The core rule: it has to treat, diagnose, or prevent a medical condition
A health savings account lets you spend money on medical expenses without paying income tax on that money. The IRS has a specific list of what counts. The short version: if a doctor would reasonably prescribe it or a pharmacist would sell it to treat an illness or injury, it usually qualifies. If it's something you'd buy anyway for general wellness or comfort, it probably doesn't.
The IRS publishes an official list called Publication 502, which runs to dozens of pages. But you don't need to memorize it. The test is whether the expense is for medical care — meaning diagnosis, treatment, or prevention of disease or injury — and whether it's not already covered by your insurance plan.
One important detail: you can only spend HSA money on your own medical expenses, or those of your spouse and dependents you claim on your tax return. You cannot use it for a friend's medical bills or your adult child's expenses if they're not your dependent.
Key Takeaways
- Prescription medications, over-the-counter drugs (with a doctor's note), and medical devices like inhalers and glucose monitors all may have access to for HSA spending.
- Doctor visits, dental work, vision care, mental health treatment, and hospital stays are covered, whether your insurance pays part of the bill or you're paying out of pocket.
- Gym memberships, vitamins, cosmetic procedures, and general wellness products do not may have access to, even if they improve your health.
- You can use your HSA debit card at the pharmacy or doctor's office, or pay out of pocket and reimburse yourself from the account later.
- Keeping receipts and records is your responsibility — the IRS can audit HSA spending years after the fact.
Medications and medical supplies you can buy
Prescription medications are the clearest case. Anything your doctor prescribes for a diagnosed condition qualifies. This includes birth control pills, antidepressants, blood pressure medication, antibiotics, and insulin.
Over-the-counter drugs are trickier. You can buy them with HSA money only if a doctor has written a prescription or a written statement saying you need them for a specific medical condition. Aspirin for a headache doesn't may have access to on its own. Aspirin prescribed by your doctor for heart disease prevention does. Allergy medicine you buy without a doctor's note doesn't may have access to. Allergy medicine your allergist recommends in writing does.
Medical supplies and devices that treat a condition may have access to: glucose monitors and test strips for diabetes, inhalers for asthma, bandages and antiseptic for wounds, crutches, braces, hearing aids, and prescription eyeglasses. Sunscreen does not may have access to, even though it prevents skin damage, because it's not treating or diagnosing a disease.
Doctor visits, hospital care, and mental health treatment
Any visit to a doctor, nurse practitioner, or physician assistant for diagnosis or treatment of a medical condition qualifies. This includes the copay you owe at the time of the visit, or the full cost if you're paying out of pocket. The same applies to urgent care visits, emergency room visits, and hospital stays.
Mental health and substance abuse treatment are covered: therapy sessions with a licensed therapist, psychiatrist visits, counseling for addiction, and inpatient rehabilitation programs all may have access to. You can use HSA money to pay your copay or coinsurance, or to pay the full cost if you're seeing an out-of-network provider.
Preventive care visits — annual physicals, cancer screenings, vaccinations — may have access to because they're medical care aimed at preventing disease. The cost of the visit itself counts, though some insurance plans cover preventive care at no cost to you.
Dental and vision expenses
Dental work qualifies: cleanings, fillings, root canals, extractions, crowns, and orthodontics. You can use HSA money for the dentist's bill whether your dental insurance covers part of it or you're paying the full amount yourself. If your insurance has a deductible or copay, you can use HSA money for that too.
Vision care qualifies: eye exams, prescription glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) qualifies because it's a medical procedure to correct a vision problem. Cosmetic procedures like eyelid surgery for appearance alone do not may have access to.
What does not may have access to, even if it's good for you
Gym memberships and fitness classes do not may have access to, even if your doctor recommends exercise. General wellness products — vitamins, supplements, protein powder — do not may have access to unless a doctor has prescribed them for a specific deficiency or condition. A multivitamin you take for general health does not may have access to. A vitamin D supplement prescribed by your doctor for diagnosed deficiency does.
Cosmetic procedures do not may have access to: teeth whitening, Botox, hair removal, or plastic surgery for appearance. If the same procedure serves a medical purpose — reconstructive surgery after an accident or illness — it may may have access to, but cosmetic intent disqualifies it.
Over-the-counter pain relievers, cold medicine, antacids, and allergy medicine do not may have access to unless a doctor has written a prescription or a note saying you need them. Maternity clothes, diapers, and baby formula do not may have access to. Childcare does not may have access to, even if it allows you to work and earn money for medical expenses.
How to actually spend the money
Most HSA accounts come with a debit card. You can use it at pharmacies, doctor's offices, and hospitals just like a regular debit card. The card works at any pharmacy that accepts debit cards — CVS, Walgreens, local pharmacies — and at medical providers' billing windows.
You can also pay for a medical expense out of pocket with your regular money, keep the receipt, and reimburse yourself from your HSA later. This is actually common: some people use their HSA as a savings account and only reimburse themselves when they need the money. You can do this indefinitely — there's no time limit on reimbursement, as long as you have the receipt and the expense was incurred while you had the HSA.
If you use the debit card, keep your receipt. The IRS can audit HSA spending years later, and you'll need to show that the purchase was a may have access to medical expense. If you can't prove it, you'll owe income tax on that money plus a 20 percent penalty.
Frequently Asked Questions
Can I use my HSA to pay my insurance premium?
No, with one exception: you can use HSA money to pay for COBRA coverage (continuation coverage after job loss) or for health insurance premiums while you're receiving unemployment benefits. You cannot use it to pay your regular monthly health insurance premium.
Does my spouse need their own HSA to use my account for their medical expenses?
No. If your spouse is covered under your HSA (as a dependent), you can use the same account to pay for both of your medical expenses. The money in the account belongs to you, but you can spend it on your spouse's may have access to medical expenses.
What happens if I use my HSA debit card for something that doesn't may have access to?
You'll owe income tax on that amount plus a 20 percent penalty. The IRS can audit your HSA spending for up to three years after you make a withdrawal. If you're unsure whether an expense qualifies, pay out of pocket and ask your HSA administrator before you reimburse yourself.
Can I buy medical equipment online with my HSA?
Yes, if the retailer accepts HSA debit cards or if you pay out of pocket and reimburse yourself. Some online pharmacies and medical supply retailers accept HSA cards directly. For others, you'll need to use a regular payment method and then request reimbursement from your HSA administrator with a receipt.
Does my child's college health insurance count as a may have access to expense?
No. You can only use HSA money for medical expenses of dependents you claim on your tax return. If your child is in college and you don't claim them as a dependent, their medical expenses don't may have access to, even if you're paying for them.