HSA funds cover medical expenses that your health insurance doesn't, and the IRS maintains a specific list of what qualifies

An HSA (Health Savings Account) is designed to pay for healthcare costs, but not every healthcare expense counts. The IRS publishes an official list of may have access to medical expenses, and if you spend HSA money on something not on that list, you'll owe income tax on the withdrawal plus a 20% penalty. The list is longer than most people think — it includes things beyond just doctor visits — but it has clear boundaries.

The core rule: the expense must be for diagnosis, treatment, or prevention of a medical condition, and it must not be covered by your health insurance. If your insurance pays for it, your HSA can't pay for it again. If your insurance doesn't cover it but it's not a medical expense at all, your HSA can't pay for it either.

Key Takeaways

  • Deductibles, copays, and coinsurance from your health insurance are always HSA-may be able to access, even if you haven't met your deductible yet.
  • Prescription medications and over-the-counter drugs (with a prescription from your doctor) are covered, but vitamins and supplements without a medical diagnosis are not.
  • Dental work, vision care, and hearing aids are HSA-may be able to access, but cosmetic procedures like teeth whitening or LASIK for convenience are not.
  • You can use HSA funds to pay for long-term care insurance premiums and certain may have access to long-term care services, subject to dollar limits.
  • Gym memberships, weight loss programs, and general wellness expenses are not HSA-may be able to access unless your doctor prescribes them to treat a specific medical condition.

Insurance costs and out-of-pocket medical bills

Your HSA can pay for any out-of-pocket cost tied to your health insurance: deductibles, copays, and coinsurance. This is true even if you haven't met your deductible yet. If your plan requires you to pay $50 per doctor visit before insurance kicks in, that $50 comes straight from HSA funds without penalty.

You can also use HSA money to pay premiums for certain types of insurance. COBRA continuation coverage (the temporary health insurance you can keep after leaving a job) is HSA-may be able to access. Long-term care insurance premiums are may be able to access up to an annual limit that changes each year. Medicare premiums — Part A, Part B, Part D, and Medigap — are HSA-may be able to access once you turn 65, though using HSA funds for Medicare premiums counts as a distribution that reduces your account balance.

Health insurance premiums for your regular coverage (the plan your HSA is attached to) are not HSA-may be able to access. You pay those with after-tax dollars.

Prescription and over-the-counter medications

Prescription medications are always HSA-may be able to access. Over-the-counter drugs are may be able to access only if your doctor writes a prescription for them or documents a medical diagnosis that the drug treats. Insulin is HSA-may be able to access without a prescription because it's a special case in the tax code. Allergy medicine, cold medicine, pain relievers, and antacids are HSA-may be able to access if you have a doctor's prescription or a written diagnosis from your doctor stating you need them.

Vitamins, supplements, and herbal products are not HSA-may be able to access unless your doctor prescribes them to treat a specific medical condition and documents that diagnosis. A multivitamin for general health does not may have access to. A vitamin D supplement prescribed by your doctor to treat vitamin D deficiency does.

Menstrual products (pads and tampons) became HSA-may be able to access in 2023. Nicotine replacement products like patches and gum are HSA-may be able to access if used to stop smoking.

Dental, vision, and hearing care

Dental work is HSA-may be able to access: cleanings, fillings, root canals, extractions, orthodontia, and dentures all count. Cosmetic dental work like teeth whitening or veneers is not may be able to access unless your dentist documents that it's medically necessary (rare). Dental insurance premiums are also HSA-may be able to access.

Vision care is HSA-may be able to access: eye exams, glasses, contact lenses, and contact lens solution all may have access to. LASIK and other vision correction surgery is HSA-may be able to access if it corrects a vision defect. LASIK done purely for convenience (to avoid wearing glasses) is not may be able to access. Vision insurance premiums are HSA-may be able to access.

Hearing aids and hearing tests are HSA-may be able to access. Hearing aid batteries and repairs are covered. Hearing aid insurance premiums are HSA-may be able to access.

