HSA-eligible expenses cover a surprisingly wide range of medical, dental, vision, and everyday health products. The IRS defines qualified expenses as anything that counts as “medical care” for you, your spouse, or your dependents, as long as insurance isn’t already covering the cost. That includes obvious things like doctor visits and prescriptions, but also items you might not expect, like sunscreen, first-aid kits, and menstrual products.
Medical and Hospital Services
Most services from licensed healthcare providers qualify. That includes visits to your primary care doctor, urgent care clinics, specialists, hospitals, and labs. Copays, deductibles, and coinsurance amounts you pay out of pocket for these visits are all eligible. Surgery that treats a medical condition qualifies, as do imaging scans, blood work, and physical therapy.
Chiropractic care and acupuncture also qualify when they’re treating a medical issue. The general rule: if a licensed provider is treating or diagnosing a health problem, the expense is likely eligible.
Prescription Medications
Any medication prescribed by a doctor, psychiatrist, or other licensed provider qualifies. This covers everything from antibiotics and blood pressure medications to insulin and prescription skin treatments. Medications prescribed for mental health conditions are included too.
Over-the-Counter Products
Since the CARES Act took effect in 2020, over-the-counter medications and products are eligible without a prescription. This was a major expansion. Common qualifying items include:
- Pain relievers like aspirin, ibuprofen, and acetaminophen
- Allergy and sinus medicine
- Antacids and digestive aids
- Antibiotic ointments and first-aid creams
- Acne treatments
- Cold and flu medicine
- Menstrual care products including tampons, pads, liners, cups, and sponges
The menstrual care addition catches many people off guard. Any product designed for menstrual management counts, no prescription or medical condition needed.
Dental Expenses
Dental care is one of the broadest HSA-eligible categories. Cleanings, fillings, crowns, root canals, extractions, braces, and dentures all qualify. X-rays taken during dental visits count too. If you need dental implants or oral surgery to address a medical problem, those expenses are eligible.
Teeth whitening, however, is considered cosmetic and does not qualify.
Vision Expenses
Eye exams, prescription eyeglasses, prescription sunglasses, and contact lenses (including solution and supplies) are all eligible. LASIK and other corrective eye surgeries qualify as well, since they treat a diagnosed vision problem. Reading glasses purchased over the counter also count.
Mental Health and Therapy
Therapy sessions with a psychologist, psychiatrist, or licensed counselor qualify when they treat a diagnosed mental health condition. This covers conditions like depression, anxiety, PTSD, and eating disorders. Psychiatric consultations and assessments are included, and so is substance abuse treatment for drug or alcohol addiction.
The key distinction is medical purpose. Therapy for a diagnosed condition qualifies. Marriage counseling or life coaching that isn’t tied to a specific mental health diagnosis typically does not. Some alternative treatments like massage therapy or acupuncture for mental health may qualify with a letter of medical necessity from your doctor.
Everyday Health Items You Might Not Expect
Several common household health products are eligible, and many people leave money on the table by not realizing it.
Sunscreen qualifies as long as it offers broad-spectrum protection (blocking both UVA and UVB rays) with an SPF of 15 or higher. First-aid kits and supplies, including bandages, thermometers, and antibiotic creams, are covered. Premade first-aid kits sold at drugstores typically qualify as a single purchase. Pregnancy tests and blood pressure monitors are eligible too.
Items That Require a Doctor’s Letter
Some expenses fall into a gray area where they can qualify, but only with a letter of medical necessity from your healthcare provider. Your doctor fills out a form stating the product or service is medically necessary to treat a specific condition you’ve been diagnosed with.
Common items that need this extra step include:
- Weight loss programs when prescribed for a specific condition like obesity or heart disease
- Massage therapy for a diagnosed medical issue
- Vitamins and supplements recommended to treat a specific diagnosed condition
- Certain alternative treatments like holistic therapies
Without that letter, these expenses are considered general wellness and won’t qualify.
What’s Not Eligible
The IRS draws a clear line between medical care and general health or appearance. These common expenses do not qualify:
- Cosmetic surgery including face lifts, hair transplants, electrolysis, and liposuction. Any procedure aimed at improving appearance rather than treating a condition or restoring function is excluded.
- Gym memberships and health club or spa dues. However, separate fees charged at a gym specifically for weight loss activities can qualify.
- General vitamins and supplements taken to maintain ordinary health. Multivitamins, protein powder, and herbal supplements you buy on your own don’t count unless a doctor prescribes them for a diagnosed condition.
- Teeth whitening and other cosmetic dental procedures
- Marriage counseling not tied to a diagnosed mental health condition
Spending for Your Spouse and Dependents
Your HSA funds can pay for qualified medical expenses for three categories of people: yourself, your spouse, and your tax dependents. This is true even if your spouse or dependents aren’t covered by your high-deductible health plan. Your child’s braces, your spouse’s prescription, your dependent parent’s medical bills: all eligible as long as the expense itself qualifies.
If you use HSA funds for anything that isn’t a qualified medical expense, the withdrawal gets taxed as income and you may face an additional 20% tax penalty on top of that.
How to Keep Track
There’s no master list the IRS updates every year with every single eligible product. The guiding principle is IRS Section 213(d), which defines medical care as amounts paid for the diagnosis, cure, treatment, or prevention of disease, or for treatments affecting any structure or function of the body. When in doubt, check whether the item treats or prevents a health condition. If it does, it likely qualifies. If it’s for general wellness or appearance, it likely doesn’t.
Save your receipts for every HSA purchase. The IRS can ask you to prove an expense was qualified, and there’s no time limit on when they can ask. Many HSA providers now flag eligible items automatically at checkout, which makes tracking easier, but holding onto documentation protects you if questions come up later.