Yes, you can use your HSA for dental expenses — but only certain ones

A Health Savings Account (HSA) can pay for dental work, but not every dental visit qualifies. The IRS has a specific list of what counts as a medical expense, and dental care is split into two categories: treatments the IRS considers medical (which your HSA covers) and treatments it considers cosmetic (which it does not).

The key difference is whether the dental work treats a disease or injury versus improving appearance. A filling for a cavity is covered. Teeth whitening is not. Root canals, extractions, and gum disease treatment are covered. Veneers for cosmetic reasons are not — though veneers placed to repair a broken tooth may be.

You pay out of pocket first, then withdraw the money from your HSA to reimburse yourself. Or, if your dentist's office accepts HSA cards directly, you can pay with the card at the time of service. Either way, you need to keep receipts and documentation showing what the expense was for, in case the IRS asks.

Key Takeaways

  • Dental treatments that treat disease or injury — like fillings, root canals, extractions, and gum disease treatment — are covered by your HSA.
  • Cosmetic dental work — like teeth whitening, veneers for appearance only, and orthodontics for adults — is not covered by your HSA.
  • Orthodontics for children may be covered, but orthodontics for adults is not, because the IRS considers adult braces cosmetic.
  • You must keep the receipt and any documentation from your dentist showing what procedure was done, in case you need to prove it to the IRS later.
  • Some dental offices accept HSA debit cards directly; others require you to pay and then withdraw the money from your HSA account yourself.

What dental work your HSA will cover

The IRS covers dental expenses that treat a medical condition. This includes fillings, root canals, tooth extractions, crowns placed to restore a damaged tooth, and treatment for gum disease or periodontal disease. If your dentist is treating an infection, decay, or injury, your HSA can pay for it.

Dental X-rays and cleanings are also covered, because they are preventive care for a medical condition (tooth decay and gum disease). Fluoride treatments and sealants for children fall into this category as well.

Orthodontics — braces — are covered only for children. The IRS considers braces for adults to be cosmetic, even if they improve your bite or jaw alignment. If you are an adult and your dentist recommends braces for a medical reason (such as correcting a severe bite problem that affects chewing), you may still be able to cover it, but you would need to document the medical necessity and may need to request a ruling from the IRS.

What your HSA will not cover

Cosmetic dental work is not covered. This includes teeth whitening, veneers placed for appearance, bonding for cosmetic reasons, and implants placed purely for appearance (though implants placed to replace a missing tooth due to disease or injury may be covered). Braces for adults are not covered unless there is documented medical necessity.

Dentures and partial dentures are covered if they replace teeth lost to disease or injury. However, if you are replacing teeth that were extracted for cosmetic reasons, the replacement is also not covered.

Cosmetic gum surgery — such as gum contouring to change your smile — is not covered. But gum surgery to treat gum disease is covered.

How to pay for dental work with your HSA

If your dentist's office accepts HSA debit cards, you can swipe the card at the time of service, just like a regular debit card. The money comes directly from your HSA account. You will receive a receipt, which you should keep for your records.

If your dentist does not accept HSA cards, pay with your regular debit card, credit card, or check. Then, log into your HSA account (through your bank or HSA administrator) and request a reimbursement. You will need to submit a copy of the receipt or invoice showing the date, the dentist's name, and what procedure was performed. The HSA administrator will review it and send the money back to your bank account, usually within a few business days.

Some people keep receipts for years and reimburse themselves later, even decades later. There is no time limit on when you can withdraw money for a past medical expense — as long as you have the documentation and the expense was incurred after your HSA was opened.

Keeping records for the IRS

The IRS does not require you to submit receipts when you withdraw money from your HSA, but you must keep them. If the IRS audits your account, they will ask to see documentation that the expenses were actually medical expenses and that you did not use HSA money for non-medical purposes.

A receipt from your dentist showing the date and the procedure is usually enough. If the procedure name is unclear — for example, if it just says "dental work" — ask your dentist for an itemized invoice that describes what was done. Keep these documents in a folder, either physical or digital, for at least three years after you file your taxes for the year in which you made the withdrawal.

What happens if you use your HSA for non-covered dental work

If you withdraw money from your HSA for a dental expense that is not covered — such as teeth whitening — you will owe income tax on that withdrawal, plus a 20 percent penalty. For example, if you withdraw $500 for teeth whitening and you are in the 22 percent tax bracket, you would owe $110 in income tax plus $100 in penalty, for a total of $210 in taxes and penalties on top of the $500 you spent.

This is why it is important to check with your dentist or your HSA administrator before you pay for a procedure. If you are unsure whether something is covered, ask. It is better to clarify before you spend the money.

HSA coverage versus dental insurance

If you have both an HSA and dental insurance, your dental insurance is usually your primary payer. You submit the claim to your dental insurance first, and they pay their portion. Then you use your HSA to cover your out-of-pocket costs — the deductible, copay, or coinsurance.

If you have an HSA but no dental insurance, you can use your HSA to pay for covered dental work directly. This can be a good option if you are healthy and do not expect major dental work, because you can save the money in your HSA year after year and use it when you need it.

Some people use their HSA to cover the cost of dental work that their insurance does not cover well — for example, if their insurance covers only 50 percent of a crown, they can use their HSA to pay the remaining 50 percent.

Frequently Asked Questions

Can I use my HSA to pay for teeth whitening?

No. The IRS considers teeth whitening cosmetic, not medical, so your HSA cannot pay for it. This applies whether you have it done at a dentist's office or use an over-the-counter kit.

Are dental implants covered by my HSA?

Implants placed to replace a tooth lost to disease or injury are covered. Implants placed for cosmetic reasons are not. Ask your dentist to document in writing that the implant is being placed to replace a missing tooth due to decay or injury, and keep that documentation with your receipt.

Can I use my HSA for my child's braces?

Yes. Orthodontics for children are covered by HSA. Braces for adults are not covered unless there is documented medical necessity, such as a severe bite problem that affects chewing or speech.

What if I am not sure whether a dental procedure is covered?

Contact your HSA administrator or your dentist's office before you have the work done. Your HSA administrator can tell you whether a specific procedure is covered under IRS rules. It is better to ask before you pay than to discover later that you owe taxes and penalties.

Do I need to submit receipts to my HSA when I withdraw money?

No, but you must keep them. The IRS does not require you to submit receipts at the time of withdrawal, but if you are audited, you will need to show documentation that the expense was medical and covered. Keep receipts for at least three years after you file your taxes for that year.