What HSA money can cover

An HSA (Health Savings Account) lets you pay for specific medical and dental costs with pretax money. The IRS maintains a detailed list of what counts as an may have access to medical expense. If an expense is on that list, you can withdraw HSA funds to pay for it without owing income tax on the withdrawal. If it is not on the list, you can still pay for it out of pocket, but you cannot use HSA money without facing taxes and a penalty.

The may have access to expenses fall into several broad categories: doctor visits and hospital care, prescription medications, dental work, vision care, mental health treatment, and medical equipment or supplies. Preventive care like vaccines and screenings are covered. So are X-rays, lab tests, physical therapy, and surgery. If a doctor orders it as treatment for a diagnosed condition, it is almost always on the list.

Over-the-counter medications are covered only if you have a prescription from a doctor — a pharmacist's recommendation does not count. Insulin is the one exception: you can buy insulin over the counter and pay for it with HSA funds without a prescription.

Key Takeaways

  • may have access to medical expenses include doctor visits, hospital stays, prescription drugs, dental work, vision care, and medical equipment ordered by a doctor.
  • Over-the-counter medications require a doctor's prescription to be paid for with HSA funds, except for insulin.
  • Cosmetic procedures, gym memberships, and general wellness products are not covered, even if they improve your health.
  • You can use HSA funds to pay for a spouse's or dependent's medical expenses, even if they are not on your health insurance plan.
  • Keeping receipts and records of what you paid for is important, because the IRS can ask you to prove an expense was may have access to.

Dental and vision expenses that count

Dental work covered by HSA funds includes fillings, root canals, crowns, extractions, and orthodontia like braces. Teeth cleaning and exams are covered. Dentures and dental implants are covered. Whitening and other cosmetic dental work is not covered unless it is part of a medically necessary procedure — for example, if a tooth needs to be rebuilt after an accident, the crown counts, but whitening alone does not.

Vision expenses include eye exams, glasses, contact lenses, and the solution you use to clean them. Laser eye surgery (LASIK) is covered. Sunglasses are not, even if they have a prescription in them, because they are considered general eyewear rather than a medical device. Hearing aids are covered, but regular hearing tests that are not part of treatment are not.

What is not covered, even if it helps your health

Cosmetic procedures — including Botox, facelifts, hair removal, and teeth whitening done for appearance — are not covered. Gym memberships, fitness classes, and general wellness products like vitamins and supplements are not covered, even if your doctor recommends them for your overall health. Weight-loss programs and diet plans are not covered unless they are prescribed as treatment for a specific diagnosed condition like obesity or diabetes, and even then, only the medical component (not the food or general coaching) may count.

Long-term care insurance premiums are not covered. Health insurance premiums themselves are generally not covered, with narrow exceptions for COBRA continuation coverage, Medicare premiums if you are over 65, and long-term care insurance up to an annual limit set by the IRS. Copays and deductibles on your health insurance are covered. Out-of-pocket costs you pay to an in-network or out-of-network provider are covered.

Travel to get medical care is not covered, even if the care itself is. Maternity clothes are not covered, but the hospital bill for childbirth is. Childcare while you attend a medical appointment is not covered.

Medical equipment and supplies you can pay for

Medical equipment and supplies are covered if they are used to treat, manage, or prevent a medical condition. Crutches, wheelchairs, walkers, and hearing aids are covered. Blood pressure monitors, glucose meters, and thermometers are covered. Bandages, braces, and compression stockings are covered. Oxygen equipment is covered. Prosthetics and orthopedic shoes are covered.

The line between a medical device and a general product can be blurry. A mattress is not covered, but a mattress prescribed by a doctor to treat a specific condition like severe back pain may be. A humidifier is not covered as a general wellness tool, but one prescribed to treat asthma or sleep apnea may be. The key is whether a doctor has ordered it as treatment for a diagnosed condition, not whether it happens to improve your health.

Mental health and therapy expenses

Therapy, counseling, and psychiatric care are covered. This includes sessions with a therapist, psychologist, psychiatrist, or counselor, whether in person, by phone, or by video. Medications prescribed for mental health conditions are covered. Inpatient mental health treatment and rehabilitation programs are covered. Substance abuse treatment is covered.

Self-help books, meditation apps, and general stress-reduction programs are not covered unless they are part of a treatment plan prescribed by a licensed mental health professional. If your doctor or therapist orders a specific app or program as part of your treatment, ask whether it qualifies before you pay for it with HSA funds.

Expenses for family members and dependents

You can use your HSA to pay for medical expenses of your spouse and any dependent you claim on your tax return, even if they are not covered by your health insurance plan. You do not need to be on the same insurance policy. A dependent is generally a child under 26 (or under 24 if they are a full-time student), a parent you support financially, or another relative you support who lives with you — the exact definition depends on your tax situation.

You cannot use your HSA to pay for a family member's expenses if you do not claim them as a dependent on your taxes, even if you support them financially. If you are unsure whether someone counts as your dependent, check your most recent tax return or speak with a tax professional.

Keeping records and what happens if you use HSA funds incorrectly

The IRS does not require you to submit receipts when you withdraw money from your HSA, but you must keep records of what you spent it on. If the IRS audits your account, you will need to show that the expenses were may have access to. If you cannot prove an expense was may have access to, you owe income tax on that withdrawal, plus a 20 percent penalty.

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 can withdraw money for any reason, but non-may have access to withdrawals are still taxed as income — you just do not pay the 20 percent penalty anymore. This makes an HSA a useful retirement savings tool if you do not spend all the money on medical expenses while you are working.

Some HSA providers offer a debit card that lets you pay directly at a pharmacy or doctor's office. Others require you to pay out of pocket and then request a reimbursement. Either way, keep the receipt or explanation of benefits showing what you paid for and when.

Frequently Asked Questions

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

Yes. You can pay for any may have access to medical expense of your spouse or tax dependents, regardless of whether they are on your health insurance plan. You will need to keep records showing what the expense was and that it was may have access to.

Are over-the-counter pain relievers and cold medicine covered?

Only if you have a prescription from a doctor. A pharmacist's recommendation does not count. Insulin is the only over-the-counter medication you can buy and pay for with HSA funds without a prescription.

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 cardiac rehabilitation as treatment for a specific condition, that is covered.

What happens if I use HSA money for something that is not may have access to?

Before age 65, you owe income tax on the withdrawal plus a 20 percent penalty. After age 65, you owe income tax but not the penalty. Keep receipts so you can prove an expense was may have access to if you are ever audited.

Are prescription glasses and contact lenses covered?

Yes. Eye exams, glasses, contact lenses, and contact lens solution are all covered. LASIK surgery is also covered. Sunglasses, even with a prescription, are not covered.