What Health Expenses are Covered by an HSA? A Comprehensive List

Health Savings Accounts (HSAs) are a great way to save money tax-free for current and future healthcare expenses. One of the key benefits of an HSA is that funds can be used tax-free for a wide range of qualified medical expenses. But what exactly counts as a qualified expense for HSA purposes?

This comprehensive guide will cover what type of health expenses you can pay for with HSA funds.

HSA Expense Rules and Guidelines

First, a quick overview of the basic HSA rules regarding medical expenses:

  • Expenses must be primarily for the diagnosis, cure, treatment, or prevention of disease or for treatment of conditions affecting any body part or function.

  • Expenses must be for medical care provided to you, your spouse, or tax dependents.

  • Expenses generally need to be medically necessary and not just for general health.

  • Expenses must not be reimbursable through insurance or other sources.

  • Over-the-counter (OTC) medicines require a prescription to be reimbursable (with some exceptions like insulin).

With those basic rules in mind, let’s look at the long list of eligible expenses.

Medical Practitioners and Facilities

Visits, procedures, and costs associated with the following medical practitioners or facilities can be covered:

  • Doctors
  • Dentists
  • Optometrists
  • Psychologists
  • Chiropractors
  • Physical therapists
  • Acupuncturists
  • Hospitals
  • Clinics
  • Medical labs

Typical costs include:

  • Doctor visit copays
  • Deductibles
  • Coinsurance
  • Dental care like cleanings, X-rays, fillings, crowns, orthodontics
  • Lasik eye surgery
  • Prescription eyeglasses, contacts, vision exams
  • Chiropractic adjustments
  • Physical therapy
  • Acupuncture
  • Fertility treatments
  • Surgical procedures
  • Hospital stays

As long as the primary purpose is medical care, these expenses can be covered with HSA funds.

Prescription Drugs and Medicines

The following prescription drugs and medications are HSA-eligible:

  • Prescription drugs and medications
  • Insulin
  • Antibiotics
  • Pain relievers
  • Blood pressure medications
  • Antidepressants
  • Sleep aids
  • Motion sickness pills
  • Antihistamines
  • Heartburn medication
  • Birth control
  • Fertility drugs
  • Hormone therapy
  • Prescription vitamins

Over-the-counter medicines are also eligible with a prescription from your doctor. This includes things like:

  • Allergy medicine
  • Cold medicine
  • Pain relievers
  • Stomach remedies
  • Acne treatment
  • Anti-fungal or anti-itch creams

The key is having that prescription which makes the OTC medicine reimbursable through an HSA.

Medical Equipment and Supplies

A wide variety of medical equipment, devices, and supplies can be covered by your HSA, including:

  • Blood sugar test kits and test strips for diabetics
  • Blood pressure monitors
  • Nebulizers
  • Wheelchairs
  • Crutches and walkers
  • Canes
  • Braces
  • Splints
  • Supports
  • Compression socks
  • Orthotics
  • Glucometers
  • Hearing aids
  • Cochlear implants
  • Artificial limbs
  • Breast pumps
  • Portable oxygen
  • CPAP machines
  • Nebulizer machines
  • Health tracking devices (when prescribed)
  • Pill organizers
  • Thermometers
  • Humidifiers
  • Personal protective equipment like masks and sanitizer

Having the proper medical equipment and supplies to treat or manage a health condition are definitely HSA-qualified expenses.

Preventive Care

Many routine preventive care services can be covered with HSA funds, including:

  • Annual physical exams
  • Well-child visits and immunizations
  • Routine vaccinations like flu shots
  • Screenings like mammograms, colonoscopies, skin cancer screenings
  • Counseling for tobacco cessation
  • Obesity weight-loss programs (prescribed)
  • Depression and substance abuse treatment
  • Smoking cessation programs
  • STD testing
  • Cardiovascular disease testing
  • Prenatal care and lactation expenses
  • Bone density testing
  • Prescription sunglasses
  • Sunscreen (SPF 15 and higher)

Using HSA funds for preventive care helps you stay proactive about protecting your health.

Dental and Orthodontic Expenses

Nearly all dental and orthodontic expenses are eligible for HSA reimbursement if they are medically necessary and provided by licensed dentists or orthodontists.

Common eligible expenses include:

  • X-rays
  • Cleanings
  • Fillings
  • Crowns
  • Dentures
  • Extractions
  • Implants
  • Gum treatment
  • Root canals
  • Wisdom tooth removal
  • Oral surgery
  • Orthodontia – braces, retainers
  • Occlusal guards

Cosmetic procedures like teeth whitening would not be eligible. But any dental work to diagnose, treat, or prevent dental disease can be covered with your HSA.

