What HSA money covers and what it doesn't

An HSA lets you spend pre-tax dollars on medical expenses, but not on every health-related purchase. The IRS maintains a specific list of what counts. Prescription medications, doctor visits, dental work, vision care, and mental health treatment all may have access to. Over-the-counter pain relievers, allergy medicine, and cold remedies do not—unless you have a prescription for them. Vitamins and supplements do not may have access to, even if a doctor recommends them. Gym memberships and general wellness programs do not may have access to, even if your employer offers them as part of your health plan.

The rule is straightforward: the expense must treat, diagnose, or prevent a specific medical condition. Preventive care that targets a diagnosed condition qualifies. Preventive care that is purely general wellness does not. A colonoscopy for screening qualifies. A massage for stress relief does not, unless a doctor prescribes it as treatment for a documented medical condition.

Key Takeaways

  • Prescription medications, doctor and dentist visits, mental health care, and vision correction all may have access to for HSA spending.
  • Over-the-counter medications do not may have access to unless you have a prescription, and vitamins or supplements never may have access to even with a doctor's recommendation.
  • The IRS distinguishes between treating a medical condition and general wellness, so gym memberships and wellness programs do not may have access to.
  • Medical equipment and supplies—hearing aids, crutches, wheelchairs, diabetic testing supplies—may have access to if they treat a diagnosed condition.
  • You can spend HSA money on insurance premiums in specific situations: COBRA continuation coverage, long-term care insurance, and health insurance while unemployed.

Medical equipment, supplies, and devices that may have access to

If you have a diagnosed medical condition and need equipment to manage it, HSA money covers the purchase and ongoing supplies. Diabetic testing strips, lancets, and glucose monitors may have access to. Hearing aids and replacement batteries may have access to. Crutches, canes, wheelchairs, and walkers may have access to. Continuous positive airway pressure (CPAP) machines and supplies may have access to. Orthopedic braces, compression stockings, and corrective shoes may have access to if prescribed for a medical condition.

The equipment must be primarily medical in nature—it cannot serve a general purpose that happens to have a medical benefit. A regular bed does not may have access to, but a hospital bed prescribed by a doctor for a specific condition does. Regular eyeglasses do not may have access to, but prescription eyeglasses and contact lenses do. The distinction matters because the IRS looks at whether the item is designed specifically for medical use or is a general item that someone with a medical condition happens to use.

Insurance premiums you can and cannot pay with HSA funds

You cannot use HSA money to pay your regular health insurance premium—the one tied to your job or the one you buy on your own. That money comes from your paycheck before the HSA deduction, so paying it twice would be double-dipping. You can, however, use HSA funds for three specific insurance situations: COBRA continuation coverage if you leave your job, long-term care insurance premiums, and health insurance premiums while you are unemployed and receiving unemployment benefits.

Long-term care insurance is the most common exception people use. If you buy a policy that covers nursing home care, assisted living, or in-home care for a chronic condition, you can pay the premiums from your HSA. There is an annual limit on how much you can spend this way—the limit changes each year and depends on your age. For 2024, the limit ranges from $450 for someone under 41 to $3,000 for someone 71 or older. Check the current year's limit with your HSA provider before you commit to a premium payment.

Dental and vision care that qualifies

Dental work covered by your health plan qualifies for HSA spending. Cleanings, fillings, root canals, extractions, and crowns all may have access to. Orthodontia—braces and retainers—qualifies. Dental implants and bridges may have access to. Cosmetic dental work does not may have access to unless it is reconstructive following an injury or disease. Teeth whitening does not may have access to because it is cosmetic.

Vision care follows the same logic. Eye exams, prescription glasses, contact lenses, and contact lens solution all may have access to. LASIK and other vision correction surgery qualifies. Sunglasses do not may have access to, even if they are prescription, because they serve a general purpose beyond medical treatment. Non-prescription reading glasses do not may have access to. If you need vision correction for a medical condition, the correction itself qualifies; the general eyewear category does not.

