Learn from my mistake: I put $3,050 in my FSA last year specifically for GLP-1 costs. Then in September, my insurance APPROVED my Wegovy PA and my copay dropped from $1,349/month to $45/month.

Suddenly I had ~$1,800 in FSA funds I couldn't use by year-end. I scrambled to find eligible expenses — bought prescription sunglasses, stocked up on contact lenses, got a dental procedure I'd been putting off.

The lesson: if there's ANY chance your insurance coverage might change during the year, be conservative with FSA elections. HSA is safer because the funds roll over. FSA is use-it-or-lose-it.

Great cautionary tale. That's exactly why I prefer HSA over FSA for GLP-1 expenses — the rollover and investment features are too valuable, especially when coverage situations can change unexpectedly.

One more tip I forgot to mention: some HSA debit cards are accepted directly at compounding pharmacies and telehealth platforms. This makes the payment seamless — you don't have to pay out of pocket and then submit for reimbursement. Ask your HSA administrator which merchants are coded as medical providers in their system.

The combination of HSA + compounded GLP-1 is genuinely one of the most tax-efficient healthcare strategies available right now for people without insurance coverage for these medications.

One final point: for those of you investing your HSA funds (Fidelity, Lively, etc.), there's an advanced strategy worth considering:

Pay your GLP-1 costs out of pocket NOW, let your HSA investments grow tax-free, and reimburse yourself from the HSA later (even years later). The IRS allows HSA reimbursement for any qualified expense incurred after the HSA was established, with no time limit.

So you could let $2,742 grow in your HSA invested in index funds for 10 years, and then reimburse yourself tax-free. At 8% average annual returns, that $2,742 would be worth ~$5,920. You'd withdraw the full amount tax-free by submitting your saved receipts from 2026.

Obviously this only works if you can afford to pay out of pocket today and let the HSA grow. But for those who can, it's incredibly powerful.