The basics: what an HSA pays for

A Health Savings Account covers medical expenses that your regular health insurance does not pay for — or pays for only partially. The IRS publishes a list of what counts as a medical expense, and if it is on that list, you can withdraw HSA money tax-free to pay for it. If it is not on the list, you can still withdraw the money, but you will owe income tax plus a 20% penalty on that withdrawal.

The key word is medical. An HSA is not a general savings account. It is specifically for costs related to diagnosing, treating, or managing a health condition — whether that is a doctor visit, a prescription, or equipment your doctor says you need.

What counts is surprisingly broad. It includes not just doctor visits and hospital stays, but also dental work, vision care, mental health treatment, physical therapy, and many over-the-counter items. But it does not include things like cosmetic surgery, gym memberships, or vitamins unless a doctor has prescribed them for a specific condition.

Key Takeaways

  • HSA money covers any medical expense the IRS recognizes, including doctor visits, prescriptions, dental work, vision care, and mental health treatment.
  • Over-the-counter items like pain relievers, allergy medicine, and bandages count as covered expenses, but only if you have a prescription or a doctor's written recommendation for some of them.
  • Cosmetic procedures, gym memberships, and general wellness products do not count unless they treat a diagnosed medical condition.
  • You can withdraw HSA money for a family member's medical expenses, not just your own, as long as they are your dependent.
  • If you withdraw money for something not on the IRS list, you pay income tax on that withdrawal plus a 20% penalty.

Doctor visits, tests, and hospital care

Any visit to a doctor, specialist, or hospital for diagnosis or treatment is covered. This includes the doctor's fee, any lab work or imaging they order, and any procedures they perform. If you have a copay or coinsurance (the percentage you pay after insurance), you can use HSA money to cover that out-of-pocket cost.

Preventive care visits — the annual checkup your insurance covers at no cost to you — are also covered expenses, even though you do not pay anything at the time. You can still withdraw HSA money to reimburse yourself for the cost of getting there or for any supplies you bought for the visit.

Emergency room visits, surgery, hospital stays, and rehabilitation after an injury or illness all count. If you are admitted to a hospital, the room, meals, nursing care, and medications given during your stay are covered HSA expenses.

Prescriptions and over-the-counter medications

Any prescription your doctor writes is a covered expense. This includes medications for chronic conditions like diabetes or high blood pressure, as well as short-term prescriptions like antibiotics or pain medication after surgery.

Over-the-counter medications are trickier. Pain relievers, cold medicine, allergy medicine, antacids, and similar items count as covered expenses — but only if a doctor has prescribed them or written a note saying you need them for a specific condition. You cannot just buy ibuprofen off the shelf and use HSA money without that documentation. The exception is insulin: you can buy insulin over the counter and use HSA money without a prescription.

If you are unsure whether a specific medication counts, check the receipt or packaging. Many over-the-counter items are labeled as HSA-may be able to access. If it is not labeled, ask your pharmacist or check the IRS list of approved medications before you buy.

Dental, vision, and hearing care

Dental work is fully covered: cleanings, fillings, root canals, extractions, crowns, and braces all count. Orthodontia for children and adults is a covered expense. Dentures and dental implants are covered too. If your insurance does not cover dental or covers only part of it, HSA money fills the gap.

Vision care includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK) is covered. If you need a new prescription, the exam and the glasses or contacts are both covered expenses.

Hearing aids and hearing tests are covered. If you need a hearing aid, the device itself, the fitting, and any adjustments or repairs are all HSA expenses.

Mental health and therapy

Therapy, counseling, and psychiatric care are covered HSA expenses. This includes visits to a therapist, psychologist, or psychiatrist, whether in person or by video. If your therapist charges a copay or you see someone outside your insurance network, you can use HSA money to cover that cost.

Medications prescribed for mental health conditions — antidepressants, anti-anxiety medication, mood stabilizers — are covered just like any other prescription. Inpatient mental health treatment and rehabilitation programs are also covered expenses.

Medical equipment and supplies

If your doctor says you need medical equipment or supplies, HSA money covers it. This includes crutches, wheelchairs, walkers, canes, braces, and compression stockings. Blood pressure monitors, glucose meters, and test strips for managing diabetes are covered. Bandages, gauze, and other wound care supplies count. Heating pads and ice packs for pain management are covered.

Larger equipment like a hospital bed, oxygen equipment, or a CPAP machine for sleep apnea are all covered expenses. The key is that a doctor has to say you need it for a medical reason — it cannot be something you buy for general comfort or convenience.

Fertility treatments and related supplies are covered. This includes medications, procedures, and equipment used in fertility treatment.

What does not count

Cosmetic procedures — including cosmetic surgery, teeth whitening purely for appearance, and similar treatments — are not covered unless they are fixing something that resulted from an injury or illness. For example, reconstructive surgery after an accident is covered, but a facelift for aging is not.

Gym memberships, fitness classes, and general wellness programs do not count, even if your doctor recommends exercise. However, if your doctor prescribes physical therapy for an injury or condition, that is covered.

Over-the-counter vitamins and supplements are not covered unless a doctor has prescribed them for a specific diagnosed condition. General multivitamins for wellness do not count. Sunscreen, toothpaste, and other hygiene products are not covered. Maternity clothes are not covered, but pregnancy-related medical care is.

Using HSA money for family members

You can withdraw HSA money to pay for medical expenses of your spouse and any dependent children, even if they are not on your health insurance plan. You do not have to be married or have custody — the IRS definition of dependent is what matters for tax purposes.

You cannot use HSA money for an adult child's medical expenses unless that child is still your dependent for tax purposes. Once they are independent, their medical expenses do not count, even if you are paying for them out of your own pocket.

Frequently Asked Questions

Can I use my HSA for my partner's medical expenses if we are not married?

Only if your partner is your dependent for tax purposes, which is rare for unmarried partners. If you are married, yes — your spouse's medical expenses are covered. If you are not married, check with a tax professional about your specific situation.

Do I need a receipt to prove something is a covered expense?

You should keep receipts and documentation, especially for over-the-counter items or anything that might be questioned. The IRS can audit HSA withdrawals, and you need to show that the expense was medical and that you paid for it. Your HSA provider may ask for proof before allowing a withdrawal.

What happens if I use my HSA for something that is not covered?

You can withdraw the money, but you will owe income tax on that amount plus a 20% penalty. For example, if you withdraw $100 for a non-covered expense and you are in the 22% tax bracket, you will owe $22 in tax plus $20 in penalty — a total of $42 on top of the $100 you withdrew.

Are prescription glasses and contacts covered if I buy them online?

Yes. As long as you have a valid prescription from an eye doctor, glasses and contacts from any retailer — online or in-person — are covered HSA expenses. Keep your prescription and receipt as proof.

Can I use HSA money to pay my health insurance premium?

Not usually. HSA money cannot pay your regular health insurance premium. However, there are narrow exceptions: you can use HSA money to pay for COBRA coverage (continuation coverage after job loss), Medicare premiums if you are retired, or long-term care insurance premiums. Ask your HSA provider about your specific situation.