You can use your HSA to pay for medical expenses that your health insurance does not cover, and for some costs it does cover but you want to pay out of pocket instead.
An HSA works like a spending account: money goes in, you spend it on may have access to medical expenses, and you keep the receipts. The IRS publishes a list of what counts. If you spend HSA money on something that is not on that list, you owe income tax on the amount plus a 20 percent penalty — so knowing the boundary matters.
The practical rule is this: if a doctor, dentist, or other licensed provider says you need it for medical care, and it is not cosmetic, you can usually pay for it with your HSA. That includes the cost of the service itself, the equipment, the medication, and sometimes the travel to get there. What you cannot do is use it for health or wellness things that are not medical — gym memberships, vitamins, toothpaste, or sunscreen, even though they might prevent problems later.
Key Takeaways
- You can use HSA money to pay deductibles, copays, coinsurance, and any medical service your insurance does not cover.
- Prescription medications, medical equipment, dental work, vision care, and mental health treatment all count as may have access to expenses.
- Over-the-counter medications and supplies count only if you have a prescription or a letter from your doctor saying you need them for a specific condition.
- Cosmetic procedures, gym memberships, vitamins, and general wellness products do not count, even if they improve your health.
- You need to keep receipts and documentation for every HSA purchase in case the IRS asks to see them.
Medical services and supplies you can pay for
Doctor visits, hospital stays, surgery, physical therapy, mental health counseling, and prescription medications are all covered. So are dental cleanings, fillings, root canals, and orthodontia. Vision care — eye exams, glasses, contact lenses, and laser eye surgery — counts. Hearing aids and hearing tests count. Chiropractic care, acupuncture, and other licensed treatments count if a doctor refers you or if your state recognizes the provider as licensed.
Medical equipment and supplies are covered if they treat a specific condition: a blood glucose monitor for diabetes, an inhaler for asthma, a CPAP machine for sleep apnea, crutches after an injury, a wheelchair, a prosthetic limb. Bandages, gauze, and medical tape count. Pregnancy tests and ovulation kits count. Hearing aid batteries count. The rule is that the item has to be something a doctor would prescribe or recommend for a diagnosed condition, not something you buy to stay generally healthy.
You can also use your HSA to pay for travel to medical appointments — mileage, parking, tolls, airfare, and hotel if you have to travel out of state for treatment. You cannot pay for meals during that travel, even if you are staying overnight.
Over-the-counter medications and when they count
Over-the-counter drugs — pain relievers, cold medicine, allergy pills, antacids — do not count unless you have a prescription from a doctor. A prescription for ibuprofen or diphenhydramine is unusual but possible; if your doctor writes one, you can use your HSA. Without a prescription, you cannot.
The exception is insulin. You can buy insulin over the counter with your HSA without a prescription, even though it is not prescribed to you in that moment. Insulin is the only OTC medication with this exception.
Supplements, vitamins, and herbal products do not count, even if a doctor recommends them. The IRS treats them as food, not medicine. If your doctor prescribes a specific supplement as treatment for a diagnosed deficiency — rare, but it happens — ask your HSA administrator whether they will accept it; some will, some will not.
What does not count, even if it feels medical
Cosmetic procedures do not count unless they are reconstructive — meaning they repair damage from injury, disease, or birth. Botox, teeth whitening, and elective nose surgery do not count. Reconstructive surgery after a car accident or cancer treatment does count. The line is whether the procedure treats a medical condition or improves appearance.
General wellness does not count. Gym memberships, fitness classes, and sports equipment do not count, even if your doctor says exercise would help your health. Sunscreen, toothpaste, and floss do not count. Weight loss programs do not count unless they are prescribed by a doctor as treatment for a specific condition like obesity-related diabetes, and even then some HSA administrators will reject them.
Cosmetic dentistry — whitening, veneers, bonding for appearance — does not count. Medically necessary dental work does. If you need a crown because a tooth is broken or decayed, that counts. If you want a crown because you prefer how it looks, it does not.
How to document what you spend
Keep every receipt, invoice, and explanation of benefits (EOB) from your insurance. If you pay out of pocket, keep the receipt from the provider. If you use your HSA debit card, the transaction will show up in your account, but you still need the receipt to prove what you bought if the IRS asks. A receipt that just says "medical supplies" is not enough; you need to know what the supplies were.
If a provider gives you an invoice that lists what was done or what was dispensed, that is your documentation. If you pay cash and get only a receipt with a dollar amount, write on the back what you paid for — "Dr. Smith office visit, 3/15/24" — and keep it with your HSA records.
You do not have to submit receipts to your HSA administrator when you make a purchase. But the IRS can audit your HSA at any time and ask to see documentation for any expense. If you cannot show what you spent the money on, you owe income tax plus the 20 percent penalty on that amount, plus interest. The audit can happen years after the purchase, so keep receipts for at least three to seven years.
Expenses that depend on your specific situation
Some expenses fall into a gray area where the answer depends on details. Therapy and counseling count if they treat a diagnosed mental health condition. Therapy for general life improvement or personal growth does not count. Prescription antidepressants count; supplements marketed for mood do not.
Fertility treatment counts — IVF, egg freezing, sperm freezing, and related procedures. Contraception counts if it is prescribed by a doctor. Maternity care and childbirth count. Abortion counts. Adoption does not count, even though it is a way to build a family.
Long-term care insurance premiums count, but only up to an IRS limit that changes each year. Life insurance does not count. Disability insurance does not count. Health insurance premiums do not count, with one exception: if you are receiving unemployment benefits, you can use your HSA to pay for health insurance premiums while you are unemployed.
What happens if you spend HSA money on something that does not count
If you use your HSA for a non-may have access to expense, you owe income tax on that amount at your ordinary tax rate, plus a 20 percent penalty. If you spent $100 on something that does not count and your tax rate is 22 percent, you owe $22 in tax plus $20 in penalty — $42 total on top of the $100 you already spent.
You report non-may have access to expenses on your tax return. Your HSA administrator will send you a Form 1099-SA each year showing how much you withdrew. If you withdrew $5,000 and $500 of it was non-may have access to, you report the $500 as taxable income and add the $100 penalty.
There is no way to "undo" a non-may have access to purchase by putting the money back. Once you spend it, if it does not count, you owe the tax and penalty. This is why keeping receipts and knowing the rules before you spend matters.
Frequently Asked Questions
Can I use my HSA to pay for my spouse's or child's medical expenses?
Yes. Your HSA can pay for medical expenses of your spouse and any dependent you claim on your tax return, even if they are not covered by your HSA-may be able to access health plan. You need receipts showing the expense and proof of the relationship.
Can I use my HSA to pay my health insurance premium?
Not usually. You cannot use your HSA to pay premiums for your regular health insurance. You can use it to pay for long-term care insurance premiums (up to an IRS limit), COBRA premiums if you are between jobs, or health insurance premiums while you are receiving unemployment benefits.
Does my HSA cover prescription glasses and contacts?
Yes. Eye exams, glasses, contact lenses, contact lens solution, and the cost of fitting are all may have access to expenses. Laser eye surgery (LASIK) also counts.
Can I use my HSA to pay for a gym membership if my doctor recommends exercise?
No. Even if your doctor says exercise would help your health, gym memberships and fitness classes do not count as may have access to medical expenses. You can use your HSA only for medical treatment, not for general wellness.
What if I am not sure whether something counts?
Contact your HSA administrator before you spend the money. They can tell you whether a specific expense is may have access to under IRS rules. If you spend first and ask later, you may owe the penalty. Getting written confirmation from your administrator before you pay is the safest approach.