Can You Use Your HSA or FSA at Costco? (2026 Guide)
Where the HSA card works at Costco (pharmacy, optical, hearing aids, marked items), what it won't cover, and how to get paid back for the treadmill or sauna.
8 minute read
Short answer
You can use an HSA or FSA card at Costco for items your plan already counts as medical: prescriptions, glasses and contacts, hearing aids, and over-the-counter medicine and supplies marked "FSA Eligible" on the shelf tag or on Costco.com. Costco's customer service page lists the pharmacy, optical and hearing aid departments as where the cards are taken; many warehouses now run marked items through the regular registers too, so ask at the membership desk before you rely on it. Your membership fee, groceries, Kirkland vitamins, the treadmill and the massage chair are not eligible on a receipt.
For the big-ticket health purchases Costco is known for (walking pads, treadmills, infrared saunas, blood pressure monitors that don't scan as eligible), the path is different: get a letter of medical necessity first, buy with any card at any register, and Burst files the claim so your plan pays you from your account. Burst's letter costs $35, and you get it back if the clinician declines or the plan says no. Request a letter.
Where does the HSA card work at Costco?
It works in the departments that sell medical items, and on Costco.com for items marked eligible. Costco's official payment page says FSA and HSA Visa or Mastercard debit cards are accepted at the pharmacy, optical and hearing aid departments in U.S. warehouses. Costco's optical FAQ adds that an FSA card can be used on Costco.com like any other card. Costco also notes it cannot identify which items your plan covers before the transaction is run, which is the polite way of saying the card either goes through or it doesn't.
On the main registers and self-checkout, the picture has been changing. Since 2025, shoppers have reported that FSA-eligible items ring through at regular lanes, and Costco's pharmacy site says the cards are accepted at every checkout. Older guides say the opposite. The safe move for a big trip: ask at the desk, or pay with a regular card and keep the receipt. Your plan will reimburse eligible items either way.
Costco.com has one quirk worth knowing: it won't split a single order between two payment methods unless the second one is a Costco Shop Card. So an online cart with contact lens solution and paper towels can't be paid half with your HSA card and half with a Visa. Either order the eligible items separately, or pay the whole thing with a regular card and claim the eligible lines.
What's eligible at Costco, item by item
Three tiers: works with the card, needs a letter first, and never. Prices are August 2026 warehouse and Costco.com prices and vary by location.
Item | Typical Costco price | Status |
|---|---|---|
Prescriptions at the pharmacy | varies | Card works |
Prescription glasses (Kirkland frames, single-vision lenses) | $129 to $150 | Card works |
Kirkland Signature Daily Disposable contacts, 90-pack | $58.99 | Card works |
Hearing aids (Philips, Rexton, Sennheiser, Jabra) | $1,500 to $1,700 a pair | Card works |
Omron 5 Series blood pressure monitor | $24.99 to $39.99 | Card works if marked FSA Eligible |
Kirkland Signature Aller-Tec, 365 tablets | $13.49 | Card works |
Kirkland Signature Omeprazole, 42 tablets | $7.99 to $10.29 | Card works |
Kirkland Signature Daily Multi, 500 tablets | $12.99 to $15.99 | Letter first |
Kirkland Signature Extra Strength D3, 600 softgels | $7.99 to $10.79 | Letter first |
Kirkland Signature Fish Oil 1000 mg, 400 softgels | $12.49 to $15.99 | Letter first |
Grüns Adult Greens Gummies, 35 packs | $31.99 to $39.99 | Letter first |
Kingsmith Walk & Work WalkingPad | $299.97 to $399.99 | Letter first |
NordicTrack T Series 8 treadmill | $999.99 | Letter first |
Dynamic 2-person infrared sauna | $1,799.99 to $1,899.99 | Letter first |
Massage chair (Best Massage, Osaki) | $999.97 to $4,499.99 | Rarely, even with a letter |
Gold Star or Executive membership | $65 or $130 a year | Never |
Why does the card get declined on a mixed cart?
Because the card is only allowed to pay for items the register can identify as eligible, and Costco's system has to make that call for every line before it charges the card. At the pharmacy counter, everything is eligible, so the card sails through. At a regular register with a $300 cart of groceries, sunscreen and allergy pills, the card either declines outright or approves only the eligible lines and asks for a second card for the rest, depending on how that warehouse's registers are set up. The card was never going to pay for the rotisserie chicken.
