What an HSA covers: the basic rule
You can use your HSA to pay for medical expenses that would otherwise be deductible on your taxes. That is the governing standard. The IRS publishes a list of what counts, and it is longer than most people expect — but it has hard limits too.
The key distinction: the expense must be for diagnosis, treatment, or prevention of a medical condition. Cosmetic procedures, general wellness products, and anything that improves your appearance without treating disease do not may have access to, even if they make you feel better.
You can use HSA money to pay for yourself, your spouse, or any dependent you claim on your tax return — even if they are not covered by your health plan. You do not need to be enrolled in the HSA-may be able to access plan at the time you withdraw the money, as long as you were enrolled when you made the contribution.
Key Takeaways
- Medical expenses that may have access to for HSA withdrawal include doctor visits, prescription drugs, dental work, vision care, mental health treatment, and many medical devices and supplies.
- Over-the-counter medications and supplies now may have access to without a prescription, but only if they treat a diagnosed medical condition — not for general wellness.
- Cosmetic procedures, gym memberships, vitamins, and most personal care items do not may have access to, even if recommended by a doctor.
- You can use HSA funds to pay for a family member's medical expenses if they are your spouse or tax dependent, regardless of whether they are on your health plan.
- Keeping receipts and documentation is essential because the IRS can audit HSA withdrawals years later, and you may owe taxes plus penalties if you cannot prove the expense was medical.
Doctor visits, prescriptions, and hospital care
Copays, coinsurance, and deductibles for any medical visit are HSA-may be able to access. This includes primary care appointments, specialist visits, emergency room care, and hospital stays. You can also use HSA funds to pay your health insurance premiums if you are receiving unemployment benefits — a specific exception to the general rule that premiums do not may have access to.
Prescription medications are always covered. Over-the-counter drugs now may have access to too, but only if they treat a specific medical condition you have been diagnosed with. Aspirin for a headache counts; a daily multivitamin for general health does not. You do not need a prescription for the OTC medication to may have access to, but you do need to be able to show it was for a diagnosed condition if audited.
Mental health and addiction treatment — therapy, psychiatry, inpatient rehab, and medication — all may have access to. So do vaccines and preventive screenings, even if your insurance covers them at no cost.
Dental and vision expenses
Dental work is fully HSA-may be able to access: cleanings, fillings, root canals, extractions, orthodontia, and dentures all count. You can use HSA funds for dental insurance premiums too. Cosmetic dentistry — teeth whitening or veneers for appearance — does not may have access to unless it is part of reconstructive work after an injury or disease.
Vision expenses include eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) qualifies. Sunglasses do not, even if prescribed, because they are considered general eyewear rather than treatment.
Medical equipment, supplies, and devices
Durable medical equipment — wheelchairs, walkers, canes, crutches, hearing aids, and blood pressure monitors — qualifies. So do diabetic supplies (test strips, lancets, glucose meters), bandages, first aid kits, and medical-grade compression stockings.
Certain home modifications for medical reasons are HSA-may be able to access: grab bars, ramps, stairlifts, and bathroom modifications to accommodate a disability. The expense must be primarily medical, not a general home improvement. A walk-in shower installed because of arthritis qualifies; one installed for convenience does not.
Crutches, braces, splints, and other supports for injury or chronic conditions all may have access to. Elastic bandages and athletic tape for an injury count; the same products used for sports performance do not.
What does not may have access to
Cosmetic procedures — Botox, facelifts, hair removal, teeth whitening for appearance — are not covered. Gym memberships and fitness classes do not may have access to, even if your doctor recommends exercise. Vitamins and supplements do not may have access to unless they treat a specific diagnosed deficiency (and you can document that diagnosis).
General wellness products — air purifiers, humidifiers, massage chairs — do not may have access to. Weight loss programs and diet plans do not may have access to unless they are part of treatment for a diagnosed medical condition like diabetes or obesity-related disease, and even then the rules are narrow.
Maternity clothes, childcare, and school tuition do not may have access to. Cosmetic hair loss treatment does not, but treatment for hair loss caused by a medical condition (alopecia, chemotherapy) may. Sunscreen does not may have access to as a preventive expense, though it is recommended for health.
Long-term care insurance premiums have limits: you can use HSA funds for them only up to a certain annual amount, which changes yearly. Nursing home care itself is HSA-may be able to access if it is primarily for medical reasons, not custodial care.
How to document and keep records
The IRS does not require you to submit receipts when you withdraw HSA money, but you must keep them. The agency can audit HSA accounts years after a withdrawal, and if you cannot produce documentation showing the expense was medical, you owe income tax on that withdrawal plus a 20 percent penalty.
Keep the receipt or invoice showing what was purchased, the date, the amount, and the provider's name. For prescriptions, keep the pharmacy receipt. For medical devices, keep the receipt and any documentation of the diagnosis or prescription. For dental and vision work, keep the itemized bill from the provider.
If you are unsure whether an expense qualifies, do not withdraw the money until you have confirmation. You can contact the IRS directly, or ask your HSA administrator — most have a customer service line that can tell you whether a specific item is covered.
Frequently Asked Questions
Can I use my HSA to pay for my spouse's medical expenses?
Yes, if your spouse is your tax dependent. You can use HSA funds for any dependent's medical expenses, whether or not they are on your health plan. You do not need to be married to use HSA funds for a spouse's care — the rule is based on tax dependency.
Does my HSA cover over-the-counter pain relievers like ibuprofen?
Yes, if you have a diagnosed condition that the medication treats. Ibuprofen for a headache or arthritis pain qualifies; taking it daily for general wellness does not. You do not need a prescription, but you should keep the receipt and be able to document the condition if audited.
Can I use HSA money for my child's braces?
Yes, if your child is your tax dependent. Orthodontia is a covered medical expense. Keep the itemized bill from the orthodontist showing the treatment plan and total cost.
What happens if I use my HSA for something that does not may have access to?
If you withdraw money for a non-medical expense, you owe income tax on that amount plus a 20 percent penalty. The IRS can assess this years after the withdrawal if they audit your account. If the expense was truly medical but you cannot document it, you still owe the tax and penalty.
Are prescription glasses covered, or just the exam?
Both the eye exam and the glasses themselves are covered. Contact lenses and contact lens solution also may have access to. Sunglasses do not, even if prescribed, because they are considered general eyewear rather than medical treatment.