What Can You Buy with an HSA? The Complete List

Short answer

Your HSA covers qualified medical and dental expenses. Many items are reimbursable outright under IRS Publication 502. Many others, like gym memberships or alternative therapies, become reimbursable when a licensed clinician explains how they treat a diagnosed condition. A few things are never reimbursable, no matter the circumstance.

The three categories are straightforward. An item either comes out of your account right away (outright), requires a letter of medical necessity to be reimbursed (with a letter), or isn't reimbursable at all. This guide maps every common expense into one of those three and explains the IRS rule behind it.

What your HSA covers, in three categories

A Health Savings Account can reimburse qualified medical expenses. The IRS defines a medical expense 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". Unspent money in the account carries forward every year: "amounts that remain at the end of the year are generally carried over to the next year". Three types of reimbursement exist: outright (the expense qualifies immediately), with a letter (it requires a clinician to document that it treats a condition), or not reimbursable (the IRS does not allow it). Every item below lands in one of the three.

How to read the list

Below you'll see items grouped by category. Each item shows whether it's reimbursable outright, reimbursable with a letter, or not reimbursable. The IRS rule is cited. Items marked 'with a letter' need a licensed clinician to write a brief statement explaining how the purchase treats your diagnosed condition. Items marked 'not reimbursable' cannot be claimed. When in doubt, check your plan document, since it governs what your specific plan allows.

Over-the-counter and pharmacy

OTC medicines, prescription drugs, and basic pharmacy supplies are among the simplest HSA expenses to claim. None of these require a letter.

Personal care and hygiene

Some personal care items are covered, while others depend on whether they treat a specific condition. Routine hygiene products are generally not reimbursable.

Vision and dental

Vision and dental care are broadly covered by HSA. Routine exams, corrections, and treatment are reimbursable outright. Cosmetic procedures are not.

Medical devices and equipment

Medical devices are reimbursable outright under IRS Publication 502. Equipment tied to fitness or general home comfort is reimbursable with a letter naming the condition it treats. Water filters are a common gray area, covered in the water filter guide.

Fitness and wellness

Fitness and wellness purchases are reimbursable with a letter when a licensed clinician ties them to a diagnosed condition. Without a diagnosis behind the purchase, it isn't reimbursable.

Services and professional care

Medical services from doctors, therapists, and specialists are broadly reimbursable. The line between medical and cosmetic determines eligibility for some procedures. The IRS draws that line at appearance: cosmetic work is anything "directed at improving the patient's appearance and doesn't meaningfully promote the proper function of the body or prevent or treat illness or disease".

Family expenses

Your HSA can cover eligible medical expenses for your spouse and tax-dependent children, even if they're not on your health plan. The expenses must be eligible under IRS Publication 502. Dependent care (childcare or elder care) is never eligible for HSA reimbursement. That has its own account type, called a Dependent Care FSA.

What changes by plan

The IRS sets the baseline for what qualifies under Publication 502, but your employer's HSA plan document can be more restrictive. Some plans exclude certain items even though the IRS allows them. For example, one plan might cover acupuncture outright, while another requires a letter. Your plan document and summary plan description are what your administrator actually uses.

Example 1: Gym memberships

The IRS allows reimbursement with a letter when a clinician ties the membership to a diagnosed condition. Plan A might require the letter for every claim. Plan B might cap the dollar amount per year. Plan C might allow it outright with a note on file. Check your plan first.

Example 2: Mental health services

The IRS qualifies mental health counseling outright. Most plans allow it without conditions. Some plans cap the number of visits you can claim per year. Check with your administrator.

How reimbursement gets paid

When an expense qualifies outright, you request the reimbursement yourself and the administrator pays you out of your account by deposit or check. For items that require a letter, Burst files the reimbursement claim on your behalf after you request a letter of medical necessity, and the administrator pays you the same way. Your plan document governs whether unused funds carry over. Unlike an FSA, this account has no year end deadline, so unspent money simply carries into next year.

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.

Get reimbursed for my eligible expense

Frequently asked questions

Can I use my HSA to pay for anything?

No. Only qualified medical and dental expenses under IRS Publication 502 are eligible, and every expense lands in one of three outcomes: reimbursable outright, reimbursable with a letter, or not reimbursable. Gym memberships and vitamins fall into the 'with a letter' group when a clinician ties them to a diagnosed condition. Purely cosmetic purchases and general toiletries are not reimbursable.

What's the difference between reimbursable outright and with a letter?

Outright means the expense qualifies immediately under IRS rules. With a letter means a licensed clinician must explain in writing how the expense treats your diagnosed condition. Burst writes the letter for $35 once, and files the reimbursement claim for you.

Can I use my HSA for cosmetic procedures?

Cosmetic procedures like Botox for wrinkles, fillers, hair removal for appearance, or laser skin resurfacing are never reimbursable. The same procedure becomes eligible if a doctor prescribes it for a medical condition, like Botox for migraines.

Can my HSA pay for my family's medical expenses?

Yes. Your HSA can reimburse eligible medical expenses for your spouse and tax-dependent children, even if they're not on your plan. Childcare and elder care are not eligible for HSA. Those have a separate account type.

Does this account have a use-it-or-lose-it rule?

No. That rule belongs to Flexible Spending Accounts. Money in this account carries forward year after year with no deadline to spend it, and it keeps growing tax free.

Can my HSA pay for something my plan document excludes?

No. Even though the IRS may allow an expense, your plan document can be more restrictive. Check with your HSA administrator about your specific plan rules.

What if my administrator denies a reimbursement claim?

If you requested a letter and Burst filed the claim but the administrator denies it, Burst refunds your $35. You pay nothing if the claim is denied. If the administrator requests more information, Burst can write an appeal.

Can I just use my HSA debit card to buy these?

For anything reimbursable outright, yes: most pharmacies, doctors' offices, and vision or dental providers accept the card directly at checkout. For anything reimbursable with a letter, pay with any card first and get the letter afterward, since the merchant has no way to know the purchase treats a diagnosed condition.

Keep reading: What Can I Use My HSA Funds On?, HSA Benefits: What You Actually Get, What's an HSA?, HDHP and HSA: How the Pairing Works, and all guides on this topic.

Sources

• IRS Publication 502, Medical and Dental Expenses (Defines a medical expense, and the rules behind vitamins and supplements, weight-loss programs, cosmetic procedures, and personal-use items like a toothbrush)

• IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (HSA carryover of unspent balances. Use-it-or-lose-it is a separate rule that applies only to FSAs)

• Instructions for Form 8889 (How HSA distributions are reported and matched to qualified medical expenses on the account holder's tax return)