What You Can Actually Spend HSA Money On

HSA funds cover medical expenses the IRS defines as may have access to

An HSA (Health Savings Account) holds money you set aside before taxes to pay for medical costs. You can spend that money on doctor visits, prescriptions, hospital stays, and dozens of other health-related expenses. The catch: the IRS has a specific list of what counts as a may have access to medical expense. Spend money on something not on that list, and you'll owe income tax on the withdrawal plus a 20% penalty.

The may have access to expense list is long and includes obvious things like office visit copays and insulin, but also less obvious things like dental work, vision care, and even some over-the-counter items if a doctor prescribes them. What's not on the list matters just as much: gym memberships, vitamins without a prescription, cosmetic procedures, and most wellness products are off-limits.

Key Takeaways

may have access to medical expenses include doctor and dentist visits, prescription drugs, hospital care, medical equipment, and vision and hearing care.
Over-the-counter medications and supplies now count as may have access to expenses only if a doctor writes a prescription for them, even for common items like pain relievers.
Expenses for cosmetic procedures, gym memberships, vitamins without a prescription, and general wellness products do not count and will trigger taxes and penalties if paid with HSA funds.
You can use HSA funds to pay insurance premiums in specific situations: COBRA continuation coverage, long-term care insurance, and health insurance while unemployed.
Keep receipts and documentation for every HSA withdrawal because the IRS can audit your account and require proof that expenses were may have access to.

Doctor visits, hospital care, and prescription drugs

The most straightforward may have access to expenses are the ones you encounter at a medical provider's office or facility. This includes copays and coinsurance for doctor visits, urgent care, emergency room treatment, and hospital stays. Prescription medications are always may have access to, regardless of what they treat. Insulin, blood pressure medication, antibiotics, and psychiatric drugs all count.

Diagnostic tests and lab work are may have access to: blood tests, X-rays, MRIs, CT scans, and ultrasounds. Mental health treatment—therapy sessions, psychiatry visits, and inpatient psychiatric care—is may have access to. Physical therapy and occupational therapy are may have access to. Surgery and anesthesia are may have access to. If a licensed medical provider bills you for it, it almost certainly counts.

Dental, vision, and hearing care

Dental expenses are fully may have access to: cleanings, fillings, root canals, extractions, crowns, and orthodontia (braces). Dentures and dental implants count. Vision care includes eye exams, glasses, contact lenses, and laser eye surgery like LASIK. Hearing aids and hearing tests are may have access to. Replacement batteries for hearing aids are may have access to.

These categories often get overlooked because people assume HSA funds only cover primary medical care. In reality, dental and vision expenses can be one of the largest uses of an HSA over time, especially if you need ongoing orthodontia or have hearing loss.

Medical equipment and supplies

Medical equipment and supplies are may have access to if they are used to treat a medical condition and are not normally used for other purposes. A blood pressure monitor, glucose meter, or thermometer is may have access to. Crutches, wheelchairs, walkers, and braces are may have access to. Bandages, gauze, and medical tape are may have access to. Elastic compression stockings are may have access to.

The line between medical and non-medical can be blurry. A heating pad used to treat arthritis is may have access to; a heating pad used for general comfort is not. Sunscreen is not may have access to as a general product, but sunscreen prescribed by a dermatologist to treat a skin condition may be. When in doubt, keep the prescription or doctor's note that connects the item to a diagnosed condition.

Over-the-counter medications and when they count

The rules for over-the-counter items changed in 2020. Before that year, you could buy aspirin, cold medicine, allergy pills, and antacids with HSA funds without a prescription. Now, over-the-counter drugs and medicines are may have access to only if a doctor writes a prescription for them—even for items you can buy without one.

This means if your doctor prescribes ibuprofen for arthritis pain, you can pay for it with HSA funds. If you buy the same ibuprofen off the shelf for a headache, you cannot. The prescription is what makes it may have access to, not the item itself. Over-the-counter medical supplies that are not drugs—like bandages, thermometers, and glucose test strips—remain may have access to without a prescription.

Insurance premiums you can pay with HSA funds

You cannot use HSA funds to pay your regular health insurance premium. However, three specific insurance situations are exceptions. First, if you are on COBRA continuation coverage after losing a job, you can use HSA funds to pay the COBRA premium. Second, you can pay premiums for long-term care insurance (the kind that covers nursing home or in-home care for chronic conditions). Third, if you are unemployed, you can use HSA funds to pay health insurance premiums while you are receiving unemployment benefits.

You can also use HSA funds to pay Medicare premiums and Medicare supplemental insurance premiums once you turn 65, even though you are no longer may be able to access to contribute new money to the HSA at that point.

What does not count and will trigger penalties

Cosmetic procedures are not may have access to unless they treat an injury or deformity. Botox for wrinkles is not may have access to. Rhinoplasty for appearance is not may have access to. Rhinoplasty to repair a deviated septum that affects breathing is may have access to. Gym memberships and fitness classes are not may have access to, even if recommended by a doctor for weight loss or heart health. Vitamins and supplements are not may have access to unless a doctor prescribes them for a specific deficiency or condition.

General wellness products—protein powders, meal replacement shakes, weight loss programs—are not may have access to. Maternity clothes are not may have access to (though prenatal care is). Childcare is not may have access to. Travel to a medical appointment is not may have access to, though the medical appointment itself is. If you withdraw HSA funds for a non-may have access to expense, you owe income tax on that amount plus a 20% penalty.

Keeping records and avoiding audit trouble

The IRS can audit your HSA at any time, and the burden is on you to prove that withdrawals were for may have access to expenses. Keep receipts, invoices, and explanation of benefits statements for every HSA withdrawal. If you paid out of pocket and reimbursed yourself from the HSA later, keep both the original receipt and documentation of when you withdrew the HSA funds.

Your HSA provider sends you a Form 1099-SA each year showing total withdrawals, but they do not track what those withdrawals were for. You track that. If you cannot produce documentation that a withdrawal was for a may have access to expense, the IRS will treat it as a non-may have access to withdrawal and assess taxes and penalties retroactively, plus interest. The safest approach is to keep a simple spreadsheet or folder with the date, amount, provider name, and type of expense for each withdrawal.

Frequently Asked Questions

Can I use my HSA to pay for my spouse's or child'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 are covered under your health plan. You do not need to be on the same insurance policy. Keep documentation showing the relationship and the expense.

Are prescription glasses and contacts may have access to?

Yes. Eyeglasses, contact lenses, and the exams to fit them are all may have access to. Lens coatings and frames are may have access to. Contact lens solution is may have access to. Non-prescription sunglasses are not, but prescription sunglasses are.

Can I use HSA funds to pay for therapy or counseling?

Yes. Mental health treatment from a licensed therapist, psychologist, or psychiatrist is a may have access to expense. This includes individual therapy, group therapy, and psychiatric medication management. Substance abuse treatment is also may have access to.

What happens if I spend HSA money on something that is not may have access to?

You owe federal income tax on that amount at your ordinary tax rate, plus a 20% penalty. If you are under 65, there is no exception. If you are 65 or older, the penalty goes away but you still owe income tax. You report non-may have access to withdrawals on Form 8889 when you file your tax return.

Are fertility treatments and birth control may have access to expenses?

Yes. Fertility treatments, including IVF and medications, are may have access to. Birth control prescriptions and devices (like IUDs) are may have access to. Pregnancy tests are may have access to. Prenatal care and delivery are may have access to.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.