Medical expenses you can pay for with HSA funds
You can use HSA money to pay for any medical service or product that treats, manages, or prevents a diagnosed health condition — as long as it is not cosmetic. This includes doctor visits, prescription medications, dental work, vision care, mental health treatment, and medical equipment like wheelchairs or hearing aids. The IRS publishes a list of what counts, and it is longer than most people expect.
The key rule is that a doctor must have diagnosed or prescribed the thing you are buying. You cannot use HSA funds for general wellness products like vitamins or gym memberships unless a doctor has written an order saying you need them for a specific condition. If your doctor prescribes a particular supplement to manage your diabetes or high blood pressure, that counts. If you buy the same supplement because you think it is good for you, it does not.
Prescription medications are always covered, whether you fill them at a pharmacy or order them online. Over-the-counter medications like ibuprofen, allergy pills, or cold medicine are also covered, but only if you have a prescription from your doctor — the over-the-counter status does not matter. Insulin is covered without a prescription because it is a special case.
Key Takeaways
- HSA funds cover any medical service or product prescribed or ordered by a doctor to treat a diagnosed condition, including prescriptions, dental work, vision care, and mental health treatment.
- Over-the-counter medications require a doctor's prescription to be HSA-may be able to access, except for insulin, which is always covered.
- Cosmetic procedures, general wellness products, and gym memberships are not covered unless a doctor has prescribed them to treat a specific medical condition.
- You can use HSA funds to pay for family members' medical expenses, not just your own, as long as they are your tax dependents.
- After age 65, you can withdraw HSA money for any reason without penalty, though non-medical withdrawals are taxed as income.
Dental, vision, and hearing care covered by HSA
Dental work paid for with HSA funds includes cleanings, fillings, root canals, crowns, extractions, and orthodontia like braces. Cosmetic dental work — teeth whitening or veneers done purely for appearance — is not covered. But if your dentist prescribes braces because your bite affects your ability to chew or causes jaw pain, that is a medical expense and HSA funds can pay for it.
Vision care covers eye exams, glasses, contact lenses, and laser eye surgery like LASIK. You can use HSA money at any optometrist or ophthalmologist, and you can buy frames and lenses from any retailer as long as you have a current prescription. Sunglasses are not covered, even if they have a prescription, because they are considered cosmetic.
Hearing aids and related services are fully covered. This includes the device itself, the audiologist's exam and fitting, batteries, repairs, and replacement parts. Hearing aid insurance is also an HSA-may be able to access expense.
Mental health, therapy, and substance abuse treatment
Psychiatry visits, therapy sessions, and counseling are all HSA-may be able to access. You can pay for a therapist, psychologist, or psychiatrist out of your HSA, whether you see them in person or through telehealth. Medications prescribed for mental health conditions are covered the same way as any other prescription.
Inpatient and outpatient treatment for substance abuse — including rehabilitation programs, detoxification, and ongoing counseling — is covered. If you pay out of pocket for a treatment program, you can later reimburse yourself from your HSA as long as you keep the receipt and documentation showing it was treatment for a diagnosed condition.
Medical equipment, supplies, and home modifications
Durable medical equipment like crutches, wheelchairs, walkers, canes, and hospital beds are HSA-may be able to access. So are diabetic supplies (test strips, lancets, glucose monitors), bandages, braces, compression stockings, and peak flow meters. You do not need a prescription for most supplies, but you do need to keep receipts showing what you bought and when.
Home modifications made for medical reasons are covered if they are necessary because of a diagnosed condition or disability. A ramp installed so someone in a wheelchair can enter the house, grab bars in a bathroom for someone with balance problems, or a stair lift for someone with mobility issues all count. The modification itself is the expense — not the labor cost, in most cases, though some modifications allow you to deduct the full cost including installation.
Mobility aids like canes, walkers, and wheelchairs are covered. So are orthopedic shoes if they are prescribed by a doctor to treat a foot condition, though regular shoes are not covered even if they are comfortable.
