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Globalcare Consulting· Group

Pre-tax health benefits · 2026

HRA, HSA & FSA Options (Group)

Four different vehicles let employees pay for care with pre-tax dollars — and one of them, the QSEHRA, is a genuine alternative to offering a group health plan at all. They’re usually decided against each other, so here’s how the four actually compare for 2026.

The four vehicles, at a glance

Each has a different funding source and a different rulebook.

  • QSEHRA

    Qualified Small Employer HRA

    $6,450 / $13,100

    Employer-funded only. For businesses under 50 FTEs that don’t offer a traditional group plan. Reimburses individual-market premiums and medical expenses tax-free.

  • ICHRA

    Individual Coverage HRA

    No cap

    Employer-funded only. Any size employer, any number of employee classes, can run alongside or instead of a group plan. Must be “affordable” to avoid ALE penalties.

  • HSA

    Health Savings Account

    $4,400 / $8,750

    Employee and/or employer funded. Requires enrollment in a qualifying high-deductible health plan. Fully portable — the employee keeps it forever.

  • FSA

    Flexible Spending Account

    $3,400

    Primarily employee-funded. No HDHP required. Generally “use it or lose it” each year, with up to $680 allowed to carry over. Stays with the employer if the employee leaves.

    • Side by side

    The practical differences that usually decide it.

    CategoryQSEHRAICHRAHSAFSA
    Who funds itEmployer onlyEmployer onlyEither / bothMostly employee
    2026 limit$6,450 / $13,100No cap$4,400 / $8,750$3,400
    Requires HDHPNoNoYesNo
    Employer sizeUnder 50 FTEsAny sizeAny sizeAny size
    Portable if employee leavesNoNoYesNo
    Can run alongside a group planNo — replaces itYes or instead ofYes, if HDHPYes

    Which one fits your situation?

    Four common employer scenarios and where they usually land.

    • A

      Under 50 employees, no group plan today

      QSEHRA is often the simplest starting point — employees shop the individual marketplace, you reimburse tax-free up to the 2026 limit.

    • B

      Want more budget flexibility than QSEHRA allows

      ICHRA has no cap and works at any size — the trade-off is more administrative complexity, including the 2026 affordability test (9.96% of household income).

    • C

      Already offering a high-deductible plan

      Pair it with an HSA — it’s the only one of the four that’s fully portable and belongs to the employee permanently.

    • D

      Offering a traditional plan, want to add flexibility

      An FSA lets employees set aside pre-tax dollars for predictable expenses like copays and prescriptions.

    Frequently asked questions

    No. A QSEHRA is specifically designed as an alternative to a traditional group plan — offering both isn’t permitted. If you want to keep a group plan and add flexibility, an ICHRA, HSA, or FSA is the right direction instead.

    Yes, generally. A QSEHRA or ICHRA offer typically affects — and often eliminates — an employee’s eligibility for marketplace premium tax credits, depending on whether the offered amount is considered affordable. This is worth modeling carefully before switching.

    Under the standard rule, unused funds are forfeited — though your plan can allow up to $680 to carry over into the next year (2026 limit) instead of a grace period, depending on how it’s designed.

    Not a general-purpose FSA — that would disqualify HSA contributions. A limited-purpose FSA, restricted to dental and vision expenses, can be paired with an HSA without a conflict.

    Not sure which vehicle fits your team?

    We’ll walk through your census and current plan setup — no cost.

    Request a callback