What Is an HRA and How Does It Work?
You pay for your hormone patch out of pocket every month. Your plan put it on a tier that costs you real money, or left it off entirely.
There is a good chance your job already has a way to pay you back. It is called an HRA, and most women have never heard of it.
What the letters mean
HRA stands for Health Reimbursement Arrangement.
HRA stands for Health Reimbursement Arrangement.
In plain words, it is a pot of money your job sets aside to pay you back for health costs.
Your job is the only one who puts money in. You cannot add any of your own, which makes it different from an FSA or an HSA where the money comes out of your paycheck.
When the money comes back to you, it comes back tax free. It does not count as income and you do not owe tax on it.
Money you do not use can roll over to next year if your job sets it up that way.
How it works, step by step
Your job says it will cover up to a set amount each year. Say $1,500.
You go to the doctor. You pay for the visit or the medicine yourself.
You save the receipt.
You send the receipt in.
The money comes back to you, with no tax taken out.
You pay first and get paid back after. That is the whole thing.
Your job writes the rules, sets the dollar amount, and decides which costs count. Some plans cover almost any medical expense and some cover a short list.
Your job picks the rules. It picks the dollar amount. It picks which costs count. Some plans cover almost any medical expense. Some cover only a short list.
Why this matters if you are in perimenopause
Perimenopause is the stretch of years before your period stops for good. It can last four to eight years and often starts in your early forties.
A lot of what helps you during those years is covered badly or not at all.
Look at what you may be paying for right now:
A hormone patch your plan put on a high tier
A non-hormonal pill for hot flashes
A visit with a menopause specialist who does not take insurance
Pelvic floor therapy
A sleep study
Vaginal estrogen cream
A bone density scan your plan says you are too young for
These are not small costs, and they land in the same years. An HRA can cover them.
The part almost nobody knows
Most large companies pay your medical bills with their own money. Benefits people call this being self-funded. In 2025, 80% of covered workers at larger firms were in self-funded plans.
Your card may say Aetna. If your plan is self-funded, Aetna is processing the paperwork while your company pays the bill.
That means the denial on your patch came from your company. A company can change a decision it made itself.
Adding an HRA is one of the fastest ways to do that. Your job does not have to rewrite the whole health plan, because an HRA sits on top of what already exists. It can be done in one benefits cycle.
Why your job would say yes
Money.
Mayo Clinic studied 4,440 working women aged 45 to 60 and found that menopause symptoms cost $1.8 billion a year in lost work time, and $26.6 billion a year once medical costs are counted. In that study, 13% of women had a bad work outcome because of symptoms.
Carrot Fertility asked 2,000 working women about it. Eighty percent called menopause a work problem, and more than half had thought about changing jobs because of it.
Picture a 48-year-old operations manager with 20 years at the same company. She knows the systems, the people, and the customers. Replacing her costs far more than a reimbursement account would.
Where things stand today
Very few companies have set one of these up.
Mercer found 18% of employers planned to offer menopause help, up from 4% in 2023. NFP’s numbers are lower. Only 10% of employers offer any menopause support at all, and 62% of almost 800 companies said they were unlikely to add it in the next five years.
So the power sits with most companies while the benefit sits with very few. That gap comes out of your pocket. It is the Menopause Tax™.
One Thing To Do This Month
Ask HR one question. “Do we have an HRA?” If the answer is yes, ask what it covers. You may already have money sitting there.
Ask. You may be the first one.
Be honest. Had you heard of an HRA before this post? I ask because I want to know how big the gap is between what your job offers and what you were told about.