The fix is not to fight the register. Pay with a regular card, keep the receipt, and claim the eligible items. Costco warehouse receipts abbreviate item names ("KS ALLERTEC 365"), so if your plan asks for an itemized receipt, circle the line and note the full product name, or shop the item on Costco.com so the confirmation email spells it out.
Are Kirkland vitamins HSA eligible?
Not on a receipt. Kirkland Signature Daily Multi, Extra Strength D3, Fish Oil, glucosamine and the rest are supplements, and your plan treats supplements as general health under IRS Publication 502. They don't carry the FSA Eligible tag and the card won't pay for them.
They can qualify for reimbursement when a licensed clinician ties them to a condition you have. A vitamin D deficiency confirmed by labs is the common one for the D3; documented high triglycerides for fish oil; osteoarthritis for glucosamine. The letter has to come before you buy, and your plan makes the final call. At Costco prices ($7.99 for 600 D3 softgels) a letter for a single bottle isn't worth $35; a letter that covers your D3, fish oil, and a $35 pouch of Grüns for the year is. List everything you take for the condition on one request and let the clinician decide what belongs on the letter.
What about the treadmill, the walking pad, and the sauna?
These are the purchases where the letter path pays off, because they're expensive and Costco sells them cheaper than almost anyone. The Kingsmith Walk & Work WalkingPad runs $299.97 to $399.99 at Costco versus $449 to $599 direct from WalkingPad. The NordicTrack T Series 8 is $999.99. Dynamic infrared saunas run $1,799.99 to $1,999.99 for two- and three-person models.
None of them are eligible on a receipt; exercise equipment and saunas are general health until a clinician says otherwise. Tied by a clinician to a documented condition (weight management with high blood pressure or type 2 diabetes for the treadmill, chronic pain or a cardiovascular condition for the sauna), they can qualify for reimbursement. On a $1,799.99 sauna reimbursed from an HSA at a combined 30 percent tax rate, that's about $540 back, minus the $35 letter.
Massage chairs are the exception. Plans deny them routinely, even with a letter, because a chair is furniture with a massage function. If a clinician documents a condition for you, a handheld massage device is a much easier claim than a $1,200 chair.
How to get a letter for a Costco purchase
Before you shop, go to app.getburst.com/request-lmn and fill out the form. Under two minutes. Name what you plan to buy (walking pad, sauna, D3 and fish oil) and describe your condition.
Pay $35, about the price of a pouch of Grüns at the warehouse. A licensed clinician weighs the condition you described against what you're buying and decides what goes on the letter. If the clinician decides against a letter, the charge reverses on its own.
Once the signed letter hits your inbox (usually the same day), buy at the warehouse or on Costco.com with any card, including your Costco Visa. No special checkout.
Burst sends the claim to your plan. The administrator pays you from your HSA, FSA, or HRA, and a denied claim means the $35 comes back to you.
Costco is not a Burst partner and doesn't need to be. The letter and the receipt are what your plan looks at; where you bought it doesn't matter.
Frequently asked questions
Can I pay my Costco membership with my HSA?
No. The $65 Gold Star and $130 Executive fees are membership dues, not medical expenses, and no letter changes that.
Does Costco Optical take FSA cards?
Yes. Prescription glasses, prescription sunglasses and contact lenses are eligible, and Costco lists optical as a department that accepts FSA and HSA debit cards. Non-prescription sunglasses are not eligible.
Can I use my HSA card at Costco self-checkout?
It depends on the warehouse. Shoppers report it working for marked items since 2025, and Costco's pharmacy site says every checkout, but Costco's customer service page still names three departments. If it declines, pay with a regular card and claim the eligible items.
Are Costco hearing aids HSA eligible?
Yes. Hearing aids, batteries and fittings are medical expenses, and Costco's Hearing Aid Center takes FSA and HSA cards. Pairs run about $1,500 to $1,700.
Can I get a letter for a treadmill I bought at Costco last month?
No. The letter has to be dated on or before the purchase. If you're planning a second purchase (a sauna, a set of dumbbells your clinician recommends), get the letter before that one.
Does my plan have to accept a letter for a Costco treadmill?
That's your plan's decision to make. Most administrators take a well-written letter for a documented condition, and Burst refunds the $35 on any denial.
Related reading: HSA-eligible walking pads and treadmills, HSA-eligible saunas and cold plunges, Are Gruns and greens powders HSA eligible?, and Can you use your HSA on Amazon?
