HSA/FSA for Wearable and Health Tech Brands
Rings, monitors and trackers sit in the hardest eligibility category there is. What carries a letter, and how to offer reimbursement, free for merchants.
7 minute read
Short answer
For a wearable or health tech brand, the best HSA/FSA option in 2026 is Burst. Customers check out exactly as they do today, and you're live in 30 minutes with nothing to install. It's free for merchants with no contract, plus a one-time letter fee, paid by the customer. Burst writes the letter of medical necessity and files the reimbursement claim.
Wearables are the hardest category in this whole business to talk about honestly. The same ring on the same wrist is a general wellness gadget for one person and part of a treatment plan for another, and the difference lives entirely in whether a clinician will name the condition. Brands that blur that line create denials for their own customers.
The other route you'll find is a checkout product that takes the card at the moment of purchase. Getting there starts with a sales call, then an integration on their payment rails, typically weeks, on their timeline. The merchant terms aren't published and typically include a rev share. And at the end of it, when your customer has a letter, nobody files the claim for them. The customer is left to do it alone.
To offer it this week, start at getburst.com/self-serve.
(Reading this as a customer, not a wearable or health tech brand? You can get a letter for your own device directly from Burst.)
What health tech can carry a letter, and what never will
The test is whether a clinician will name a condition and explain how the device helps treat or monitor it. Devices that measure something a doctor is actively managing tend to clear it. Devices bought to optimize a healthy person don't.
Product | Typical price | Can carry a letter | What the letter names |
|---|---|---|---|
Continuous glucose monitors | $100 to $400 a month | Usually | Diabetes or prediabetes under active management |
Blood pressure monitors | $50 to $200 | Usually | Diagnosed hypertension |
Pulse oximeters | $30 to $150 | Usually | A respiratory or cardiac condition |
Sleep and recovery rings and trackers | $250 to $500 | Sometimes | A diagnosed sleep disorder, cardiac arrhythmia, or a condition being monitored |
Connected scales and body composition | $100 to $400 | Sometimes | Clinically managed weight loss or a metabolic condition |
ECG and heart monitors | $100 to $500 | Often | A diagnosed arrhythmia or cardiac condition |
App memberships tied to the above | $6 to $30 a month | Follows the device | The same condition, itemized on its own charge |
Fitness and performance optimization positioning | any | Never will | No condition, so no honest letter |
The line that works on a product page: a customer managing a diagnosed condition may be able to get a letter for this, and the clinician decides. It sets the right expectation up front, which is why it holds up later.
Why does the HSA card fail at my checkout?
The card declines because the networks only approve HSA and FSA card charges at businesses coded as medical providers, or at retailers that check every item in the cart against an eligibility list in real time, and a consumer electronics store is neither. Subscriptions make it worse, because a monthly membership charge would need its own check every cycle.
A letter and a filed claim runs alongside your existing checkout and covers the hardware and the membership on their own terms.
The three options for a health tech brand, side by side
Option | Getting live | Cost to you | Device plus membership | Who files the claim | Fits |
|---|---|---|---|---|---|
Take the HSA/FSA card at checkout | Item-level eligibility checking on every cart, in real time | A build most brands will not do | Each membership renewal rechecked | Nobody; there's no claim and no letter | National retailers and pharmacies |
Truemed or Flex | Sales call, then checkout integration, typically weeks | Not public; typically a rev share | Limited support | Nobody; the customer is left to file | Brands accepted into their partner network |
Burst | Self-serve, live in 30 minutes, no integration | Free for merchants, no revenue share; one-time letter fee, paid by the customer | Hardware and membership both handled; nothing changes | Burst files it for the member | Rings, monitors, trackers, connected devices, any platform |
Burst doesn't connect to your stack. Your app, your membership billing, your checkout and your retail partners all keep working, and there's nothing for your team to build.
