HSA Gray Areas: Hot Tubs, E-Bikes, Ski Passes and More

Short answer

Most of the things people wonder about (a hot tub, an e-bike, a massage chair, a standing desk, an Apple Watch) fall into the same bucket: not covered on a receipt alone, sometimes covered when a licensed clinician documents a specific condition the item treats, and always subject to your plan's final call. A few things are a flat no even with a doctor's note, because the IRS names them: ski passes, dance and swim lessons for general health, gym clothes, and food that replaces normal meals. And one surprise is a clear yes: a service animal.

The test a clinician applies is the same every time. Is there a diagnosed condition, and does this item treat it? "It would be good for me" is not enough. Below, item by item.

Can you use your HSA for a hot tub or swim spa?

Sometimes, with a letter, and plans look at these harder than anything else on this list. IRS Publication 502 treats a pool or spa installed at home as a capital expense: the deductible amount is the cost minus any increase in your home's value, and only when it is there mainly for medical care. A clinician would need a condition like rheumatoid arthritis, fibromyalgia, or chronic pain with a documented reason hydrotherapy is part of treatment, and a note that you have no reasonable alternative. Swim spas run $15,000 to $70,000 installed; Endless Pools' R-Series starts around $25,000. A portable above-ground hot tub is an easier claim than a built-in pool because it does not raise your home's value.

Can you use your HSA for an e-bike or bicycle?

Sometimes, with a letter for a condition that cycling treats. Obesity, high blood pressure, type 2 diabetes, and knee osteoarthritis (where low-impact cardio is preferred over running) are the diagnoses clinicians typically document. A bike you want for commuting or weekend rides does not qualify, no matter who signs the letter. Aventon's 2026 range runs $1,199 to $5,999; Rad Power Bikes run $1,299 to $2,399. Several bike retailers already have letter services at checkout, which tells you plans do approve these when the paperwork is right.

Can you use your HSA for a ski pass?

No. Skiing is recreation, and the IRS rules out expenses that are "only for the improvement of general health" even when a doctor recommends them. An Epic Pass is $1,089 and an Ikon Pass is $1,399 for 2026-27; both are after-tax money. Lift tickets, ski lessons, and season passes for a child's team are the same answer. This is one we would tell you not to request a letter for.

Can you use your HSA for a massage chair?

Sometimes, with a letter for chronic back pain, sciatica, fibromyalgia, or a similar diagnosis where massage is part of the treatment plan. The clinician should say why a home chair rather than periodic massage therapy. Human Touch chairs run from about $2,499 for the Perfect Chair recliner to $5,999 for the Certus and $11,999 for the Super Novo 3.0, so the paperwork is worth getting right. Massage chair retailers are among the most aggressive about advertising HSA eligibility; read that as "with a letter, and your plan decides," not as a promise.

Can you use your HSA for a standing desk or treadmill desk?

Sometimes, with a letter for chronic low back pain, sciatica, a circulation problem, or a weight-related diagnosis. An Uplift V2 starts at $599. An under-desk walking treadmill is the same logic as a walking pad: the clinician documents the condition and the activity target. Ergonomics for comfort, or because you sit all day, is not a diagnosis.

Can you use your HSA for an air conditioner?

Sometimes. The IRS has long allowed an air conditioner as a medical expense when a doctor prescribes it for a specific condition, such as severe allergies or a heart condition, and Publication 502's capital expense rule applies if it is a permanent installation. A portable unit is cleaner: a Midea 10,000 BTU portable runs about $499 and does not change your home's value. The letter should name the condition and say why controlled air temperature is part of treating it.

Can you use your HSA for gym clothes or running shoes?

Clothes, no, ever. Shoes, only when a clinician documents a diagnosed foot condition (plantar fasciitis, diabetic foot care, severe overpronation, post-surgical recovery) and the shoe is chosen for that condition. Everyday running shoes for training do not qualify. Our running shoes guide covers what kind of shoe and what kind of letter.

Can you use your HSA for meal delivery?

Mostly no. The IRS specifically excludes food bought for weight loss because it replaces what you would eat anyway. The narrow exception is special food that does not meet normal nutritional needs, treats a specific condition, and is documented by a clinician, and even then only the cost above what normal food would cost. Trifecta and similar services start around $112 per delivery and advertise HSA eligibility through letter programs; expect your plan to push back on a full meal plan.

Can you use your HSA for pet costs or a service animal?

Regular pet costs, no. A service animal, yes: Publication 502 lists the cost of buying, training, and maintaining a guide dog or other service animal for a person who is visually impaired, hearing impaired, or has another physical disability, including food and vet care. An emotional support animal sits in between; a diagnosis and a clinician's letter are the minimum, and many plans still decline.

Can you use your HSA for dance or swim lessons?

No, when they are for general health, and the IRS says so by name: dancing lessons and swimming lessons are not medical expenses "even if they are recommended by a doctor." Aquatic therapy delivered by a physical therapist as part of a treatment plan is a different expense and is eligible on the provider's receipt.

Can you use your HSA for a smartwatch?

Sometimes, with a letter that names the condition and the feature you need. An Apple Watch Series 11 ($399) or SE 3 ($249) for atrial fibrillation monitoring, or an Oura Ring 4 ($349 plus membership) for a diagnosed sleep disorder, is the kind of claim that gets through. A watch for step counting does not. Plans deny these more than most because the device is general-purpose, so the letter has to be specific. See our wearables guide for the details by brand.

The whole list in one table

How to get a letter for a gray-area purchase

1. Go to app.getburst.com/request-lmn and describe the item and the condition you have. Under 2 minutes, $35, one time.

2. A licensed clinician goes through your answers. If a letter is appropriate, you get a signed PDF by email, usually the same day. If the clinician decides it is not, the $35 is refunded automatically. For the items above marked "No," expect that outcome.

3. Purchase from any retailer on any card and send the receipt to Burst, which files with your administrator. The reimbursement comes to you from the account, and a denial gets your $35 back.

Frequently asked questions

Does a letter of medical necessity guarantee my plan will pay?

No. The clinician documents the medical reason; your plan administrator applies its rules and makes the final decision. A letter is what gives a gray-area claim a real chance.

Does the letter have to be dated before I buy?

Yes. Letter first, purchase second. One written after the receipt date will not support the claim.

Can one letter cover two gray-area items?

Only if the clinician ties both to the same condition and names both, for example a walking treadmill and a standing desk for chronic low back pain. Otherwise each item gets its own letter, and each claim stands on its own.

Why do some stores say their product is "HSA eligible" when it is on the no list?

Usually because they partner with a letter service and are describing the best case. The plan still decides, and for recreation and clothing the answer does not change.

Related: 75 surprising items people ask about, Gym memberships and your HSA or FSA, and Letter of medical necessity FAQ.