Your HSA card covers a wide range of medical, dental, and vision expenses, plus many everyday health products you might not expect. The IRS defines qualified medical expenses broadly: anything used to diagnose, cure, treat, or prevent disease, or that affects any structure or function of the body. That includes everything from doctor visits and prescriptions to sunscreen, acne treatments, and mental health therapy.
Medical Services and Treatments
The core use of your HSA is paying for medical care. Doctor visits, hospital stays, lab work, physical exams, surgery, and specialist appointments all qualify. So do ambulance services, physical therapy, psychiatric care, and nursing services. If a licensed medical practitioner provides it and it treats or prevents a health condition, your HSA card almost certainly covers it.
Acupuncture and chiropractic care are both eligible. Mental health counseling qualifies too, as long as the counseling addresses a medical or mental health condition. Marriage counseling or life coaching generally won’t qualify unless you have documentation tying it to a diagnosed condition. Your HSA administrator may ask for a letter of medical necessity in some counseling situations, so keep any relevant paperwork from your provider.
Fertility treatments, birth control pills, breast pumps, and long-term care services are all on the list. Hearing aids, artificial limbs, wheelchairs, oxygen equipment, and other medical devices qualify as well.
Dental Expenses
Routine dental care is fully eligible. Cleanings, fillings, X-rays, and extractions can all go on your HSA card. Beyond the basics, your card covers more extensive work: crowns, dental implants, bridges, dentures, and sealants used to prevent or treat dental disease.
Orthodontic treatment qualifies too. Traditional braces, Invisalign, and other corrective devices are all eligible expenses. Cosmetic procedures are the exception. Teeth whitening doesn’t qualify, and veneers typically require a letter of medical necessity showing they serve a non-cosmetic purpose. Everyday items like toothbrushes, toothpaste, floss, and mouthwash are not covered.
Vision and Eye Care
Prescription eyeglasses and contact lenses are straightforward HSA purchases, including contact lens solution and cleaning supplies. Eye exams qualify whether they result in a prescription or not, since they count as preventive care. LASIK and other corrective eye surgeries are eligible because they treat a diagnosed vision problem. Reading glasses sold over the counter also qualify as long as they correct your vision.
Over-the-Counter Products and Medications
Since the CARES Act took effect in 2020, you no longer need a prescription to use your HSA for over-the-counter medications. Pain relievers, allergy medicine, cold and flu remedies, antacids, sleep aids, and anti-itch creams all qualify. This change was permanent, not temporary.
Menstrual care products are also eligible. Tampons, pads, liners, menstrual cups, sponges, and similar products all count as qualified medical expenses.
First aid supplies round out this category: bandages, gauze, antiseptic wipes, thermometers, and blood pressure monitors. Sunscreen with SPF 15 or higher qualifies because the IRS treats sun protection as disease prevention. Even certain skincare products can be eligible if they treat a specific condition like eczema or acne. Products containing active ingredients like salicylic acid for acne, hydrocortisone for eczema, or colloidal oatmeal for skin conditions can typically be purchased with HSA funds.
What Your HSA Cannot Cover
The key rule is that an expense must treat or prevent a specific medical condition. Items that are “merely beneficial to general health” don’t qualify. That means general-purpose vitamins and supplements are out unless a doctor prescribes them for a diagnosed deficiency. Gym memberships, cosmetic procedures (like teeth whitening or elective plastic surgery), and vacations don’t qualify, even if they make you feel healthier.
If you use your HSA card for a non-qualified expense, you’ll owe income tax on that amount plus a 20% penalty. After age 65, the penalty drops away, but you still owe income tax on non-medical withdrawals, effectively making your HSA work like a traditional retirement account at that point.
Travel for Medical Care
When you need to travel for treatment, your HSA covers transportation costs. You can reimburse yourself for mileage driven to and from medical appointments, parking fees, tolls, and bus or train fares. If your treatment requires an overnight stay away from home, lodging expenses qualify up to $50 per night per person. Meals during medical travel are not covered.
This applies to any legitimate medical trip, whether you’re driving across town to a specialist or flying to another city for a procedure not available locally. The travel must be primarily for medical care, not a trip that happens to include a doctor visit.
Paying for Your Family’s Expenses
Your HSA funds aren’t limited to your own medical bills. You can use your card to pay for qualified expenses for your spouse and any dependents you claim on your tax return. Your family members don’t need to be covered under your health insurance plan for this to apply.
The rules extend even further in some family situations. If you could have claimed someone as a dependent except for certain technicalities (they filed a joint return, earned too much income, or you yourself are claimed as a dependent on someone else’s return), their medical expenses still qualify. For divorced or separated parents, a child is treated as the dependent of both parents for HSA purposes, regardless of which parent claims the exemption.
Keeping Your Records Straight
The IRS doesn’t require you to submit receipts with your tax return, but you should keep them anyway. If you’re ever audited, you’ll need to prove each HSA withdrawal went toward a qualified expense. Save receipts that show the date of service, the provider or retailer, the amount paid, and a description of what was purchased or the service performed.
A useful strategy: save every receipt digitally in a folder organized by year. There’s no time limit on when you reimburse yourself from your HSA. You can pay out of pocket today, let your HSA balance grow tax-free, and reimburse yourself years later as long as you have the receipt and the expense occurred after your HSA was established.