Medical expenses you can pay for with HSA funds

You can use your HSA to pay for most medical care that your health insurance does not cover or that you pay out of pocket. This includes deductibles, copays, and coinsurance for doctor visits, hospital stays, surgery, and emergency care. You can also use HSA money for prescription medications, insulin, and over-the-counter drugs if a doctor has written a prescription for them.

Dental work qualifies: cleanings, fillings, root canals, crowns, orthodontia, and dentures all count. Vision care is covered too—eye exams, glasses, contact lenses, and laser eye surgery. Mental health treatment, including therapy and psychiatric medications, is a valid HSA expense. Physical therapy, chiropractic care, acupuncture, and other treatments your insurance covers or your doctor recommends are also allowed.

Medical equipment and supplies you purchase yourself are covered: blood pressure monitors, glucose meters, hearing aids, crutches, wheelchairs, and orthopedic braces. You can pay for medical transportation to treatment, including mileage to and from appointments at a set rate per mile (the IRS updates this rate annually). Long-term care insurance premiums and some long-term care services also may have access to, though the rules are stricter and depend on your age.

Key Takeaways

  • You can use HSA funds for any medical expense a doctor recommends or your insurance covers, including deductibles, copays, prescriptions, dental work, and vision care.
  • Over-the-counter medications and medical supplies count only if a doctor has written a prescription for them or they treat a diagnosed condition.
  • Non-medical purchases—cosmetic procedures, gym memberships, vitamins without a prescription—are not allowed and trigger taxes plus a 20 percent penalty if you withdraw them.
  • You can withdraw money for a spouse or dependent's medical expenses even if they are not on your health insurance plan.
  • After age 65, you can withdraw HSA money for any reason without penalty, though non-medical withdrawals are taxed as income.

Over-the-counter items you can and cannot buy

Over-the-counter medications are allowed only if a doctor has written a prescription for them. This means you can use your HSA to buy aspirin, antacids, cold medicine, or allergy pills if your doctor has prescribed them specifically. Without a prescription, these purchases are not covered, even though you can buy them at a pharmacy.

Medical supplies that treat a diagnosed condition are covered without a prescription: bandages, heating pads, ice packs, crutches, and compression sleeves all count. Sunscreen is not covered. Toothpaste and toothbrushes are not covered. Vitamins and supplements are not covered unless a doctor has prescribed them to treat a specific deficiency or condition. Feminine hygiene products became covered starting in 2023, so tampons, pads, and similar items now may have access to.

If you are unsure whether a specific item qualifies, check the IRS Publication 502, which lists what counts as a medical expense. When you buy something at a pharmacy or online, keep your receipt and the prescription or doctor's note. If the IRS audits your HSA withdrawals, you will need proof that the expense was medical and that a doctor approved it.

What you cannot use HSA money for

Cosmetic procedures are not covered unless they treat an injury or illness. Botox, teeth whitening, hair removal, and elective plastic surgery do not may have access to. However, reconstructive surgery after an accident or to correct a birth defect does count. If you are unsure whether a procedure is cosmetic or reconstructive, ask your doctor to document the medical reason before you pay.

Gym memberships, fitness classes, and sports equipment are not covered, even if your doctor recommends exercise. Weight loss programs and diet plans are not covered unless they treat a diagnosed disease like diabetes or obesity disorder and your doctor has prescribed them. General wellness expenses—vitamins without a prescription, health foods, or wellness retreats—do not may have access to.

Childcare, school tuition, and educational expenses are not medical. Travel for pleasure, even if you travel for your health, is not covered. Cosmetic dentistry like teeth whitening does not count, but medically necessary dental work does. If you withdraw HSA money for a non-may have access to expense, you owe income tax on that amount plus a 20 percent penalty. After age 65, the penalty goes away, but you still owe income tax on non-medical withdrawals.