What is not covered by your HSA
Cosmetic procedures are not covered unless they are medically necessary. Botox for wrinkles is not covered. Botox for migraines, prescribed by a neurologist, is covered. Nose surgery for appearance is not covered; nose surgery to fix a deviated septum that affects breathing is covered.
General wellness expenses are not covered: gym memberships, fitness classes, diet programs, or nutritional supplements you buy on your own. A weight loss program is not covered unless your doctor prescribes it as treatment for obesity or a related condition like diabetes, and even then only certain programs count.
Cosmetic dentistry like teeth whitening or veneers is not covered. Cosmetic hair removal is not covered. Sunscreen is not covered (it is considered cosmetic, not medical). Over-the-counter pain relievers, allergy medications, and cold medicine are not covered unless you have a prescription from your doctor.
Long-term care insurance premiums are not covered. Life insurance is not covered. Health insurance premiums are generally not covered, though there are narrow exceptions for COBRA continuation coverage, Medicare premiums (after age 65), and long-term care insurance in some cases.
Using HSA funds for family members
You can use your HSA to pay for medical expenses of anyone who is your tax dependent, not just yourself. This includes your spouse (if you file taxes jointly) and your children, even if they are over 18. You cannot use HSA funds to pay for an adult child's medical expenses if you do not claim them as a dependent on your taxes, even if you help support them.
The person receiving the care does not need to be on your health insurance plan. If your spouse has their own health insurance and their own HSA, you can still use your HSA to pay for their medical expenses. Keep receipts showing who the expense was for, in case you are audited.
How to pay for HSA-may be able to access expenses
Most HSA accounts come with a debit card that you can use at pharmacies, doctors' offices, and medical retailers. When you swipe the card, the transaction is flagged as medical, and the funds come directly from your HSA. Keep your receipt — the card company does not always know whether a purchase is HSA-may be able to access, so you may need to prove it later.
You can also pay out of pocket and then reimburse yourself from your HSA later. This is useful if you do not have your HSA debit card with you, or if you want to let the money grow in your HSA and pay medical expenses from your regular bank account. You have until the tax filing deadline of the following year to reimburse yourself for expenses from the current year, though it is safer to do it sooner and keep clear records.
Some HSA providers let you set up automatic payments to recurring medical expenses like monthly therapy or prescription refills. Check with your HSA administrator about what payment methods they support.
Frequently Asked Questions
Can I use my HSA to buy over-the-counter pain relievers or allergy medicine?
Only if you have a prescription from your doctor. Over-the-counter status does not matter — the IRS requires a prescription for most OTC medications. Insulin is the exception and is always covered. If your doctor writes a prescription for ibuprofen or an allergy medication, you can then buy the OTC version and use your HSA.
Is teeth whitening covered by my HSA?
No, teeth whitening is considered cosmetic and is not covered. Dental work that treats a condition — fillings, root canals, extractions, braces for bite problems — is covered. If whitening is prescribed as part of treatment for a diagnosed dental disease, ask your dentist to document that and contact your HSA administrator.
Can I use HSA money to pay for my gym membership?
Not unless your doctor has prescribed it as treatment for a specific condition like obesity or heart disease. Even then, only certain structured programs count. A general gym membership for fitness is not covered. If your doctor writes an order for a medically supervised weight loss or cardiac rehabilitation program, that may be HSA-may be able to access.
What happens to my HSA money if I do not spend it?
HSA funds roll over year to year — you do not lose them. The money stays in your account and grows. After age 65, you can withdraw HSA funds for any reason without penalty, though non-medical withdrawals are taxed as income. If you withdraw money for non-medical reasons before age 65, you pay income tax plus a 20 percent penalty.
Can I use my HSA to pay for my spouse's medical expenses?
Yes, if your spouse is your tax dependent. You can use your HSA for any dependent's medical expenses, whether or not they are on your health insurance. Keep receipts showing who the expense was for. If your spouse has their own HSA and their own health insurance, they can use their own HSA for their expenses.