You can use HSA funds for most medical expenses, but not for insurance premiums or over-the-counter drugs without a prescription
An HSA (Health Savings Account) is designed to pay for may have access to medical expenses — the IRS has a specific list, and staying within it matters because withdrawals for non-may have access to expenses trigger taxes plus a 20% penalty. The most common may have access to expenses are copays, coinsurance, deductibles, and prescription medications. But the list is longer than most people realize, and it includes some expenses that feel routine and others that surprise people.
The key rule: the expense must be for diagnosis, treatment, or prevention of a medical condition, and it must not be covered by your health insurance. If your insurance pays for it, your HSA cannot. If your insurance does not cover it but a doctor says you need it for your health, your HSA usually can.
Key Takeaways
- Copays, coinsurance, deductibles, and prescription medications are always may have access to HSA expenses.
- Over-the-counter drugs and medicines are only may have access to if you have a doctor's written prescription for them.
- Dental work, vision care, and hearing aids are may have access to, but cosmetic procedures and teeth whitening are not.
- You cannot use HSA funds for health insurance premiums, gym memberships, or vitamins unless prescribed by a doctor for a specific medical condition.
- Keep receipts and documentation for every HSA withdrawal — the IRS can ask for proof years later.
Medical visits and procedures covered by your HSA
Doctor visits, urgent care, emergency room visits, and hospital stays are all may have access to expenses. This includes the facility fee, the provider's fee, and any tests or imaging done during the visit. If you see a specialist, that visit is may have access to. Physical therapy, mental health counseling, and substance abuse treatment are also covered.
Surgical procedures and diagnostic tests — MRIs, CT scans, X-rays, blood work, colonoscopies — are may have access to. If your doctor orders it for medical reasons, your HSA can pay for it. This applies even if your insurance has not yet met your deductible or if you have not yet satisfied your out-of-pocket maximum.
Prescription and over-the-counter medications
Prescription medications are always may have access to, regardless of what they treat. Insulin, blood pressure medication, antibiotics, antidepressants — all of them are covered by your HSA.
Over-the-counter drugs and medicines are may have access to only if you have a written prescription from a doctor. Aspirin, allergy medicine, cold medicine, antacids, and pain relievers can all be HSA expenses — but only with a prescription. A doctor's note saying "take ibuprofen for your back pain" counts as a prescription. A receipt from the pharmacy showing you bought it without a prescription does not. This rule changed in 2020, so if you have been using your HSA for over-the-counter items without a prescription, that was not allowed.
Dental, vision, and hearing care
Dental work is a may have access to HSA expense: cleanings, fillings, root canals, extractions, crowns, and orthodontia (braces). Dental X-rays and exams are covered. Cosmetic dental work — teeth whitening, veneers for appearance only — is not may have access to unless it is also medically necessary (for example, a crown that restores function after an accident).
Vision care is covered: eye exams, glasses, contact lenses, and laser eye surgery (LASIK). Hearing aids and hearing tests are may have access to. Hearing aid batteries and repairs are also covered.
Medical equipment and supplies you can buy with HSA funds
Crutches, wheelchairs, walkers, and other mobility aids are may have access to. Diabetic supplies — test strips, lancets, glucose monitors — are covered. Bandages, first aid supplies, and medical tape are may have access to. Compression stockings, orthopedic shoes, and back braces are covered if prescribed by a doctor for a medical condition.
Thermometers, blood pressure monitors, and pulse oximeters are may have access to. Heating pads and ice packs are covered. Oxygen equipment and supplies are may have access to. If your doctor says you need it for your health, and it is not primarily for comfort or convenience, your HSA can usually pay for it.
What your HSA cannot pay for
Health insurance premiums are not may have access to HSA expenses — neither your individual premium, your family premium, nor your employer contribution. The one exception: if you are receiving unemployment benefits, you can use your HSA to pay for COBRA or other continuation coverage, but only while you are unemployed.
Gym memberships and fitness classes are not may have access to, even if your doctor recommends exercise. Cosmetic procedures — facelifts, Botox, hair removal — are not covered unless medically necessary. Vitamins and supplements are not may have access to unless prescribed by a doctor for a specific medical condition (for example, a prescription for vitamin D for a deficiency).
Meals and lodging are not may have access to, even if you are staying overnight for a medical procedure. Travel to a medical appointment is not covered. Childcare while you attend a medical appointment is not may have access to. Maternity clothes, cribs, and baby formula are not covered by HSA funds.
How to document HSA expenses and avoid IRS problems
Keep every receipt, explanation of benefits (EOB), and invoice for every HSA withdrawal. The IRS does not require you to submit receipts when you withdraw the money, but they can ask for documentation years later if they audit your account. If you cannot produce proof that an expense was may have access to, you will owe income tax on the withdrawal plus a 20% penalty.
For prescriptions, keep the pharmacy receipt showing the medication name and that it was prescribed. For medical procedures, keep the itemized bill from the provider. For equipment, keep the receipt and any documentation showing it was medically necessary. If you paid out of pocket and reimbursed yourself from your HSA later, keep the original receipt and a record of when you withdrew the HSA funds.
Many HSA providers offer a debit card that you can use at pharmacies and medical providers. When you use the card, the provider reports the transaction to your HSA administrator, which creates a record. This is simpler than paying out of pocket and seeking reimbursement later, but you still need to keep receipts in case of an audit.
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 may have access to medical expenses for you, your spouse, and your dependents — even if they are not covered by your health insurance plan. You do not need to be on the same insurance policy. Keep documentation showing the relationship and the medical expense.
What happens if I use my HSA for a non-may have access to expense?
You will owe income tax on the amount withdrawn, plus a 20% penalty. If you withdraw $1,000 for a non-may have access to expense, you owe income tax on that $1,000 plus $200 in penalties. After age 65, the penalty goes away but you still owe income tax on non-may have access to withdrawals.
Can I use my HSA to pay for a procedure my insurance does not cover?
Yes, as long as the procedure is medically necessary and recommended by a doctor. If your insurance denies coverage but your doctor says you need it, your HSA can pay for it. Keep the denial letter and the doctor's recommendation as documentation.
Are prescription glasses and contacts may have access to HSA expenses?
Yes. Eyeglasses, contact lenses, and the eye exam to determine your prescription are all may have access to. Sunglasses are not may have access to, even if they have a prescription, because they are not primarily for medical treatment.
Can I use my HSA for mental health or therapy?
Yes. Therapy, counseling, and psychiatric care are may have access to medical expenses. Copays for therapy visits, the full cost if you pay out of pocket, and medication for mental health conditions are all covered by your HSA.