What HSA money can and cannot pay for

An HSA covers medical expenses that your health insurance does not—but only specific ones. The IRS maintains a list of what counts as a may have access to medical expense, and if you spend HSA money on something not on that list, you pay income tax on the withdrawal plus a 20 percent penalty. The rule is strict: the expense must be for diagnosis, cure, mitigation, treatment, or prevention of disease, or for treatment of a bodily condition.

In practice, this means your HSA covers doctor visits, hospital stays, prescription drugs, and most medical equipment. It does not cover cosmetic procedures, gym memberships, vitamins (unless prescribed by a doctor for a specific condition), or over-the-counter medications like cold medicine or pain relievers—unless your state has passed a law allowing OTC drugs without a prescription. The line between what qualifies and what does not is often unclear, which is why the IRS publishes a searchable database of past rulings on specific items.

Key Takeaways

  • HSA funds cover doctor visits, hospital bills, prescription medications, and medical equipment like wheelchairs or hearing aids, but only if they treat or prevent disease.
  • Over-the-counter medications like ibuprofen and cold medicine do not may have access to unless your state allows them without a prescription or a doctor prescribes them for a specific condition.
  • Cosmetic procedures, gym memberships, and general wellness products are not covered, even if they improve your health.
  • Spending HSA money on a non-may have access to expense triggers income tax plus a 20 percent penalty, so it is worth checking the IRS database before you withdraw.
  • Some expenses, like dental and vision care, may have access to only if they are medically necessary—routine cleanings and glasses for refractive error are covered, but cosmetic dentistry is not.

Medical services and procedures that may have access to

Doctor visits, specialist consultations, and hospital stays are covered. This includes emergency room visits, surgery, anesthesia, and post-operative care. Mental health treatment—therapy, psychiatry, and inpatient psychiatric care—qualifies. Physical therapy, occupational therapy, and speech therapy all count if they treat a medical condition.

Diagnostic tests and imaging are covered: X-rays, MRIs, CT scans, blood work, and ultrasounds. Preventive care also qualifies—annual physicals, cancer screenings, vaccinations, and colonoscopies are all covered expenses. This is one area where HSA rules are generous: the IRS treats prevention the same as treatment.

Medications and medical supplies

Prescription drugs are covered in full. Over-the-counter medications are not covered unless your doctor prescribes them for a specific condition in writing, or your state has passed a law allowing OTC drugs to be purchased with HSA funds without a prescription. As of 2024, a handful of states have passed such laws, but most have not. Check your state's rules before assuming an OTC medication qualifies.

Medical supplies that treat a condition are covered: insulin, syringes, test strips for diabetes, inhalers, EpiPens, and bandages for wound care. Supplies for general hygiene—toothpaste, soap, shampoo—are not covered, even if they prevent disease. The distinction is whether the item treats an existing condition or merely maintains health.

Dental and vision expenses

Routine dental care—cleanings, fillings, and root canals—qualifies because it treats disease (tooth decay and gum disease). Orthodontics (braces) qualifies if it corrects a medical problem, not for cosmetic reasons. Cosmetic dentistry—whitening, veneers, and purely cosmetic bonding—does not may have access to. Dentures and bridges may have access to because they replace missing teeth and restore function.

Vision care is similarly split. Eye exams, glasses, and contact lenses may have access to because they correct refractive error (nearsightedness, farsightedness, astigmatism). LASIK and other refractive surgery may have access to for the same reason. Cosmetic procedures like eyelid surgery for appearance do not may have access to, though eyelid surgery to correct a drooping eyelid that impairs vision does.

Equipment and devices

Durable medical equipment qualifies if it is prescribed by a doctor and treats a medical condition. Wheelchairs, walkers, canes, crutches, and hospital beds all may have access to. Hearing aids and cochlear implants may have access to. Continuous positive airway pressure (CPAP) machines for sleep apnea may have access to. Braces and supports for joints may have access to if they treat an injury or condition.

The key word is "durable"—the item must be designed to last and be reusable. A one-time use item like a bandage qualifies, but a general-purpose item that happens to help with a condition does not. A mattress designed to prevent pressure ulcers in a bedridden patient qualifies; a regular mattress that happens to be better for your back does not.

What does not may have access to, even if it helps your health

Cosmetic procedures are never covered: facelifts, Botox, hair transplants, and teeth whitening do not may have access to. Gym memberships and fitness classes do not may have access to, even if your doctor recommends exercise. Vitamins and supplements do not may have access to unless a doctor prescribes them in writing for a specific medical condition—and even then, only if they are not available over the counter as a general wellness product.

Meals and lodging do not may have access to, even if you are staying in a hospital or treatment facility, unless the meal or lodging is part of an inpatient hospital stay or a residential treatment program. Travel to receive medical care does not may have access to. Childcare while you attend a medical appointment does not may have access to. Weight-loss programs and diet plans do not may have access to unless they are prescribed by a doctor to treat obesity as a medical condition, and even then the rules are narrow.

How to know if something qualifies

The IRS publishes Publication 502, which lists hundreds of medical expenses and whether they may have access to. It is searchable and updated regularly. If you are unsure about a specific item, search the publication first. If the item is not listed, you can search the IRS database of private letter rulings, which shows how the IRS has ruled on similar items in the past.

When in doubt, ask your HSA administrator before you withdraw the money. Most HSA custodians (the banks and financial companies that hold HSA accounts) have customer service lines and can tell you whether a specific expense qualifies. Spending money on a non-may have access to expense is expensive—you lose the tax advantage and pay a penalty—so it is worth the five-minute phone call.

Frequently Asked Questions

Can I use my HSA to pay for my spouse's medical expenses?

Yes, if your spouse is a dependent on your tax return. You can also use your HSA to pay for the medical expenses of your children, parents, and other dependents. The expense must still be a may have access to medical expense—the dependent status just determines whose expenses you can cover, not what counts as medical.

Does my HSA cover over-the-counter pain relievers like ibuprofen?

Not in most states. Over-the-counter medications do not may have access to unless a doctor prescribes them in writing for a specific condition, or your state has passed a law allowing OTC drugs without a prescription. A handful of states have done this, but most have not. Check your state's rules or call your HSA administrator to be sure.

What happens if I spend HSA money on something that does not may have access to?

You owe income tax on the withdrawal at your ordinary tax rate, plus a 20 percent penalty. So if you withdraw $100 for a non-may have access to expense and you are in the 22 percent tax bracket, you owe $22 in tax plus $20 in penalty—$42 total. Keep receipts and track what you spend so you can report it correctly on your tax return.

Are preventive care visits covered even if I have not met my deductible?

Yes. Under the Affordable Care Act, preventive care services—annual physicals, cancer screenings, vaccinations, and certain other preventive services—are covered at no cost even before you meet your deductible. This is true for all health insurance plans, including those paired with HSAs. You can use your HSA to pay the copay if there is one, but the service itself is covered.

Can I use my HSA to pay for my pet's medical care?

No. Veterinary expenses do not may have access to as medical expenses under IRS rules, even if the pet is a service animal. If the animal is a service dog that has been trained to perform a specific task for a disability, you may be able to deduct the cost of training and care as a medical expense on your tax return, but not through your HSA.