You can use HSA funds for medical expenses you pay out of pocket, but the list is narrower than most people think

A Health Savings Account lets you set aside pre-tax money for healthcare costs. The catch is that you can only withdraw that money for may have access to medical expenses — a specific list defined by the IRS. If you spend HSA funds on something not on that list, you pay income tax on the withdrawal plus a 20% penalty (unless you're over 65, in which case you pay income tax but no penalty).

The may have access to list includes obvious things like doctor visits, prescriptions, and hospital bills. It also includes some things that surprise people — like certain over-the-counter items and dental work. But it excludes others that sound medical but aren't on the IRS's definition, like cosmetic procedures and most gym memberships.

The IRS publishes the full list in Publication 502, but the practical version is simpler: if it treats or prevents a diagnosed medical condition, it's probably covered. If it's for general wellness or appearance, it probably isn't.

Key Takeaways

  • may have access to medical expenses include doctor and dentist visits, prescription drugs, hospital stays, and medical equipment like crutches or wheelchairs.
  • Some over-the-counter items may have access to — like pain relievers, allergy medicine, and first-aid supplies — but only if you have a prescription or doctor's recommendation for them.
  • Expenses that don't may have access to include cosmetic procedures, gym memberships, vitamins (unless prescribed), and most dental work that's purely cosmetic.
  • Non-may have access to withdrawals trigger income tax plus a 20% penalty, so it's worth checking the IRS list before spending HSA money on something you're unsure about.
  • You can use HSA funds to pay for a spouse's or dependent's may have access to medical expenses, even if they're not on your health plan.

Medical services and procedures that may have access to

Doctor visits, specialist consultations, and surgery all count. This includes preventive care like annual physicals and cancer screenings. Mental health treatment — therapy, psychiatry, counseling — qualifies. So do hospital stays, emergency room visits, and urgent care.

Dental work qualifies if it treats a condition: fillings, root canals, extractions, and gum disease treatment all count. Orthodontia (braces) counts too. But cosmetic dental work — like teeth whitening or veneers done purely for appearance — does not.

Vision care qualifies: eye exams, glasses, contact lenses, and LASIK surgery. Hearing aids and hearing tests count. Physical therapy, chiropractic care, and acupuncture count if a doctor recommends them for a diagnosed condition.

Prescription and over-the-counter drugs

Any prescription medication your doctor writes qualifies, whether it's for a chronic condition or a one-time infection. This includes birth control pills, inhalers, and psychiatric medications.

Over-the-counter drugs are trickier. You can use HSA funds for OTC pain relievers, allergy medicine, cold medicine, antacids, and anti-diarrheal medication — but only if a doctor has recommended them for your specific condition or you have a prescription for them. You cannot use HSA funds for OTC vitamins, supplements, or general wellness products, even if they're sold in the pharmacy section.

The rule is: if it treats a diagnosed medical condition and a doctor has signed off on it, it qualifies. If it's for general health or you bought it on your own without medical direction, it doesn't.

Medical equipment and supplies

Crutches, wheelchairs, walkers, and canes may have access to. So do blood pressure monitors, glucose meters, and other diagnostic equipment. Hearing aid batteries, CPAP machines, and oxygen equipment count. Bandages, gauze, and other first-aid supplies may have access to.

The equipment has to be primarily medical — designed to treat or manage a health condition. A regular mattress doesn't may have access to, but a special mattress prescribed by a doctor for a back condition might. A regular chair doesn't may have access to, but a specially designed chair for someone with mobility issues could.

Prosthetics, braces, and orthotics all may have access to. So do corrective shoes prescribed for a foot condition (though regular shoes, even if they're comfortable, do not).

Insurance premiums and long-term care

You can use HSA funds to pay premiums for long-term care insurance — the kind that covers nursing home or in-home care if you become unable to care for yourself. There are limits: the IRS caps how much you can spend on long-term care premiums based on your age, ranging from about $450 per year for someone under 40 to about $3,000 per year for someone over 60.

You cannot use HSA funds to pay premiums for your regular health insurance, Medicare, or employer coverage. The one exception is COBRA continuation coverage — if you leave a job and elect COBRA to keep your health insurance temporarily, you can use HSA funds to pay those premiums.

You also cannot use HSA funds to pay for supplemental insurance, dental insurance, or vision insurance premiums.

What doesn't may have access to, even if it sounds medical

Cosmetic procedures — including cosmetic surgery, Botox, dermal fillers, and teeth whitening — do not may have access to unless they're medically necessary. For example, reconstructive surgery after an accident or burn qualifies, but elective cosmetic surgery does not.

Gym memberships and fitness classes do not may have access to, even if a doctor recommends exercise. General wellness programs, weight loss programs, and diet plans do not may have access to. Vitamins and supplements do not may have access to unless a doctor prescribes them for a specific deficiency.

Maternity clothes, baby formula, and diapers do not may have access to. Sunscreen does not may have access to. Toothpaste and mouthwash do not may have access to. Over-the-counter sleep aids, energy drinks, and general wellness teas do not may have access to.

Marijuana, whether medical or recreational, does not may have access to under federal tax law, even in states where it's legal. This is because the IRS follows federal law, not state law.

How to know if something qualifies

The IRS publishes a full list in Publication 502, available free on the IRS website. Your HSA provider (the bank or financial company holding your account) usually has a searchable database of may have access to expenses on their website. Many providers let you text or call with a question about a specific item.

A good rule of thumb: if it requires a doctor's prescription or recommendation, and it treats or prevents a diagnosed medical condition, it almost certainly qualifies. If you bought it on your own for general wellness, it probably doesn't.

Keep receipts and documentation. If you're ever audited, the IRS will want to see proof that the expense was medical and that you actually paid it. Your HSA provider will also ask for documentation if you withdraw a large amount or if the expense seems unusual.

Frequently Asked Questions

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

Yes. You can use your HSA to pay for may have access to medical expenses for your spouse and any tax dependents, regardless of whether they're on your health plan. You don't need to be married or have them listed on your HSA — you just need to pay their may have access to expenses out of your HSA funds.

What happens if I spend HSA money on something that doesn't may have access to?

You'll owe income tax on that withdrawal at your regular tax rate, plus a 20% penalty. So if you withdraw $500 for something non-may have access to and you're in the 24% tax bracket, you'd owe $120 in taxes plus $100 in penalty — $220 total. After age 65, the penalty goes away but the income tax remains.

Can I use my HSA to pay for therapy or mental health treatment?

Yes. Therapy, psychiatry, counseling, and other mental health treatment all may have access to as long as it's for treating a diagnosed condition. You can use HSA funds to pay for the therapist's fees, psychiatric medications, and inpatient mental health treatment.

Does my HSA cover birth control?

Yes. Prescription birth control pills, patches, rings, IUDs, and other prescription contraceptives all may have access to. Over-the-counter condoms do not may have access to, but prescription contraceptives do.

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

No. Veterinary expenses do not may have access to under any circumstances, even if the pet is a service animal. The IRS considers pet care a personal expense, not a medical expense for the owner.