HSA funds cover medical expenses that your insurance doesn't, plus some that insurance won't touch at all

A health savings account lets you pay for specific medical costs with pretax money. The IRS maintains a detailed list of what counts, and it's broader than most people think. You can use HSA funds for doctor visits, prescriptions, dental work, vision care, mental health treatment, and dozens of other health-related expenses. The key rule: the expense must be for diagnosis, treatment, or prevention of a medical condition—not for general wellness or cosmetic procedures.

The money stays in your account year to year, so you don't lose it if you don't spend it all. You can withdraw funds at any time for a covered expense without penalty. If you withdraw money for something that doesn't count as a medical expense, you'll pay income tax on that amount plus a 20% penalty (unless you're over 65, disabled, or covered by Medicare).

Key Takeaways

  • HSA funds cover doctor visits, hospital stays, prescription drugs, dental care, vision care, and mental health services without requiring a copay or deductible first.
  • You can use HSA money for medical equipment like crutches, wheelchairs, and blood pressure monitors, as well as for over-the-counter items like bandages and pain relievers if you have a doctor's prescription.
  • Expenses for cosmetic procedures, gym memberships, and general wellness products do not count as HSA-may be able to access, even if they improve your health.
  • HSA funds roll over year to year with no "use it or lose it" deadline, so you can build a balance for future medical costs.
  • Withdrawals for non-medical expenses trigger income tax plus a 20% penalty, so keep receipts and know what qualifies before you spend.

Doctor visits, hospital care, and prescription drugs

The most straightforward HSA expenses are the ones your insurance already covers. You can use HSA funds to pay your deductible, copays, and coinsurance for doctor visits, urgent care, emergency room visits, and hospital stays. This includes surgery, anesthesia, lab work, and imaging like X-rays or MRI scans. Any prescription drug your doctor writes—whether for a chronic condition or a one-time infection—counts as an HSA expense.

If your insurance requires prior authorization or has other restrictions, those don't change whether an expense is HSA-may be able to access. The expense itself has to be medically necessary, but the insurance company's approval process is separate. You can use HSA funds to pay for a procedure even if your insurance denies it, as long as a doctor ordered it for a legitimate medical reason.

Dental, vision, and hearing care

Dental expenses covered by HSA include cleanings, fillings, root canals, extractions, crowns, and orthodontia like braces. You can pay for dentures, bridges, and implants. Teeth whitening and cosmetic dental work do not count unless they're part of a medically necessary procedure—for example, reconstruction after an accident.

Vision care is similarly broad: eye exams, glasses, contact lenses, and surgery like LASIK all may have access to. Hearing aids and the cost of fitting them are HSA-may be able to access. Hearing tests also count. If you need replacement batteries or repairs for a hearing aid, those are covered too.

Mental health treatment and therapy

Therapy, counseling, and psychiatric care are HSA-may be able to access whether you see a therapist in person, by video, or by phone. This includes treatment for depression, anxiety, addiction, eating disorders, and other mental health conditions. Prescription medications for mental health count as well. If your therapist charges a fee that your insurance doesn't cover, you can use HSA funds to pay it.

Some employers offer mental health apps or meditation programs as part of their benefits. If those apps are prescribed by a doctor or required as part of a treatment plan, they may be HSA-may be able to access—but check with your HSA administrator first, because the rules vary by provider.

Over-the-counter items and medical equipment

Over-the-counter medications like pain relievers, allergy medicine, and antacids are HSA-may be able to access only if your doctor writes a prescription for them. Without a prescription, they don't count. The same rule applies to items like bandages, thermometers, blood pressure monitors, and glucose meters—they're may be able to access if prescribed, but not if you buy them on your own.

Medical equipment and supplies have different rules. Crutches, wheelchairs, walkers, braces, and compression stockings are HSA-may be able to access without a prescription. Diabetic supplies like test strips and lancets count. Heating pads, ice packs, and other therapeutic devices are may be able to access if they're primarily medical rather than general wellness items. If you're unsure whether something qualifies, ask your HSA administrator or check the IRS Publication 502, which lists hundreds of specific items.

Fertility treatment, pregnancy, and childbirth

Fertility treatments, including in vitro fertilization (IVF), are HSA-may be able to access. You can use HSA funds to pay for diagnostic testing, medications, and procedures. Pregnancy-related care—prenatal visits, ultrasounds, delivery, and hospital stays—all count. Postpartum care and newborn screening are covered.

Adoption-related medical expenses, like a surrogate's prenatal care, do not count as HSA expenses. However, the medical care for the child after birth does count once the child is on your health plan.

Long-term care and nursing home expenses

If you need nursing home care or assisted living for a medical condition, part of the cost may be HSA-may be able to access. The IRS allows you to use HSA funds for the medical portion of long-term care—nursing, therapy, medications, and medical equipment. The non-medical portion, like room and board or housekeeping, does not count.

Determining what portion is medical requires documentation from the facility. Ask the nursing home or assisted living provider to break down their charges by category. Your HSA administrator can help you figure out what you can pay from your HSA and what you'll need to cover another way.

What doesn't count: cosmetic, wellness, and general health

Cosmetic procedures—facelifts, Botox, hair removal, teeth whitening for appearance—are not HSA-may be able to access. Gym memberships, fitness classes, and general wellness programs don't count, even if they improve your health. Vitamins and supplements are not may be able to access unless they're prescribed by a doctor for a specific medical condition.

Sunscreen, toothpaste, and other personal hygiene products don't may have access to. Weight loss programs and diet plans are not covered unless they're prescribed as treatment for a diagnosed medical condition like obesity or diabetes, and even then, only the medically necessary portion counts. Travel to a medical appointment is not HSA-may be able to access, but the medical care itself is.

How to keep track and avoid penalties

Keep receipts and documentation for every HSA withdrawal. The IRS doesn't require you to submit receipts when you withdraw money, but you need to keep them in case of an audit. Your HSA administrator may ask for proof that an expense was medical before they process the withdrawal.

If you withdraw money for a non-medical expense before age 65, you'll owe income tax on that amount plus a 20% penalty. After age 65, you can withdraw money for any reason without the penalty—you'll just pay income tax, the same as you would with a regular savings account. If you're disabled or on Medicare, the penalty also doesn't apply, though income tax still does.

Frequently Asked Questions

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

Yes, as long as your spouse is on your tax return as a dependent or you file jointly. You can use HSA funds to pay for medical expenses for your spouse, children, and any other dependents you claim, even if they're not on your health plan.

Does my doctor have to prescribe something for it to be HSA-may be able to access?

It depends on the item. Prescription drugs and most over-the-counter medications require a prescription. Medical equipment like wheelchairs and blood pressure monitors do not. Check IRS Publication 502 or ask your HSA administrator if you're unsure about a specific item.

What happens if I use my HSA card for something that turns out not to be may be able to access?

If you later discover an expense wasn't may be able to access, you can repay the HSA from your own funds to correct it. You won't face a penalty if you catch the mistake and fix it. If the IRS finds the error during an audit, you'll owe income tax and a 20% penalty on the ineligible amount.

Can I use HSA funds to pay my insurance premium?

You cannot use HSA funds to pay your regular monthly health insurance premium. You can use HSA funds to pay for COBRA continuation coverage, Medicare premiums (Part A, B, and D), and long-term care insurance premiums, but not your employer or marketplace plan premium.

Do I lose my HSA money if I don't spend it each year?

No. HSA funds roll over year to year with no deadline. You can build a balance and use it for future medical expenses whenever you need it. This is different from a flexible spending account (FSA), which has a "use it or lose it" rule.