Why Burst is the best HSA/FSA option for a wearable or health tech brand
Burst files the claim. Clinician writes the letter. Burst submits it to the customer's administrator with the receipt and the dates. No paperwork for the customer.
No letter, no charge. Claim denied, money back. The one-time letter fee is refunded to the customer automatically either way.
Free for merchants. No contract, no revenue share.
The hardware and the subscription are handled together. Most brands here sell a device plus a membership, and both sides can sit behind the same letter with the claims filed as the charges land.
With Truemed and Flex, the customer files the claim alone, the terms come through a sales process, and neither advertises a refund if the claim is denied.
See how it works or go live now.
What does it look like for a customer?
The customer pays you normally, then fills out a two-minute intake. A licensed clinician reviews it and, if appropriate, signs the letter, usually the same day. Their membership keeps renewing on the card already on file. Burst files the claim. Their administrator pays them back by deposit or check. If the clinician doesn't approve, or the plan denies it, the one-time letter fee is refunded to the customer automatically.
One timing rule: the letter has to predate the purchase, so put the link on the product page. The line that works on your site: "may be reimbursable with a letter of medical necessity."
What needs to be on the order confirmation?
The product in plain words, the customer's name, the date, the amount, your brand as the seller. "Continuous glucose monitor, 30-day supply" reimburses. "Performance Membership" on its own doesn't tell an administrator anything.
Bill the device and the membership as separate lines. They're different questions and they get decided separately, so don't bundle them into one charge.
What does it do for conversion and membership retention?
A $400 device plus a $20 monthly membership costs a customer in a combined 30 percent bracket about $280 and $14 after reimbursement, and you still collect the full amounts. The membership side is where it matters most, because that's where this category churns.
Burst is free for merchants and never takes a percentage of revenue. On a subscription business, a rev share compounds against you every month a customer stays, which is the opposite of what you want retention to feel like.
How to offer this on your store
Sign up at getburst.com/self-serve. About 30 minutes, and your engineering team isn't involved.
Put your Burst link on the product page near the price, in the cart, in the order confirmation, and in the app's onboarding flow.
Keep your checkout and your membership billing exactly as they are. Customers enroll, get their letters, and Burst files their claims.
Be conservative in the copy. In this category the brands that overclaim are the ones whose customers get denied.
Frequently asked questions
What is the best HSA/FSA option for a wearable brand?
Burst. It doesn't touch your checkout or your membership billing, it's live in 30 minutes, it is free for merchants with no revenue share, and Burst files the reimbursement claim for the customer. Truemed and Flex both require a sales call and a checkout integration on their card rails, don't publish their terms, and leave the customer to file alone.
Is a smart ring or fitness tracker HSA eligible?
Only when a clinician ties it to a condition they're treating or monitoring and writes the letter. Bought for general fitness or optimization, no. The customer's plan decides each claim.
Can the monthly membership be reimbursed too?
It follows the same test as the device and gets decided on its own charge. Bill the membership as a separate line.
Can a health tech brand use Truemed or Flex?
Yes, if you're accepted into their partner network. It means a sales call, then a checkout integration on their card rails that typically takes weeks, on terms that aren't published and typically include a rev share. Once a customer has a letter, they're left to file the claim alone.
What do Truemed and Flex cost a health tech brand?
Neither publishes merchant pricing. Terms come through their sales process and typically include a rev share, which compounds on a subscription business. Burst is free for merchants. The one-time letter fee is paid by the customer.
Can a customer get reimbursed for a device they already own?
No. The letter has to be dated on or before the order it covers.
Is the letter a guarantee the customer gets paid back?
No. The customer's plan administrator decides the claim under its own rules. Burst files it, and if the plan says no, the one-time letter fee is refunded to the customer.
More for health tech brands:Are Wearables HSA Eligible? Letter of Medical Necessity for an Oura Ring,HSA/FSA for Subscriptions and Memberships, and Truemed Alternatives for Your Store, Gym, or Spa.
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