A limited-purpose FSA adds $3,400 of pre-tax money on top of your HSA for 2026. A general-purpose FSA wipes out your HSA contributions instead, for every month you have it.
That one word on the benefits portal is the whole difference. Open enrollment is the only time you can pick it.
The Rule, Straight From Pub 969
IRS Publication 969 handles this under "Qualifying for an HSA." The subsection is "Other employee health plans."
A general health FSA can pay any qualified medical expense from dollar one. The IRS counts that as disqualifying coverage. No HSA contributions for any month you are covered.
Pub 969 then lists the arrangements that do not disqualify you. The limited-purpose health FSA is first.
Pub 969 on the limited-purpose FSA: "can pay or reimburse the items listed earlier under Other health coverage except long-term care."
That earlier list is short: accidents, disability, dental care, vision care, long-term care. Remove long-term care and you have the permitted set.
Plans built this way are dental and vision only. Your plan document names the exact set yours covers.
The general-FSA conflict has its own traps, including a spouse's election. Those are covered in Can You Have an HSA and FSA at the Same Time? Mostly No. This post is the pairing that works.
What a Limited-Purpose FSA Covers
| Expense | LPFSA | HSA |
|---|---|---|
| Cleanings, fillings, X-rays | Yes | Yes |
| Crowns, root canals, dentures | Yes | Yes |
| Braces and clear aligners | Yes | Yes |
| Eye exams | Yes | Yes |
| Glasses, frames, prescription lenses | Yes | Yes |
| Contacts and solution | Yes | Yes |
| LASIK and PRK | Yes | Yes |
| Doctor visits and copays | No | Yes |
| Prescriptions | No | Yes |
| Surgery, labs, physical therapy | No | Yes |
| Teeth whitening | No | No |
Cleanings, fillings, X-rays
- LPFSA
- Yes
- HSA
- Yes
Crowns, root canals, dentures
- LPFSA
- Yes
- HSA
- Yes
Braces and clear aligners
- LPFSA
- Yes
- HSA
- Yes
Eye exams
- LPFSA
- Yes
- HSA
- Yes
Glasses, frames, prescription lenses
- LPFSA
- Yes
- HSA
- Yes
Contacts and solution
- LPFSA
- Yes
- HSA
- Yes
LASIK and PRK
- LPFSA
- Yes
- HSA
- Yes
Doctor visits and copays
- LPFSA
- No
- HSA
- Yes
Prescriptions
- LPFSA
- No
- HSA
- Yes
Surgery, labs, physical therapy
- LPFSA
- No
- HSA
- Yes
Teeth whitening
- LPFSA
- No
- HSA
- No
Every "Yes" in the LPFSA column is also HSA-eligible. That overlap is the point. You choose which account pays.
The medical side belongs to the HSA. The full breakdown is in What Can You Buy With an HSA? The Complete List.
The 2026 Numbers
The regular FSA limit applies to a limited-purpose FSA. There is no separate cap for it.
| Account | 2026 limit | Source |
|---|---|---|
| Limited-purpose FSA | $3,400 | Rev. Proc. 2025-32 |
| HSA, self-only | $4,400 | Rev. Proc. 2025-19 |
| HSA, family | $8,750 | Rev. Proc. 2025-19 |
Stacked, that is $7,800 pre-tax on self-only coverage. On family coverage it is $12,150.
The 2026 carryover cap is $680, and only if your plan offers one. A plan can offer a carryover or a grace period. Not both. A plan can also offer neither.
For the account-versus-account comparison, see HSA vs FSA: Which Health Account Is Better for You?.
When the Stack Is Worth It
The LPFSA is use-it-or-lose-it money. So the test is whether you can name the spending before you elect.
Good reasons to elect one:
- ●Braces or clear aligners starting in the plan year. A typical Invisalign case runs $3,000 to $7,000, so $3,400 gets used. See Is Invisalign HSA Eligible? Clear Aligners and the Cosmetic Line.
- ●A crown, implant, or root canal your dentist already quoted.
- ●LASIK or PRK scheduled for the year.
- ●Glasses or contacts for three or four people in the house.
- ●A dental deductible and coinsurance you hit every single year.
Reasons to skip it:
- ●No planned dental or vision spending.
- ●You cannot name a specific expense during enrollment.
- ●Your dental work might slip into next year.
Electing $3,400 with nothing to spend it on is not a tax play. It is a donation to the plan.
Elect what you can point at on a treatment plan or a quote. Fund the HSA with the rest.
The Post-Deductible Variant
Pub 969 lists a second compatible design. It is the post-deductible health FSA.
Per Pub 969, these "don't pay or reimburse any medical expenses incurred before the minimum annual deductible amount is met."
So a post-deductible FSA can pay general medical bills. It just cannot pay them until you clear the HDHP deductible.
Some employers run a combined design. Dental and vision from day one, then everything else once the deductible is met.
Read the plan document before assuming yours offers it.
One more Pub 969 line matters at year end. A general FSA grace period has one condition. The balance "in the health FSA at the end of its prior-year plan is zero."
A leftover general FSA balance on December 31 can void January, February, and March HSA eligibility. Spend it down or lose the months.
Two Accounts, Two Piles of Receipts
This is where the stack gets messy in real life.
Both accounts can pay for the same dental visit. Only one of them is allowed to.
| Limited-purpose FSA | HSA | |
|---|---|---|
| Deadline to submit | Plan year, plus any grace period | None |
| Money expires | Yes, past the carryover | No |
| Who asks for proof | Plan administrator, before it pays | The IRS, possibly years later |
| Proof needed | Itemized receipt or EOB | Itemized receipt |
Four rules that keep it clean:
- ●Dental and vision receipts go to the LPFSA first. That is the money with a deadline.
- ●Everything else goes to the HSA pile.
- ●Never submit the same receipt to both. Reimbursing one expense twice is not allowed.
- ●Keep itemized receipts, not card slips. A slip showing "$1,240 dental" does not name the service.
Sort receipts the week you get them. Sorting a year of mixed dental, vision, and medical receipts in March is the worse job.
What to Do at Open Enrollment
- ●Search the benefits portal for "limited purpose." A plain "Health FSA" is the one that blocks your HSA.
- ●Confirm it is dental and vision only, or post-deductible.
- ●Add up quoted dental and vision spending for the year.
- ●Elect that number, not the $3,400 maximum.
- ●Check whether your spouse elected a general-purpose FSA. Theirs can disqualify you.
- ●Keep the HSA election separate and fund it as usual.
The limited-purpose line is easy to miss. It sits on the same election screen as the regular FSA. One word decides whether your HSA still works.
This is educational content, not financial or tax advice. Consult a qualified professional before making decisions about your HSA.