How to pay for expenses: direct payment versus reimbursement

You can pay for a medical expense directly from your HSA in three ways. First, you can use an HSA debit card if your account provider issued one. You swipe it at the doctor's office, pharmacy, or hospital like a regular debit card, and the money comes straight from your HSA. Second, you can write a check from your HSA checking account if your provider set one up. Third, you can pay out of pocket with your own money and then request a reimbursement from your HSA later.

Reimbursement is useful if you want to let your HSA grow without touching it. You pay the medical bill yourself, keep the receipt, and submit a reimbursement request to your HSA provider weeks, months, or even years later. There is no time limit on when you can request reimbursement for a past expense, as long as you have the receipt and the expense happened after your HSA opened. This strategy lets your HSA balance grow tax-free while you cover medical costs from your regular income.

Some people use this approach to build their HSA as a retirement savings tool: they pay medical expenses out of pocket during their working years, keep receipts, and reimburse themselves from their HSA after retirement. This works because you can withdraw money for any reason after age 65 without the 20 percent penalty, though non-medical withdrawals are still taxed as income.

Paying for family members' medical expenses

You can use your HSA to pay for medical expenses of your spouse and any dependent you claim on your tax return, even if they are not covered by your health insurance plan. This means if your spouse has their own insurance or no insurance, you can still use your HSA to pay their doctor bills, prescriptions, and dental work. The same rule applies to children, parents, or other dependents you support.

You do not need to add them to your HSA account or have them be beneficiaries. You simply pay their medical expenses from your HSA funds. Keep receipts showing the expense and the person's name so you can prove the money went to a covered family member if you are audited. If you pay for a non-family member's medical expenses—a friend, roommate, or adult child you do not claim as a dependent—that withdrawal is not covered and triggers taxes plus the 20 percent penalty.

HSA withdrawals after age 65

After you turn 65, the rules change. You can withdraw HSA money for any reason without the 20 percent penalty. Non-medical withdrawals are taxed as regular income, but the penalty disappears. This means your HSA becomes similar to a traditional IRA at age 65: you can use it for medical expenses tax-free, or you can withdraw it for anything else and pay income tax only.

This flexibility makes HSAs a powerful retirement savings tool. If you have not spent your HSA balance by age 65, you can let it continue to grow, use it for medical expenses in retirement (which are often substantial), or withdraw it for other expenses and pay income tax. You still cannot use it for non-medical expenses before age 65 without the penalty, so the strategy works best if you can afford to pay medical bills out of pocket during your working years and let the HSA grow.

Frequently Asked Questions

Can I use my HSA to pay for my spouse's medical expenses if they have their own insurance?

Yes. You can use your HSA to pay for your spouse's medical expenses regardless of what insurance they have or whether they are on your plan. Keep receipts showing the expense and your spouse's name. The same rule applies to any dependent you claim on your tax return.

What happens if I use my HSA for something that is not medical?

You owe income tax on the amount you withdrew plus a 20 percent penalty. If you withdraw $500 for a non-medical expense, you pay income tax on $500 plus $100 in penalties. After age 65, the penalty goes away, but you still owe income tax on non-medical withdrawals.

Can I use my HSA to buy over-the-counter cold medicine?

Only if a doctor has written a prescription for it. Without a prescription, over-the-counter medications do not count as a covered expense, even though you can buy them at any pharmacy. Feminine hygiene products are an exception and are covered without a prescription as of 2023.

Do I have to use my HSA money in the same year I earn it?

No. HSA money rolls over year to year with no limit. You can let your balance grow indefinitely and use it whenever you need to pay for a medical expense. There is also no time limit on when you can request reimbursement for a past medical expense, as long as you have the receipt.

Can I use my HSA to pay for therapy or mental health treatment?

Yes. Mental health care, including therapy sessions and psychiatric medications, is a covered medical expense. You can use your HSA to pay for copays, deductibles, or the full cost of treatment if you pay out of pocket.