Medical expenses you can pay from an HSA
An HSA covers most medical, dental, and vision expenses that your health insurance does not pay for. This includes deductibles, copays, coinsurance, and out-of-pocket costs. You can use HSA money for prescription medications, over-the-counter drugs (with a doctor's note), medical equipment like crutches or blood pressure monitors, and mental health treatment. Dental work—cleanings, fillings, root canals, orthodontics—qualifies. So do vision expenses: eye exams, glasses, contact lenses, and laser eye surgery.
The IRS publishes a detailed list of covered expenses, but the basic rule is this: if a licensed medical provider charges you for diagnosing, treating, or preventing a medical condition, you can usually pay for it with HSA funds. That includes hospital stays, surgery, physical therapy, acupuncture (if a doctor orders it), and hearing aids. Fertility treatments, including IVF, are covered. So are insulin, inhalers, and allergy medications.
Long-term care insurance premiums are covered up to a yearly limit set by the IRS—this limit changes each year. You can also use HSA money to pay for Medicare premiums once you turn 65, including Part B, Part D, and Medigap policies. This is one of the few ways an HSA can help you after retirement.
Key Takeaways
- An HSA covers deductibles, copays, coinsurance, and any out-of-pocket medical cost that a licensed provider charges you for treatment or prevention.
- Dental and vision care—including cleanings, fillings, glasses, and exams—are covered in full, even if your health insurance does not include dental or vision.
- Over-the-counter medications and medical equipment may have access to only if a doctor writes an order or prescription for them.
- Once you turn 65, you can use HSA funds to pay Medicare premiums, including Part B, Part D, and supplemental insurance.
- Cosmetic procedures, gym memberships, and general wellness products are not covered unless they treat a diagnosed medical condition.
What is not covered by an HSA
Cosmetic procedures are not covered—this includes teeth whitening, Botox, hair removal, and plastic surgery done for appearance alone. However, if a procedure is medically necessary (for example, reconstructive surgery after an accident or to correct a breathing problem), it may be covered even if it also improves appearance.
General wellness products and services are not covered. This means gym memberships, weight loss programs, vitamins, and supplements are off-limits, even if you believe they improve your health. Sunscreen, toothpaste, and shampoo do not may have access to. Over-the-counter pain relievers, cold medicine, and allergy pills do not may have access to unless a doctor writes a prescription for them—and that prescription must be for a specific diagnosed condition, not just general use.
Expenses for a family member who is not your spouse or dependent do not may have access to. If you pay for your adult child's medical care and they are not claimed as a dependent on your tax return, you cannot use HSA funds for it. Childcare and babysitting are not covered, even if you need them to work. Travel to receive medical care—flights, hotels, meals—is not covered, though the medical treatment itself is.
How to know if a specific expense qualifies
The IRS maintains a searchable database of covered and non-covered expenses on its website. If you are unsure about a particular charge, search the IRS HSA expense list first. Many HSA providers also have customer service teams that can tell you whether a specific expense qualifies before you spend the money.
A good rule of thumb: if the expense is for treating or preventing a diagnosed medical condition and a licensed provider charged you for it, it almost certainly qualifies. If it is a general wellness product or a service that would benefit anyone (not just someone with a medical condition), it probably does not. When in doubt, ask your HSA provider or check the IRS list rather than guessing—using HSA funds for non-may have access to expenses triggers taxes and penalties.
Over-the-counter medications and the prescription requirement
As of 2020, you can no longer use HSA funds for over-the-counter medications without a prescription. This includes common items like ibuprofen, acetaminophen, antihistamines, decongestants, and antacids. The only exception is insulin, which you can buy over-the-counter without a prescription and still pay for with HSA funds.
If your doctor prescribes an over-the-counter medication—meaning they write a formal prescription for it, even though you could also buy it without one—then you can use HSA funds to pay for it. Some people ask their doctor for a prescription specifically to use HSA funds, and many doctors will write one if the medication is medically necessary for your condition. Keep the prescription with your receipt in case the IRS asks for proof later.
Medical equipment and supplies
Durable medical equipment—items meant to last and be used repeatedly—qualifies if a doctor prescribes it. This includes wheelchairs, walkers, canes, crutches, hospital beds, oxygen equipment, CPAP machines, and blood pressure monitors. Diabetic supplies like glucose meters, test strips, and lancets are covered. Hearing aids and batteries are covered. Orthopedic braces, compression stockings, and prosthetics all may have access to.
The key is that a licensed provider must order or prescribe the equipment for a specific medical condition. You cannot simply buy a back brace or knee support off the shelf and expect HSA funds to cover it unless a doctor has recommended it for your condition. Keep documentation showing the medical reason for the equipment, especially for items that might seem general-purpose.
Mental health and therapy services
Mental health treatment is fully covered by HSA funds. This includes therapy sessions with a licensed therapist, psychiatrist, or counselor; psychiatric medications; and inpatient mental health treatment. Substance abuse treatment programs, including residential rehab, are covered. The provider must be licensed and the treatment must be for a diagnosed mental health condition.
Wellness coaching, life coaching, or general counseling that is not tied to a diagnosed condition is not covered. But if you have depression, anxiety, PTSD, or another diagnosed mental health condition and you see a licensed provider for treatment, HSA funds cover it.
Frequently Asked Questions
Can I use my HSA to pay for my spouse's medical expenses?
Yes, if your spouse is covered under your tax return as a dependent. You can use your HSA to pay for your spouse's medical, dental, and vision expenses. However, your spouse cannot use your HSA card directly—you must pay the provider or reimburse your spouse, and the expense must be for a covered service.
Does an HSA cover preventive care like annual checkups and vaccines?
Yes. Preventive care—annual physicals, vaccinations, cancer screenings, and wellness visits—is covered by HSA funds. Many health insurance plans also cover preventive care at no cost to you, so you may not need to use HSA funds for these visits, but you can if you choose to.
What happens if I use HSA funds for something that is not covered?
Non-may have access to expenses are subject to income tax plus a 20 percent penalty. If you withdraw $500 for a non-covered expense, you owe income tax on that $500 plus $100 in penalties. Keep receipts for all HSA withdrawals in case the IRS asks for proof that expenses were covered.
Can I use an HSA to pay for my pet's medical care?
No. Veterinary expenses are not covered by HSA funds, even if the pet is a service animal. The only exception is if the animal is a guide dog and you are paying for training specifically to work as your guide dog—in that case, the training cost may be covered, but not routine veterinary care.
Are fertility treatments and pregnancy-related expenses covered?
Yes. Fertility treatments including IVF, medications, and procedures are covered. Pregnancy-related expenses—prenatal care, delivery, hospital stays, and postpartum care—are covered. Childbirth classes and lactation consulting are also covered if provided by a licensed healthcare provider.