026)

Introduction to Tax-Advantaged Health Care Accounts

Tax-Advantaged Account Options	Health Plan
Health Care Reimbursement Account (HCRA)	Duke Select Duke Basic Duke Options Duke USA Cigna Care
Health Savings Account (HSA)	Duke Advantage
Limited Purpose FSA (LPFSA)	Duke Advantage

HSAs vs. FSAs: What's the Difference?

	HEALTH SAVINGS ACCOUNT An individual tax-advantaged account that you own and that allows you to save what you don’t use for future health care costs	HEALTH CARE REIMBURSEMENT ACCOUNT An account your employer owns that allows you to set aside money you plan to spend, typically within the plan year
Will the account help me save on taxes?	Yes. You don’t pay taxes on your contribution or when the account grows. You can also withdraw money tax-free to cover qualified medical expenses.	Yes. You can not only add money as pre-tax payroll deductions, but also withdraw money tax-free to cover qualified medical expenses.
How do I know if I am eligible?	You can establish and contribute to an HSA if you meet all the eligibility requirements: Must be enrolled in an HSA-eligible health plan on the first day of the month Must not be covered by any other health plan unless that plan is also an HSA-eligible health plan Must not be enrolled in Medicare Cannot be claimed as a dependent on someone else’s tax return	If you meet the plan eligibility requirements, you can enroll in a Healthcare Reimbursement Account.
What happens if I have money left over at the end of the year?	The full balance carries over from year to year.	Up to $660 of your unused 2026 Health Care Reimbursement Account balance can be carried over to the 2027 plan year. Amounts above $660 remaining in your account after December 31, 2026 will be forfeited unless claims are submitted by April 15, 2027 for eligible expenses incurred January 1 - December 31, 2026.
What if I change jobs, lose my job, or retire?	Your HSA can move with you. If you lose your job, you can use the money to pay for COBRA premiums (which temporarily extend your employer-sponsored health care coverage). In retirement, you can also use your HSA for general (non-health care) expenses starting at age 65; you just have to pay normal income taxes on the money you withdraw.	The account remains with your former employer when you leave, but you may be able to elect to continue to be enrolled in a Healthcare Reimbursement Account under COBRA.
How can I make my money grow?	Contributions generally go into an interest-earning account, but you may be able to invest all or part of your balance to save for the future.	Reimbursement accounts are not designed to grow as an investment or interest-bearing account.