HRA Eligible Expenses: What an HRA Can Pay For

Short answer

An HRA is an employer-funded account that pays for qualified medical expenses. IRS Publication 502 defines that as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease and for the purpose of affecting any part or function of the body". Some expenses are reimbursable outright, others require a letter of medical necessity from a licensed clinician, and some aren't reimbursable at all.

Your HRA's plan document sets the final rules. While Publication 502 defines what counts as a medical expense, your employer's plan may cover fewer expenses or impose waiting periods. Check your plan summary or ask your administrator if you're unsure.

How to read the eligibility list

Every eligible item falls into one of three categories. Reimbursable outright means your HRA will pay for the full cost without extra paperwork once you submit a receipt. Reimbursable with a letter means a licensed clinician must examine the expense and explain in writing how it treats a specific condition they've diagnosed in you. Not reimbursable means your HRA won't cover it, even with documentation from a clinician, because it falls outside the definition of medical care.

What changes by plan

Your HRA plan document controls which expenses are covered. Two employers might use the same HRA but cover different services. For example, one employer's plan might reimburse gym memberships with a letter, while another excludes them entirely. A second employer might allow preventive visits to a therapist, while another limits reimbursement to treatment after a diagnosis. Your summary plan description lists what your employer chose to cover.

OTC and pharmacy

Most over-the-counter medicines and all prescription drugs are reimbursable outright under your HRA.

The CARES Act of 2020 expanded the types of over-the-counter medications covered by FSAs, HSAs, and HRAs. "You can include in medical expenses amounts you pay for a drug that isn't prescribed" with certain exceptions. Insulin is reimbursable on its own without a prescription. Nutritional supplements are reimbursable only "if they are recommended by a medical practitioner as treatment for a specific medical condition," meaning a clinician must tie the supplement to your diagnosed health issue.

Personal care and hygiene

A short list of personal care items is reimbursable outright, while most everyday toiletries are not.

Menstrual care became eligible under the CARES Act 2020. Sunscreen with SPF 15+ and broad-spectrum protection is also eligible outright. An electric toothbrush can be reimbursed if a dentist documents it for a diagnosed gum condition. General personal care items like deodorant and regular toothpaste are not reimbursable.

Vision and dental

Vision and dental care is reimbursable outright under IRS rules, with cosmetic treatments excluded.

Your HRA covers "amounts you pay for eyeglasses and contact lenses needed for medical reasons" and "the prevention and alleviation of dental disease." Teeth whitening is cosmetic and isn't reimbursable.

Medical devices and equipment

Medical devices and diagnostic equipment are reimbursable outright when they help treat, monitor, or manage a health condition.

Medical equipment and diagnostic devices are reimbursable outright. This includes "hearing aid and batteries, repairs, and maintenance needed to operate it" and devices that help diagnose or manage a health condition.

Fitness and wellness

Fitness and wellness purchases become reimbursable with a letter of medical necessity when a clinician ties them to a diagnosed condition.

Under IRS Publication 502, "health club dues or amounts paid to improve one's general health" are not reimbursable. However, when a clinician documents that these expenses treat a specific condition (such as arthritis, back pain, sleep apnea, or anxiety), they become reimbursable with a letter of medical necessity. The clinician must explain the connection between the purchase and the diagnosis.

Medical services

Most medical services are reimbursable outright, with weight-loss programs reimbursable only when a letter documents a diagnosed condition.

Medical care for "diagnosis, cure, mitigation, treatment, or prevention of disease" is reimbursable. This covers therapy, mental health services, lab work, and vaccines. A weight-loss program is reimbursable with a letter when a clinician documents it as treatment for a diagnosed condition like obesity, but meal replacements and food are not reimbursable regardless.

Family and home care

Home modifications and care items for a diagnosed condition can be reimbursable, while everyday family expenses are not.

Home modifications "if their main purpose is medical care" are eligible. Diapers are reimbursable only when they are needed to relieve the effects of a particular disease. Cosmetic items and everyday expenses like food and clothing are not reimbursable.

How HRA reimbursement is paid

When your HRA reimburses a qualified medical expense, the payment comes from your employer's HRA account. Your plan administrator processes the claim and sends the reimbursement to you by deposit or check. Your employer funds the entire HRA balance, which means you don't contribute to it the way you would with an FSA or HSA. If you need a letter of medical necessity for an expense, a licensed clinician can provide one to support your claim and increase the likelihood of approval.

Getting it reimbursed with Burst

When the answer is 'with a letter', this is the letter. Request it from Burst in about two minutes, a licensed clinician reviews it, and it's typically in your inbox within 24 hours. $35 once. Burst then files the reimbursement claim with your FSA, HSA or HRA administrator, and the administrator pays you out of your account by deposit or check. If no letter is issued you pay nothing, and if the claim is denied you get the $35 back. One timing rule: the letter has to be dated on or before the purchase it covers, so request it first.

Request my letter for $35

Frequently asked questions

Does my HRA work like an FSA or HSA?

All three accounts cover the same types of medical expenses under IRS Publication 502, but they work differently. Your HRA is funded entirely by your employer, your FSA is funded through payroll deductions, and an HSA is an individual savings account paired with a high-deductible health plan. Your HRA plan document sets what your employer covers, so it may differ from another employer's HRA.

What if my HRA doesn't cover something Publication 502 allows?

Your plan document controls the final rules. While Publication 502 defines eligible medical expenses, your employer can choose to cover fewer items. Check your plan summary to see which expenses your specific HRA includes.

Can I get a letter to make my gym membership reimbursable?

Yes. If a licensed clinician documents that your gym membership, fitness classes, or equipment treat a specific diagnosed condition, the expense becomes reimbursable with a letter of medical necessity.

Are supplements eligible without a letter?

No. Vitamins and supplements are only reimbursable if a medical practitioner recommends them as treatment for a specific medical condition. That recommendation must be included in your letter of medical necessity.

Is cosmetic work reimbursable?

No. Cosmetic procedures, cosmetic products, and appearance-focused treatments like teeth whitening and laser hair removal are not reimbursable. A letter cannot change this outcome.

What if I already bought something?

Your letter has to be dated on or before the purchase it covers. Request it before you buy so the letter can support a reimbursement claim.

Keep reading: HSA and FSA Eligible Items in 2026: Complete Guide, 75+ Surprising FSA/HSA Eligible Items (2025 Guide), and all guides on this topic.

Sources

• IRS Publication 502 - Medical and Dental Expenses (definition of medical expenses, eligible items in OTC and pharmacy, vision and dental, devices, services, and family care categories; ineligible cosmetic procedures and personal items)

• IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans (HRA definition, employer-funding requirement, and alignment with Publication 502 rules)