What an HSA covers: the basic rule
Your HSA money can pay for medical expenses that treat, manage, or prevent a health condition. The IRS publishes a list of what counts. If it's something a doctor would prescribe or recommend for your health, it usually qualifies. If it's something you'd buy anyway even if you were perfectly healthy, it usually doesn't.
The key is that the expense has to be for you, your spouse, or your dependents — not for anyone else. And you have to have a receipt or explanation of benefits showing what you paid for. The money doesn't expire, so you can save it year to year and use it whenever you need it.
Key Takeaways
- Copays, deductibles, coinsurance, and prescriptions are always covered by HSA funds.
- Over-the-counter items like pain relievers, allergy medicine, and bandages are covered only if you have a doctor's written order or prescription.
- Dental work, vision care, and hearing aids are covered, but cosmetic procedures and teeth whitening are not.
- Gym memberships, vitamins, and weight-loss programs are not covered unless prescribed by a doctor for a specific medical condition.
- You need a receipt for every purchase; the IRS can ask you to prove what you spent money on years later.
Medical services and supplies you can always pay for
Doctor visits, urgent care, emergency room visits, and hospital stays are covered. So are lab tests, X-rays, and imaging. Mental health counseling and therapy sessions count. Physical therapy, occupational therapy, and speech therapy are covered.
Medical equipment and supplies include crutches, wheelchairs, blood pressure monitors, glucose meters, test strips, syringes, and bandages. Hearing aids and batteries are covered. Prescription eyeglasses and contact lenses are covered. Dental cleanings, fillings, root canals, and extractions are covered. Orthodontia (braces) is covered.
Prescription medications are always covered. Over-the-counter medications are covered only if you have a prescription or written order from a doctor. That means you can use HSA funds for over-the-counter pain relievers, allergy medicine, cold medicine, or antacids — but only if your doctor has written an order saying you need them for your condition.
What requires a doctor's order to be covered
Many over-the-counter items are HSA-may be able to access, but only with a prescription or written order from your doctor. This includes pain relievers (ibuprofen, acetaminophen), allergy and cold medicine, antacids, anti-diarrheal medicine, and topical creams for skin conditions.
Vitamins and supplements are not covered unless your doctor prescribes them for a specific medical condition and provides a written order. A multivitamin for general health does not may have access to. A prescription for vitamin D because your blood test showed deficiency does may have access to.
Weight-loss programs and meal replacement products are not covered unless prescribed by a doctor for a medical condition like obesity or diabetes. Gym memberships and fitness classes are not covered, even if your doctor recommends exercise.
What is not covered, even with a prescription
Cosmetic procedures are never covered, even if a doctor performs them. That includes teeth whitening, veneers, cosmetic dentistry, Botox, dermal fillers, and elective plastic surgery. Procedures to improve appearance rather than treat a condition do not may have access to.
Toiletries and personal care items are not covered: toothpaste, mouthwash, deodorant, shampoo, soap, and cosmetics. Sunscreen is not covered. Maternity clothes are not covered. Over-the-counter reading glasses are not covered (but prescription eyeglasses are).
Long-term care insurance premiums are not covered. Life insurance is not covered. Disability insurance is 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 certain limits.
Dental, vision, and hearing care specifics
Routine dental cleanings and exams are covered. Fillings, root canals, extractions, and gum disease treatment are covered. Crowns and bridges are covered. Orthodontia (braces and aligners) is covered. Dental implants are covered. Teeth whitening and cosmetic bonding are not covered.
Routine eye exams are covered. Prescription eyeglasses and contact lenses are covered. Contact lens solution is covered. Laser eye surgery (LASIK) is covered if it corrects a refractive error. Over-the-counter reading glasses are not covered.
Hearing aids and batteries are covered. Hearing tests are covered. Cochlear implants are covered.
How to prove what you spent money on
Keep your receipt for every HSA purchase. The receipt should show the date, the amount, what was purchased, and the provider's name. If you use a debit card linked to your HSA, the transaction record counts as a receipt.
For prescriptions, the pharmacy receipt is your proof. For doctor visits, keep the explanation of benefits from your insurance or the receipt from the provider. For over-the-counter items, keep the store receipt and the prescription or written order from your doctor.
The IRS can audit your HSA spending years after you spend the money. If you cannot produce a receipt showing the expense was medical, you may have to pay taxes on that withdrawal plus a 20 percent penalty. It is worth keeping receipts organized and stored safely.
Frequently Asked Questions
Can I use my HSA to pay for my spouse's medical expenses?
Yes. Your HSA can pay for medical expenses for you, your spouse, and your dependents — even if they are not covered under your health insurance plan. You need receipts showing the expense and proof of the relationship.
Do I need a prescription for every over-the-counter medicine?
Yes, to use HSA funds. Your doctor must write a prescription or provide a written order stating that you need the specific medication for your condition. A general recommendation to "take ibuprofen for pain" is not enough; the order must be documented in writing.
Can I use my HSA for my gym membership if my doctor says exercise will help my condition?
No. Gym memberships are not covered even with a doctor's recommendation. However, physical therapy or occupational therapy prescribed by a doctor is covered. If your doctor prescribes a specific fitness program as medical treatment, ask your HSA administrator whether that particular program qualifies.
What happens if I spend HSA money on something that is not covered?
You will owe income tax on that amount plus a 20 percent penalty. The IRS considers it a non-medical withdrawal. Keep receipts so you can show what you spent money on if you are ever audited.
Can I use my HSA to buy health insurance?
Generally no, with three exceptions: COBRA continuation coverage, Medicare premiums if you are age 65 or older, and long-term care insurance up to certain annual limits set by the IRS. Regular health insurance premiums do not may have access to.