What an HSA covers: medical, dental, vision, and prescription costs

An HSA (Health Savings Account) pays for most things a doctor bills you for. That includes doctor visits, hospital stays, surgery, lab work, X-rays, and prescription drugs. It also covers dental work — fillings, cleanings, root canals, orthodontia — and vision care: eye exams, glasses, contact lenses, and laser surgery. You can use HSA money to pay the out-of-pocket costs you owe after insurance pays its share, or to cover costs entirely if you have not met your deductible yet.

The IRS publishes a list of what counts as a medical expense. The rule is roughly: if a licensed medical provider charges you for diagnosing, treating, or preventing a disease or condition, the HSA can pay for it. That is broader than many people think. It includes mental health therapy, physical therapy, chiropractic care, acupuncture (if a licensed provider does it), and hearing aids. It covers medical equipment like crutches, wheelchairs, blood pressure monitors, and glucose meters.

What an HSA does not cover is equally important to know. Cosmetic procedures — teeth whitening, Botox, hair transplants — are not covered unless they treat a medical condition. Over-the-counter medicines like ibuprofen or cold medicine do not may have access to, though you can use HSA money to pay a pharmacist to dispense them if they are behind the counter. Vitamins and supplements are not covered. Health club memberships and weight-loss programs are not covered, even if a doctor recommends them.

Key Takeaways

  • An HSA pays for doctor visits, hospital care, surgery, dental work, vision care, and prescription drugs — essentially any medical service a licensed provider charges you for.
  • Mental health therapy, physical therapy, chiropractic care, and medical equipment like wheelchairs and glucose meters are covered.
  • Cosmetic procedures, over-the-counter medicines, vitamins, and gym memberships are not covered.
  • You can use HSA money to pay deductibles, copays, and coinsurance, or to cover costs your insurance does not pay.
  • Some expenses — like travel to a medical appointment or a wig after hair loss from cancer treatment — may be covered if you have documentation that a medical provider recommended them.

Prescription drugs and over-the-counter medicines: what the difference means

Prescription drugs are always covered. You pay for them with your HSA debit card at the pharmacy, or you submit a receipt to your HSA provider for reimbursement. The drug does not have to be expensive or rare — any prescription your doctor writes qualifies.

Over-the-counter medicines are trickier. A medicine you can buy without a prescription — like aspirin, allergy pills, or cough syrup — does not may have access to for HSA payment unless a doctor has written you a prescription for it, even if it is the exact same product sold over the counter. This rule changed in 2020. Before that, you could use an HSA for any over-the-counter medicine. Now, the pharmacist has to have filled a prescription in order for the HSA to cover it. If your doctor writes "ibuprofen 200 mg, take as directed," the pharmacy can dispense it as a prescription, and your HSA covers it. If you buy the same ibuprofen off the shelf, it does not.

First aid supplies and medical equipment are different. Bandages, thermometers, blood pressure cuffs, and glucose test strips are covered even though you buy them over the counter, because they are medical devices or supplies, not medicines. The line between a medicine and a supply can be blurry — ask your HSA provider or pharmacist if you are unsure.

Dental and vision expenses covered by an HSA

Dental work is covered in full. That includes preventive care (cleanings and exams), fillings, root canals, extractions, crowns, bridges, and orthodontia (braces and aligners). You pay the dentist with your HSA debit card or submit an invoice for reimbursement. Cosmetic dentistry — like teeth whitening or veneers done purely for appearance — is not covered, but if a dentist charges you for straightening teeth because of a bite problem or jaw alignment issue, that may be covered. Keep the invoice and any notes from your dentist explaining the medical reason.

Vision care is also covered. Eye exams, glasses, contact lenses, and contact lens solution all may have access to. LASIK and other corrective eye surgery are covered. Sunglasses are not covered, even if they have a prescription, because they are not primarily medical. Blue-light-blocking glasses are not covered. If you need glasses for a specific medical condition — like special lenses after cataract surgery — keep documentation from your eye doctor.

Dental and vision insurance is separate from medical insurance for many people. If you have a dental plan through work, your HSA can still pay for dental costs your plan does not cover, or for the copays and deductibles your dental plan charges. The same applies to vision insurance.

Medical equipment, supplies, and devices your HSA can cover

Medical equipment is covered if it is primarily for diagnosing, treating, or preventing a medical condition. Wheelchairs, walkers, canes, crutches, and hospital beds are covered. Glucose monitors and test strips are covered. Blood pressure monitors, pulse oximeters, and thermometers are covered. Hearing aids and batteries are covered. Continuous positive airway pressure (CPAP) machines and supplies are covered. Compression stockings are covered if a doctor prescribes them for a circulatory condition.