Mental health and therapy services

Therapy and counseling for a diagnosed mental health condition may have access to for HSA spending. Visits to a psychiatrist, psychologist, licensed clinical social worker, or licensed counselor all may have access to if they are treating a condition. Psychiatric medications may have access to. Inpatient mental health treatment qualifies. Substance abuse treatment qualifies. The service must be provided by a licensed practitioner treating a diagnosed condition—not life coaching, general wellness counseling, or self-help programs.

Some employers offer employee information programs (EAPs) that include counseling sessions at no cost. If you use an EAP, you cannot also use HSA money for the same service—that would be paying twice. If your EAP sessions run out and you need additional therapy, you can use HSA funds for a therapist outside the program.

What does not may have access to, even with a doctor's recommendation

Vitamins and nutritional supplements do not may have access to for HSA spending, period. A doctor can recommend them, your employer can encourage them, and they may genuinely help your health—but the IRS does not allow HSA funds to pay for them. The same applies to herbal remedies and alternative medicine treatments that are not prescribed as drugs. Acupuncture does not may have access to. Chiropractic care does not may have access to. Naturopathic treatments do not may have access to.

Cosmetic procedures do not may have access to unless they are reconstructive following an injury or disease. Botox does not may have access to. Hair transplants do not may have access to. Teeth whitening does not may have access to. A facelift does not may have access to. If the procedure's primary purpose is to change appearance rather than treat a medical condition, HSA money cannot pay for it.

General wellness expenses do not may have access to: gym memberships, fitness classes, weight loss programs, and wellness retreats do not may have access to even if your doctor recommends exercise. Maternity clothes, childcare, and over-the-counter items like bandages or pain relievers do not may have access to unless you have a prescription for the medication. Travel to receive medical care does not may have access to—neither airfare nor hotel stays count as medical expenses.

How to know if something qualifies before you spend

Your HSA provider maintains a list of may have access to expenses on their website, usually searchable by category or keyword. If you are unsure about a specific item, contact your HSA provider's customer service before you make the purchase. They can tell you whether that particular expense qualifies and whether you need documentation like a prescription or doctor's note.

Keep receipts and documentation for everything you buy with HSA funds. The IRS can audit your HSA spending at any time, and you need to prove that the money went to may have access to expenses. If you cannot document an expense, you may have to repay the amount plus taxes and penalties. Many HSA providers now offer mobile apps where you can photograph and store receipts automatically.

Frequently Asked Questions

Can I use HSA money for my spouse's or child's medical expenses?

Yes. Your HSA can pay for medical expenses of your spouse and dependents, even if they are not covered under your health plan. You do not need to be enrolled in family coverage—the HSA just needs to be in your name. Keep receipts showing the relationship and the medical nature of the expense.

Does my doctor have to write a prescription for over-the-counter medicine for it to may have access to?

Yes. Ibuprofen, acetaminophen, allergy medicine, and cold medicine do not may have access to unless a doctor writes a prescription for them. A prescription for an over-the-counter item is unusual but possible—ask your doctor if you want to use HSA funds for a medication you can buy without one.

Can I use HSA money for my pet's veterinary care?

No. Veterinary expenses do not may have access to for HSA spending, even if the pet is a service animal. Service animals themselves do not may have access to either. However, if you need medical equipment or treatment because of a service animal—for example, a ramp or grab bar—that equipment qualifies.

What happens if I spend HSA money on something that does not may have access to?

The amount counts as a non-may have access to withdrawal. You must repay the amount to your HSA, and you owe income tax on it plus a 20 percent penalty. If you discover the mistake later, you can still correct it by reimbursing your HSA, though the penalty may still explore depending on when you catch the error.

Does my HSA cover preventive care like annual checkups or cancer screenings?

Yes. Preventive care visits and screenings—annual physicals, mammograms, colonoscopies, blood pressure checks—all may have access to for HSA spending. Preventive care is one of the clearest categories of may have access to expenses.