You can use your HSA card to pay for a surprisingly wide range of medical, dental, vision, and mental health expenses, plus everyday items like sunscreen, contact lens solution, and over-the-counter medications. The IRS defines eligible purchases broadly: anything that diagnoses, cures, treats, or prevents disease, or affects any structure or function of the body. Some items qualify automatically, while others need a doctor’s note.
Over-the-Counter Medications and Everyday Health Products
Since the CARES Act took effect in 2020, you no longer need a prescription to buy over-the-counter medications with your HSA card. That covers pain relievers, cold and flu medicine, allergy medications, antacids, first aid supplies, and bandages. Sleep aids also qualify without a prescription.
Sunscreen is eligible as long as it has broad-spectrum protection and an SPF of 15 or higher. Acne treatments qualify too. You can also buy menstrual care products, including tampons, pads, liners, menstrual cups, and sponges.
Doctor Visits, Hospital Care, and Prescriptions
Any payment to a licensed medical provider for diagnosis or treatment is fair game. That includes office visits, specialist appointments, surgery, lab work, imaging, and hospital stays. Prescription medications are eligible, and so is insulin (even without a prescription).
Chiropractic visits and acupuncture both qualify. Physical therapy, speech therapy, and occupational therapy are covered when they treat a medical condition.
Dental Expenses
Your HSA card works for nearly all dental care: cleanings, X-rays, fillings, sealants, extractions, braces, orthodontics, and dentures. Cosmetic procedures like teeth whitening are not eligible.
Vision Care
Eye exams, prescription eyeglasses, reading glasses, contact lenses, contact lens solution, enzyme cleaner, and eye drops all qualify. Laser eye surgery, including LASIK, is an eligible expense.
Mental Health and Therapy
Therapy and counseling sessions qualify when they’re tied to a diagnosed condition like anxiety, depression, or PTSD. Psychiatric care is also covered, including office visits, prescribed psychiatric medications, and even psychiatric hospitalization.
Life coaching and marriage counseling generally don’t qualify unless a healthcare provider deems them medically necessary. Massage therapy requires a letter of medical necessity from your doctor, and massages for general relaxation are not covered.
Medical Devices and Equipment
Home medical equipment covers a wide range. Blood pressure monitors, blood glucose monitors and test strips, thermometers, CPAP machines, nebulizers, and oxygen equipment are all eligible. So are canes, crutches, walkers, wheelchairs, hospital beds, and artificial limbs.
Hearing aids and batteries for hearing aids qualify. Diagnostic devices you use at home, like pulse oximeters, are also covered.
Items That Need a Doctor’s Note
Some purchases are only HSA-eligible if you have a letter of medical necessity (LMN) from your healthcare provider. This is a short document stating the item treats a specific medical condition. Common items in this category include:
- Vitamins and supplements prescribed for a deficiency or condition
- Massage therapy for a diagnosed condition
- Air purifiers for asthma or allergies
- Fitness programs or gym equipment like treadmills, when prescribed as treatment for a specific diagnosis
- Ergonomic chairs and cervical pillows for back or neck conditions
- Fitness trackers when part of a treatment plan
- Weight loss programs prescribed for a medical condition like obesity or heart disease
Without that letter, these purchases are considered personal expenses and won’t qualify.
Travel Costs for Medical Care
If you need to travel for medical treatment, your HSA covers more than you might expect. Bus, taxi, train, and plane fares to and from appointments are eligible, as is ambulance service. If you drive, you can claim 21 cents per mile for 2025 (dropping to 20.5 cents per mile in 2026). Parking fees and tolls at the medical facility count too. When treatment requires an overnight stay away from home, lodging costs for the patient qualify.
Paying for a Spouse or Dependents
Your HSA funds can cover qualified medical expenses for your spouse and your tax dependents, even if they’re not on your health plan. Married couples can’t share a joint HSA, but either spouse’s HSA can reimburse the other’s medical costs. You can also pay for your children’s expenses as long as they qualify as your tax dependents.
What You Cannot Buy
General health and wellness items without a medical purpose are off-limits. Gym memberships on their own don’t qualify. Cosmetic surgery, teeth whitening, and cosmetic dermatology are excluded unless they address a medical condition like a disfigurement from an accident. Toiletries, most cosmetics, and nutritional foods for general health are not eligible.
Health insurance premiums generally can’t be paid with HSA funds, with a few exceptions like COBRA coverage, long-term care insurance, and Medicare premiums once you’re 65.
What Happens If You Buy Something Ineligible
If you use your HSA card on a non-qualified expense, that amount gets added to your taxable income for the year. On top of that, you’ll owe a 20% penalty tax. So a $100 mistake could cost you $20 in penalties plus income tax on the $100. Once you turn 65, the 20% penalty goes away, though you’ll still owe regular income tax on non-qualified purchases.
Keep your receipts. If your HSA administrator or the IRS asks you to verify a purchase, you’ll need documentation showing the expense was medically necessary.