Vision and Eye Care

Routine vision expenses like eye exams, prescription eyeglasses, contacts, treatment for medical eye conditions, and corrective eye surgeries can be reimbursed from an HSA.

Some examples include:

  • Eye exams
  • Prescription glasses
  • Contact lenses
  • Laser eye surgery
  • Cataract surgery
  • Treatment for conditions like glaucoma or macular degeneration
  • Vision correction procedures

Similar to dental expenses, any vision-related costs for diagnosing, treating, or preventing medical conditions of the eye are eligible expenses.

Therapy and Counseling

Expenses related to therapy and counseling for medical issues can often be HSA-reimbursable, such as:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Alcohol and substance abuse counseling
  • Psychotherapy and psychiatric services
  • Family counseling (for a medical issue)
  • Nutritional counseling (for a medical issue like eating disorders)
  • Weight loss counseling (for morbid obesity diagnosis)
  • Smoking cessation programs
  • Stress management counseling (prescribed)
  • Grief counseling
  • Learning disability testing and treatment

The key is that the therapy addresses an underlying medical issue and is conducted by licensed practitioners.

Home Medical Equipment and Supplies

Making modifications to your home or acquiring medical equipment and supplies for home use is another category of HSA-eligible expenses. Some examples include:

  • Hospital beds
  • Mattresses and pillows for medical relief
  • Traction equipment
  • Mobility assistance like grab bars and wheelchair ramps
  • Modifications like widened doorways or railings
  • Emergency response systems
  • Handrails
  • Blood pressure monitor
  • Portable oxygen equipment
  • Thermometers
  • Heating pads
  • OTC medicines
  • Wound care supplies like bandages and gauze
  • Pill organizers and dispensers

Equipment and supplies that have a medical purpose and are intended to treat or alleviate a health condition can be reimbursed through an HSA.

Additional Eligible Expenses

And there are always miscellaneous medical expenses that can be covered as well, such as:

  • Ambulance fees
  • Emergency room services
  • Urgent care fees
  • Transportation costs related to medical treatment
  • Lodging when traveling away from home for treatment
  • Health insurance premiums (under limited circumstances)
  • Long-term care premiums
  • CPR and first-aid classes
  • Prenatal classes
  • Post-mastectomy clothing
  • Compression socks and specialty hosiery
  • Wigs for hair loss treatment
  • Service animals
  • Genetic testing
  • Experimental procedures
  • Off-label prescription drugs
  • Feminine care products

The key is showing the healthcare purpose for the expense. Your medical practitioner or tax advisor can help determine eligibility if you are unsure.

Expenses That Are Not Eligible

While the list of eligible expenses is long, some health-related costs do not qualify for HSA reimbursement. Examples include:

  • Cosmetic procedures not medically necessary
  • Teeth whitening
  • Toiletries like shampoo or hand soap
  • Gym memberships
  • Diet foods
  • Sunscreen and sunblock under SPF 15
  • Vitamins and supplements without prescription
  • Lip balm
  • Infant formula
  • diapers
  • Pet and service animal costs
  • Marijuana and other controlled substances

So when in doubt, consult IRS Publication 502 or ask your doctor to determine if something qualifies as an HSA medical expense.

Bottom Line

The wide variety of eligible medical expenses is what makes HSAs such a flexible savings option. You can use funds on deductibles, prescriptions, dental care, vision costs, preventive screenings, and much more. Just be sure to save your receipts!

Check with your HSA provider if you need help determining if a health-related expense qualifies for reimbursement

Health Savings Account (HSA): Qualified Medical Expenses


What expenses can I use my HSA for?

You can use HSA funds to pay for deductibles, copayments, coinsurance, and other qualified medical expenses. Withdrawals to pay eligible medical expenses are tax-free. Unspent HSA funds roll over from year to year, allowing you to build tax-free savings to pay for medical care later.

What is not an HSA eligible expense?

Generally, you can’t use your HSA to pay for expenses that don’t meaningfully promote the proper function of the body or prevent or treat illness or disease. Nutritional supplements and weight loss programs not prescribed by a physician are examples of expenses that would not be covered by your HSA.

What purchases are covered by HSA?

Your HSA can help you cover qualified emergency, dental, vision, and family medical expenses. The CARES Act has expanded the list of HSA-eligible items to include over-the-counter purchases such as allergy, cough, and cold medicines.

Can HSA pay for gym membership?

Gym memberships. While some companies and private insurers may offer discounts on gym memberships, you generally can’t use your FSA or HSA account to pay for gym or health club memberships. An exception to that rule would be if your doctor deems fitness medically necessary for your recovery or treatment.

Leave a Comment