The equipment does not have to be prescribed by a doctor to be covered — you can buy it yourself — but you should keep a receipt and any documentation showing it is for a medical condition. If you are ever audited by the IRS on your HSA spending, that documentation is what proves the expense was legitimate.

Some equipment sits in a gray area. A shower chair is covered if you need it because of a medical condition (arthritis, mobility issues, recovery from surgery). A regular shower chair you buy for convenience is not. A mattress is not covered. A mattress recommended by a doctor for a specific condition (like a pressure-relief mattress for someone at risk of bedsores) may be covered if you have the doctor's recommendation in writing. When in doubt, ask your HSA provider before you buy.

Mental health and therapy services covered by an HSA

Mental health care is covered. That includes therapy or counseling with a licensed therapist, psychologist, or psychiatrist. Psychiatric medication is covered. Inpatient mental health treatment and rehabilitation programs are covered. Substance abuse treatment is covered. You can use your HSA to pay for these services the same way you would pay for any other medical care — with your debit card or by submitting a receipt for reimbursement.

The provider does not have to be in your insurance network for the HSA to cover it. If you see a therapist who does not accept insurance, you can still use your HSA. You will pay out of pocket and then submit the receipt to your HSA provider for reimbursement, or you can ask the therapist's office to bill your HSA directly.

Wellness programs and life coaching are not covered, even if they address mental health topics. A meditation app is not covered. A support group run by a nonprofit is not covered. But if a licensed therapist runs a group therapy session, that is covered.

Travel, lodging, and other indirect medical costs

An HSA covers the direct cost of medical care, but some indirect costs may also may have access to. If you travel to a hospital or specialist appointment, you can use your HSA to pay for mileage (at the IRS rate, which changes yearly), parking, and tolls. You cannot use it for the cost of a vacation or a trip that happens to include a medical appointment.

Lodging during medical treatment is covered in limited cases. If you travel more than 50 miles for a medical procedure and need to stay overnight, you can use your HSA to pay for a hotel. The IRS limits this to $50 per night per person. If a family member travels with you as a caregiver, their lodging is also covered at $50 per night. You cannot use the HSA to pay for meals during travel, even if the travel is for medical reasons.

Wigs and hairpieces are covered if you need them because of hair loss from a medical condition or treatment — like chemotherapy or alopecia. You need documentation from a medical provider that the hair loss is due to a medical condition. Prosthetics are covered. Crutches, canes, and wheelchairs are covered. The rule is: if the item replaces or restores a body function lost to illness or injury, it likely qualifies.

What happens if you use your HSA for something not covered

If you use your HSA debit card to pay for something that does not may have access to — like a gym membership or over-the-counter cold medicine — you will owe income tax on that amount plus a 20 percent penalty. The HSA provider does not always catch non-may have access to expenses at the time you make them. You might not face consequences until the IRS audits your HSA records, which can happen years later.

If you realize you made a mistake, you can withdraw the non-may have access to amount and pay the taxes and penalty yourself. It is better to do this voluntarily than to wait for an audit. Keep receipts for everything you pay for with your HSA, and if you are unsure whether an expense qualifies, ask your HSA provider or a tax professional before you spend the money.

Some HSA providers offer a customer service line where you can ask whether a specific expense is covered before you pay for it. Using that service takes a few minutes and can save you from a costly mistake.

Frequently Asked Questions

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

Yes. Your HSA can pay for medical expenses of your spouse and any dependent you claim on your tax return, even if they are not covered by your health insurance plan. You do not have to be on the same insurance policy. Keep receipts showing the person's name and the medical service provided.

Does my HSA cover therapy or counseling for mental health?

Yes. Therapy with a licensed therapist, psychologist, or psychiatrist is covered, as is psychiatric medication and inpatient mental health treatment. The provider does not have to be in your insurance network. Wellness coaching and meditation apps are not covered.

Can I use my HSA for dental work and vision care?

Yes. Dental work — cleanings, fillings, root canals, braces, and crowns — is covered. Vision care — eye exams, glasses, contacts, and corrective surgery — is covered. Cosmetic dentistry and cosmetic vision procedures are not covered unless they treat a medical condition.

What if I buy an over-the-counter medicine — can I use my HSA?

Not unless a doctor has written you a prescription for it. Over-the-counter medicines require a prescription to be HSA-may be able to access, even if the product is the same one sold on the shelf. Medical supplies like bandages and glucose test strips are covered without a prescription.

Can I use my HSA to pay for travel to a medical appointment?

Yes, for mileage, parking, and tolls. If you travel more than 50 miles and need to stay overnight, you can use your HSA for lodging up to $50 per night. You cannot use it for meals or a vacation that includes a medical appointment.