HSA money covers medical expenses the IRS defines as may have access to
Your HSA can pay for doctor visits, prescriptions, dental work, vision care, and medical equipment — but only expenses the IRS calls "may have access to medical expenses." The IRS publishes a list, and it is more specific than "anything health-related." You can spend HSA funds on copays, deductibles, and coinsurance. You can also use them for things your insurance does not cover at all, as long as the IRS recognizes them as medical.
The key rule: the expense must be for diagnosis, treatment, or prevention of disease, or for treatment of an injury or condition. Cosmetic procedures do not count unless they are reconstructive — fixing something broken or damaged. Gym memberships do not count. Vitamins do not count unless a doctor prescribes them for a specific medical condition. If you are unsure whether something qualifies, the IRS maintains a searchable database of past rulings, and your HSA administrator can also tell you whether a specific expense is allowed.
Key Takeaways
- Doctor visits, prescriptions, dental care, and vision care are may have access to expenses you can pay with HSA funds.
- Copays, deductibles, and coinsurance all count as may have access to expenses, even if your insurance plan covers the underlying service.
- Medical equipment like crutches, wheelchairs, hearing aids, and blood pressure monitors qualifies, but you need to keep receipts showing what you bought.
- Cosmetic procedures do not count unless they are reconstructive — fixing damage or deformity — and your HSA administrator can tell you whether a specific expense qualifies before you spend.
Doctor visits, hospital care, and preventive services
You can use HSA funds to pay for office visits, urgent care, emergency room visits, and hospital stays. This includes the copay you hand over at check-in and any balance you owe after insurance pays its share. Preventive care — annual physicals, cancer screenings, vaccinations — also counts, even if your insurance covers it at no cost to you.
Mental health and substance abuse treatment are may have access to expenses. Therapy sessions, psychiatrist visits, and inpatient rehab programs all count. You can use HSA funds to pay the therapist directly if you see someone out of network, or you can use them to cover your share of the cost if you see someone your insurance covers.
Prescriptions and over-the-counter medications
Prescription medications are always may have access to expenses. Over-the-counter drugs are may have access to only if a doctor writes a prescription for them — not just a recommendation, but an actual prescription. Insulin is an exception: you can buy insulin over the counter without a prescription and still use HSA funds.
Vitamins and supplements do not count unless a doctor prescribes them for a specific medical condition documented in your medical record. If your doctor writes "Vitamin D supplement for deficiency," that prescription makes it may have access to. If you buy a multivitamin on your own, it does not count. Keep the prescription or the doctor's written order with your receipt, because the IRS may ask for proof that the expense was prescribed.
Dental and vision care
Dental work is a may have access to expense: cleanings, fillings, root canals, extractions, orthodontia, and dentures all count. You can use HSA funds whether you see a dentist covered by your insurance or pay out of pocket. Cosmetic dental work — teeth whitening, veneers for appearance only — does not count unless it is reconstructive, meaning it fixes damage or restores function after injury or disease.
Vision care includes eye exams, glasses, contact lenses, and laser eye surgery. You can use HSA funds to pay for the exam, the frames, the lenses, and the contacts themselves. Sunglasses do not count, even if they have a prescription, because they are not corrective.
Medical equipment and supplies
Durable medical equipment — items meant to last and be used repeatedly — qualifies if a doctor orders it for a medical condition. Wheelchairs, crutches, canes, walkers, hearing aids, blood pressure monitors, glucose meters, and continuous positive airway pressure (CPAP) machines all count. You need a prescription or doctor's order, and you should keep it with your receipt.
Supplies that go with medical equipment also count: test strips for glucose meters, batteries for hearing aids, replacement pads for CPAP masks. Bandages, elastic wraps, and over-the-counter first aid supplies do not count unless they are part of treatment for a specific condition your doctor is managing. Pregnancy tests and ovulation kits count as diagnostic tools. Condoms and other contraception do not count.
Long-term care and nursing home costs
If you are in a nursing home or assisted living facility for medical reasons, you can use HSA funds to pay the portion of your bill that covers medical care and nursing services. The facility must be able to separate the medical portion from the room and board portion — you cannot use HSA funds for the bed and meals alone. Ask the facility for an itemized bill that breaks out medical services.
In-home care — a nurse or aide coming to your home — counts the same way. The medical portion of the bill is may have access to; the housekeeping or personal care portion that is not medically necessary is not.
What does not count
Cosmetic procedures do not count unless they are reconstructive. A facelift is cosmetic. Reconstructive surgery after an accident or to correct a birth defect is may have access to. Gym memberships, fitness classes, and diet programs do not count, even if your doctor recommends exercise. Weight loss programs do not count unless they treat a specific disease your doctor has diagnosed — and even then, only the medical treatment portion counts, not the food or supplements.
Maternity clothes, baby formula, and childcare do not count. Travel to receive medical care does not count, even if your doctor refers you to a specialist in another city. Over-the-counter pain relievers, cold medicine, and allergy medicine do not count unless prescribed. Toothpaste, mouthwash, and shampoo do not count. Pet medications and veterinary care do not count, even if the pet is a service animal — though the cost of training a service animal may count in some cases.
How to document what you spend
Keep receipts for everything you buy with HSA funds. The receipt should show what you bought, the date, the amount, and the provider's name. If you use your HSA debit card, the transaction will appear on your statement, but the statement alone may not be enough proof if the IRS asks questions — you need the itemized receipt showing what the charge was for.
For prescriptions, keep the pharmacy receipt or the label from the prescription bottle. For medical equipment, keep the receipt and the doctor's prescription or order. For dental and vision care, keep the invoice from the provider. If you are reimbursing yourself from HSA funds for an expense you paid out of pocket, keep both the original receipt and documentation of the HSA withdrawal. The IRS does not require you to submit receipts when you file taxes, but you must be able to produce them if audited.
Frequently Asked Questions
Can I use my HSA to pay for my spouse's medical expenses?
Yes, if your spouse is a dependent on your tax return. You can use HSA funds to pay for their doctor visits, prescriptions, dental work, and other may have access to medical expenses. If your spouse has their own HSA, they should use theirs first, but there is no rule against using yours to cover their costs.
What happens if I spend HSA money on something that is not may have access to?
If you withdraw HSA funds for a non-may have access to expense before age 65, you owe income tax on the amount plus a 20 percent penalty. After age 65, you owe income tax but not the penalty — the account works like a traditional IRA at that point. Keep good records so you know what you have spent on and can avoid this situation.
Can I use my HSA to buy a blood pressure monitor or other medical device without a prescription?
Some devices count without a prescription — blood pressure monitors, thermometers, and pulse oximeters are generally considered diagnostic tools you can buy on your own. Others, like wheelchairs or CPAP machines, require a doctor's order. Your HSA administrator can tell you whether a specific device qualifies before you buy.
Does my HSA cover therapy or counseling?
Yes, mental health treatment is a may have access to expense. You can use HSA funds to pay for therapy, psychiatry, counseling, and inpatient mental health treatment. This includes substance abuse treatment and rehabilitation programs.
Can I use my HSA for my child's braces?
Yes, if your child is a dependent on your tax return. Orthodontia is a may have access to dental expense. You can use HSA funds to pay for the initial exam, the braces themselves, and any adjustments or repairs during treatment.