We had HRA for the first time this year. I did not have to pay anything out of pocket (no prescriptions or doctor's visits) until this month. This year, I'm going to put some money per month in the flex spending account. The difference between the monthy deduction from my check would be about $50 between HMO and HRA. I really like it. Planning is key, though. Having to come up with $500 right now is tough, but I figure I've saved a lot over the course of the year. My husband takes 4 meds a month and that really adds up.