FSA or HSA: How to Choose During Open Enrollment

Short answer: pick an HSA if you have (or can get) a high-deductible health plan and want pre-tax money that rolls over and can grow for years — pick an FSA if you don't have an HDHP, or you already know roughly what you'll spend this year, including on FSA/HSA-eligible red light therapy. Both accounts can pay for the same wellness devices pre-tax. The real decision comes down to your health plan, how predictable your spending is, and whether you want unused money to disappear at year-end or stick around.

Open enrollment is when most people make this call, often in a rush, between a dental plan and a 401(k) match. Here's a plain-English way to think it through.

What's the Actual Difference Between an FSA and an HSA?

An FSA (Flexible Spending Account) is tied to your employer and generally resets at the end of the plan year, while an HSA (Health Savings Account) is yours to keep, invest, and carry forward for as long as you're covered by a qualifying high-deductible health plan (HDHP). Both let you set aside money before taxes are taken out, and both can be used on FSA/HSA-eligible red light therapy devices — the difference is mostly about ownership and timing, not what you can buy.

An FSA is a "use it while you're here" account: it belongs to your employer's plan, and in most cases you lose access if you leave your job (unless you're eligible for COBRA continuation). An HSA is portable — it's in your name, follows you between jobs, and there's no deadline to spend what's inside it.

Can You Even Choose an HSA This Enrollment?

Short answer: only if you're enrolled in a qualifying high-deductible health plan — without one, an HSA isn't on the table this year, and a healthcare FSA is your pre-tax route instead. If your employer's open enrollment materials list an HDHP alongside a PPO or other plan type, check the deductible and out-of-pocket maximum against the IRS's HDHP thresholds before you assume you qualify. We've broken down exactly how that eligibility rule works, including what to do if your plan falls short, in our guide to HDHP and HSA eligibility.

If you're not on an HDHP, that's not a dead end — a healthcare FSA still lets you buy FSA/HSA-eligible red light therapy pre-tax, you just won't get the rollover and investment features an HSA offers.

Which One Is Better If You're Planning to Buy Red Light Therapy?

Both work equally well at checkout — an FSA/HSA-eligible device like the FX300 panel, the LX300 face mask, or the Red Light Therapy Belt runs through either card the same way, without a Letter of Medical Necessity in most cases. The difference shows up in timing. With an FSA, you're committing to a set dollar amount for the year up front, so it helps to budget for the device before enrollment closes. With an HSA, you can contribute smaller amounts throughout the year and buy the device whenever your balance covers it — there's no "use it by December" pressure. Browse the full FSA/HSA-eligible collection to see what fits your budget either way, and see our general walkthrough on how to actually pay with an FSA or HSA card at checkout.

What Happens to Money You Don't Spend?

This is usually the deciding factor. A healthcare FSA is "use it or lose it" — most employer plans allow you to carry over only a capped amount (up to $680 for a 2026 plan year) into the next year, and anything above that is forfeited. An HSA has no such deadline: HSA funds never expire, so if you don't spend it all this year, it simply stays invested and available.

If your spending is predictable — you already know you want a specific red light therapy device and maybe some other planned care — an FSA's lower flexibility is less of a downside. If you're not sure what you'll need, an HSA's rollover protects you from guessing wrong.

How Much Should You Contribute During Open Enrollment?

For 2026, the healthcare FSA cap is $3,400 per employee. The IRS typically announces the following year's FSA limit in the fall, and it hadn't been finalized as of this writing — historically it rises by roughly $100–$150 a year for inflation, so budgeting near this year's cap is a safe starting point. HSA limits are set further in advance: the IRS has already confirmed 2027 HSA limits at $4,500 for self-only coverage and $9,000 for family coverage.

A simple way to land on a number either way: add up what you already know you'll spend (prescriptions, copays, dental or vision work you're planning, any red light therapy or other eligible wellness devices) and use that as your floor. Our guide to picking an FSA election amount walks through the math in more detail if you want a fuller worksheet.

Does Red Light Therapy Actually Do Anything, or Is This Just a Tax Trick?

It's a legitimate pre-tax purchase, but it's worth knowing what the research actually supports before you commit part of your election to it. A 2025 umbrella review in Systematic Reviews, which pooled 15 meta-analyses covering more than 200 randomized trials, found moderate-certainty evidence that photobiomodulation (the mechanism behind red light therapy) can help with knee osteoarthritis disability and fibromyalgia-related fatigue, among other outcomes — while noting that no outcome yet has high-certainty evidence and that more standardized trials are needed (Systematic Reviews, 2025). Earlier systematic reviews have reported similar findings specifically for photobiomodulation and nerve-related pain (PubMed). In plain terms: it's a reasonable adjunct for certain kinds of pain and inflammation, not a guaranteed fix, and it shouldn't replace care from your doctor.

Frequently Asked Questions

Can I have both an FSA and an HSA at the same time?

Generally not a full healthcare FSA and an HSA together — but a limited-purpose FSA (covering only dental and vision) can be paired with an HSA. See our full breakdown of pairing an FSA and HSA for the exact IRS rule.

What if I pick an FSA and then don't spend it all?

You'll forfeit anything above your plan's carryover limit (up to $680 for 2026) or grace period, depending on what your employer offers. That's why it helps to plan a specific purchase, like an FSA/HSA-eligible red light therapy device, before your election locks in.

Is red light therapy actually FSA/HSA eligible?

Yes, AWA's red light therapy panels, masks, wearables, and infrared devices are FSA/HSA eligible, and most purchases don't require a Letter of Medical Necessity. Check the eligible collection for the current list.

Can I change my mind after open enrollment ends?

Usually only if you have a qualifying life event, like marriage, a new child, or a job change. Outside of that, your FSA election is locked for the plan year; HSA contribution amounts can typically be adjusted anytime through payroll.

Do I need a high-deductible plan to use an HSA I already have?

You need an HDHP to keep contributing to an HSA, but you can still spend down an existing HSA balance even if you switch to a non-HDHP plan later.

Which should I pick if I'm self-employed?

If you have a qualifying HDHP, you can open your own HSA outside of an employer plan; FSAs are only available through an employer. Our guide on self-employed HSA options covers the details.

Lights on, pain off.

This article is for general education and is not medical advice. Red light therapy devices are intended for general wellness and are not intended to diagnose, treat, cure, or prevent any disease. Always check with a qualified healthcare provider before starting a new therapy.