Medical equipment and supplies

Medical equipment prescribed by a doctor is HSA-may be able to access: crutches, wheelchairs, blood pressure monitors, glucose meters, continuous positive airway pressure (CPAP) machines, and oxygen equipment all may have access to. The equipment must be for a medical condition, not general wellness.

Medical supplies are HSA-may be able to access: bandages, gauze, syringes, lancets for blood testing, and test strips for glucose or ketone monitoring. Feminine hygiene products became HSA-may be able to access in 2023. Incontinence products are HSA-may be able to access. First aid kits are not, because they're general supplies rather than treatment for a diagnosed condition.

Mobility aids like canes, walkers, and grab bars are HSA-may be able to access if prescribed for a medical condition. A grab bar installed in a bathroom for general safety is not may be able to access; a grab bar installed because your doctor says you need it to prevent falls due to a balance disorder is.

Mental health and therapy services

Therapy and counseling are HSA-may be able to access when provided by a licensed mental health professional (therapist, psychologist, psychiatrist, or counselor) and billed as medical treatment. The copay or coinsurance you pay to your insurance for a therapy session is HSA-may be able to access. If you pay out of pocket for therapy, that cost is HSA-may be able to access.

Psychiatric medications are HSA-may be able to access. Inpatient mental health treatment and rehabilitation programs are HSA-may be able to access. Substance abuse treatment is HSA-may be able to access.

Long-term care and nursing home costs

Long-term care insurance premiums are HSA-may be able to access up to an annual limit set by the IRS (the limit varies by age and changes yearly). Actual long-term care services — nursing home care, assisted living, or in-home care — are HSA-may be able to access if they're medically necessary and provided by a licensed facility or caregiver.

The cost of meals and lodging in a nursing home or assisted living facility is HSA-may be able to access only if the primary reason for being there is to receive medical care. If you're in assisted living mainly for social reasons or because you need help with daily tasks but not medical treatment, the room and board costs are not HSA-may be able to access, though any actual medical services you receive are.

What is not HSA-may be able to access

Cosmetic procedures are not HSA-may be able to access unless medically necessary. Botox for wrinkles is not may be able to access. Botox for chronic migraines prescribed by a neurologist is may be able to access. Teeth whitening is not may be able to access. Hair transplants are not may be able to access. Liposuction for weight loss is not may be able to access.

General wellness is not HSA-may be able to access. Gym memberships, fitness classes, weight loss programs, and diet plans are not may be able to access, even if your doctor recommends exercise. A weight loss program prescribed by your doctor to treat obesity-related diabetes may be may be able to access — the key is whether your doctor documents it as treatment for a specific condition, not general health.

Cosmetic surgery is not may be able to access. Plastic surgery for appearance is not may be able to access. Reconstructive surgery after an injury or illness is may be able to access.

Over-the-counter products for general use are not may be able to access: sunscreen, toothpaste, soap, shampoo, and deodorant are not HSA-may be able to access. Prescription-strength sunscreen prescribed by a dermatologist to treat a skin condition may be may be able to access.

Frequently Asked Questions

Can I use my HSA to pay for my spouse's medical expenses?

Yes. HSA funds can pay for may have access to medical expenses of you, your spouse, and your dependents, regardless of whether they're covered under your health insurance plan. You don't have to be on the same insurance policy.

Is my HSA deductible covered?

Yes. Your health insurance deductible is an out-of-pocket cost, so it's always HSA-may be able to access. You can use HSA funds to pay your deductible even before you've met it.

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

No. Veterinary care is not HSA-may be able to access. HSA funds are limited to medical expenses for humans.

What happens if I spend HSA money on something that's not may be able to access?

You'll owe income tax on that withdrawal plus a 20% penalty. The penalty applies only to the non-may have access to amount, not your entire HSA balance. Keep receipts for all HSA withdrawals in case the IRS asks.

Can I use my HSA to pay for someone else's insurance premiums?

You can pay for your spouse's or dependent's insurance premiums with HSA funds. You cannot use HSA funds to pay premiums for someone who is not your spouse or dependent, even if you're supporting them financially.