What a health savings account can cover

A health savings account (HSA) can pay for most medical expenses that your health insurance does not cover, plus some it does. The IRS maintains a detailed list, but the practical rule is this: if it treats, prevents, or diagnoses a medical condition, and a doctor or dentist would reasonably prescribe it, your HSA can usually pay for it. That includes copays, deductibles, coinsurance, and out-of-pocket costs on top of what insurance covers.

The catch is that HSA funds cannot pay for health insurance premiums (with three exceptions), over-the-counter medications without a prescription, cosmetic procedures, or anything the IRS classifies as a general health product rather than medical treatment. A bottle of vitamins is not covered. A prescription for a specific vitamin your doctor ordered to treat a deficiency is.

You can use HSA money to pay for these expenses for yourself, your spouse, and any dependent you claim on your tax return—even if they are not on your health insurance plan. The money does not have to be spent in the same year you contribute it; HSA balances roll over indefinitely, which is why some people treat them as retirement accounts.

Key Takeaways

  • An HSA can pay for copays, deductibles, coinsurance, and out-of-pocket medical costs that your insurance does not cover.
  • Prescription medications, dental work, vision care, mental health treatment, and medical equipment like wheelchairs or hearing aids are all covered.
  • Over-the-counter drugs, vitamins, and cosmetic procedures are not covered unless a doctor prescribes them to treat a specific medical condition.
  • You can use HSA funds for your spouse and tax dependents even if they are not on your insurance plan.
  • Money in your HSA rolls over year to year and never expires, so you can save it for future medical costs or retirement.

Medical services and procedures your HSA covers

Your HSA can pay for doctor visits, hospital stays, surgery, emergency room care, and urgent care visits. It covers the full cost of the visit itself, plus any tests, imaging, or procedures done during that visit—whether your insurance covers them or not. If you have a deductible, your HSA can pay it. If you have coinsurance (a percentage you owe after insurance pays its share), your HSA can cover that too.

Mental health and substance abuse treatment are covered, including therapy sessions, psychiatric visits, inpatient rehab, and outpatient counseling. Physical therapy, occupational therapy, and speech therapy are covered. Chiropractic care is covered if a doctor refers you for a specific condition, though some plans limit how many visits. Acupuncture is covered if a licensed acupuncturist treats you and a doctor orders it for pain or a medical condition.

Preventive care like annual physicals, cancer screenings, and vaccinations are covered. Maternity and childbirth care, including prenatal visits and hospital delivery, are covered. Fertility treatment and related procedures are covered, though the specifics depend on what your insurance plan allows.

Medications and pharmacy costs

Prescription medications are covered in full—the copay, the coinsurance, or the full cost if you have not met your deductible. This includes prescription birth control, prescription inhalers, and prescription antibiotics. Your HSA can also pay for the pharmacy dispensing fee if you are charged one.

Over-the-counter medications like ibuprofen, acetaminophen, antihistamines, and cold medicine are not covered unless a doctor writes a prescription for them. This rule changed in 2020, and many people still assume OTC drugs are covered. They are not, unless you have a written prescription in hand. If your doctor prescribes ibuprofen by name for arthritis, your HSA can pay for it. If you buy the same bottle off the shelf, it cannot.

Insulin and other diabetes medications are covered whether they are prescription or available over the counter. Epinephrine auto-injectors (EpiPens) are covered. Topical creams and ointments prescribed by a doctor are covered; those you buy for general skin care are not.

Dental, vision, and hearing care

Dental work is covered: cleanings, fillings, root canals, extractions, crowns, bridges, and dentures. Orthodontia (braces) is covered. Dental X-rays and exams are covered. The only dental work not covered is cosmetic dentistry—whitening, veneers, or bonding done purely for appearance.

Vision care is covered: eye exams, glasses, contact lenses, and contact lens solution. LASIK and other vision correction surgery is covered. Sunglasses are not covered, even if you need them for a medical condition, unless they are prescribed as part of post-surgical care.

Hearing aids and cochlear implants are covered. Hearing tests are covered. Batteries for hearing aids are covered. Audiologist visits are covered.

