HSA Expense Checker

Yes. Since the CARES Act was signed into law in March 2020, over-the-counter (OTC) medications are HSA-eligible without a prescription. This includes common drugs such as pain relievers (ibuprofen, acetaminophen), allergy medications (antihistamines, nasal sprays), cold and flu remedies, antacids, and first-aid supplies. Prior to the CARES Act, OTC medications required a prescription from a doctor to qualify. The change is permanent and applies to all HSA, FSA, and HRA plans. Keep your receipts in case your HSA custodian or the IRS requests documentation.

Yes. Dental and vision expenses are generally HSA-eligible as long as they are medically necessary or preventive. Eligible dental expenses include cleanings, fillings, crowns, root canals, braces, dentures, and X-rays. Eligible vision expenses include eye exams, prescription eyeglasses, prescription sunglasses, contact lenses, contact lens solution, and LASIK surgery. Cosmetic dental procedures (such as purely cosmetic teeth whitening) and non-prescription sunglasses are not eligible. The key distinction is whether the expense serves a medical purpose or is purely cosmetic.

Yes, with an important nuance. You can use HSA funds to pay for COBRA health insurance premiums on a tax-free basis. This is one of the few situations where HSA funds can be used for insurance premiums. The IRS specifically allows HSA distributions for COBRA continuation coverage premiums, health insurance premiums while receiving unemployment compensation, and Medicare premiums (Part A, B, C, or D) once you turn 65. However, you cannot use HSA funds tax-free to pay premiums for a Medigap (Medicare supplement) policy.

Generally, no. Gym memberships, fitness classes, and general exercise equipment are not HSA-eligible expenses because the IRS considers them general health and wellness costs rather than medical expenses. However, there is an exception: if your doctor provides a Letter of Medical Necessity (LMN) stating that a specific exercise program is required to treat a diagnosed medical condition (such as obesity, heart disease, or physical therapy following an injury), the expense may become eligible. Without a formal LMN tied to a specific medical diagnosis, gym memberships remain ineligible regardless of their health benefits.

Yes. You can use your HSA funds to pay for qualified medical expenses incurred by your spouse, your tax dependents, and any children under age 26 who are covered by your health plan - even if they are not covered by your HDHP and even if they have their own separate health insurance. Your spouse does not need to be HSA-eligible or even on your health plan for you to pay their qualified expenses from your HSA. The key requirement is that the expense itself must be a qualified medical expense under IRS Publication 502. This makes the HSA an exceptionally flexible tool for managing family healthcare costs.

A Letter of Medical Necessity (LMN) is a document written by a licensed healthcare provider - typically your doctor - that states a specific product or service is medically necessary to treat, diagnose, or prevent a medical condition. An LMN is required for expenses that the IRS considers conditionally eligible, meaning they are only HSA-eligible when prescribed for a medical purpose rather than general health or convenience. Common examples include ergonomic office equipment, massage therapy, nutritional supplements, weight-loss programs, and air purifiers. The letter must identify the specific medical condition, explain why the product or service is medically necessary, and be signed and dated by the provider. You should keep the LMN with your tax records in case of an IRS audit.

No. The IRS explicitly excludes cosmetic surgery and procedures from HSA eligibility unless they are necessary to correct a deformity arising from a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease. Procedures that are not eligible include face-lifts, liposuction, teeth whitening, hair transplants for pattern baldness, and elective Botox injections. However, if a procedure has a genuine medical purpose - for example, reconstructive surgery after a mastectomy, rhinoplasty to correct a deviated septum causing breathing problems, or scar revision after an accident - it may be eligible. The distinction hinges on whether the primary purpose is to treat a medical condition or to improve appearance.