Medical equipment and supplies

Your HSA can pay for medical equipment prescribed or recommended by a doctor: wheelchairs, walkers, canes, crutches, hospital beds, oxygen equipment, CPAP machines, and blood pressure monitors. It covers the purchase price and any repairs or replacement parts. Diabetic supplies—test strips, lancets, glucose meters, and insulin pumps—are covered. Bandages, gauze, and other wound care supplies are covered.

Braces, supports, and compression garments prescribed for a medical condition are covered. Prosthetics and orthotics are covered. A wig is covered only if it is prescribed to treat hair loss caused by a medical condition like alopecia or chemotherapy, not for general baldness or appearance.

Home medical equipment like a nebulizer, pulse oximeter, or thermometer is covered. Bathroom safety equipment like grab bars or a shower chair is covered if prescribed for a medical condition. A mattress or pillow is not covered, even if recommended for back pain, because it is a general household item.

What your HSA cannot pay for

Cosmetic procedures are not covered: facelifts, Botox, dermal fillers, hair transplants, or teeth whitening done for appearance. If the same procedure treats a medical condition—reconstructive surgery after an accident or burn, for example—it is covered.

Health insurance premiums are not covered, with three exceptions: COBRA continuation coverage (if you lose your job), Medicare premiums (Part A, B, D, and supplemental), and long-term care insurance premiums. Regular health insurance, dental insurance, or vision insurance premiums cannot be paid from your HSA.

General wellness products are not covered: vitamins, supplements, protein powder, sports drinks, or fitness equipment. Gym memberships are not covered. Weight loss programs are not covered unless a doctor prescribes them to treat obesity as a medical condition, and even then only the medical component (doctor visits, prescribed meal plans) is covered, not the gym membership itself.

Childcare, babysitting, and nanny services are not covered, even if you need them to work. Cosmetic dentistry, cosmetic dermatology, and elective procedures are not covered. Travel to get medical treatment is not covered, though the treatment itself is.

How to know if something is covered

The IRS publishes a list of covered and non-covered items in Publication 502. Your HSA provider (the bank or financial company that holds your account) usually has a searchable database on their website where you can look up specific items. Many providers also have a customer service line you can call with questions before you spend the money.

When in doubt, keep your receipt. If you pay for something and later learn it was not covered, you can request reimbursement from your HSA and pay for it out of pocket instead. The IRS does not penalize you for an honest mistake, but you do have to correct it within a reasonable time.

One practical note: if you are unsure whether your doctor will prescribe something, ask before you buy it. A prescription turns many borderline items (like certain vitamins or topical treatments) from non-covered to covered. Your doctor can usually write one in a phone call if the treatment is medically necessary.

Frequently Asked Questions

Can I use my HSA to pay for my spouse's medical costs if they are not on my insurance?

Yes. You can use your HSA to pay for medical costs for your spouse and any dependent you claim on your tax return, regardless of whether they are on your health insurance plan. You do not need to be married to use it for a spouse's costs, but you do need to claim them as a dependent on your taxes.

Are over-the-counter pain relievers covered by my HSA?

Not without a prescription. Ibuprofen, acetaminophen, and other OTC pain relievers are not covered unless a doctor writes a prescription for them. If your doctor prescribes ibuprofen by name, your HSA can pay for it. If you buy the same product off the shelf, it cannot.

Can I use my HSA to pay for my gym membership or fitness classes?

No. Gym memberships and general fitness are not covered. However, if a doctor prescribes physical therapy or a specific exercise program to treat a medical condition, your HSA can pay for that. The key is that a doctor must order it as treatment, not as general wellness.

What happens if I spend HSA money on something that is not covered?

If you use HSA funds for non-covered expenses, you owe income tax on that amount plus a 20 percent penalty. You can avoid the penalty if you correct the mistake within a reasonable time by reimbursing your HSA from your own pocket. Keep receipts so you can prove what you spent the money on.

Can I use my HSA to pay for my health insurance premium?

Not for regular health insurance. Your HSA can pay for Medicare premiums (Parts A, B, D, and supplemental), COBRA continuation coverage, and long-term care insurance premiums. It cannot pay for your employer health plan, individual health insurance, or dental or vision insurance premiums.