HSA Eligible Expenses: What Qualifies

An HSA eligible expense is any qualified medical or dental cost under IRS Section 213(d) that you can withdraw from your health savings account tax-free. The list is broad—prescription drugs, surgeries, dental work, vision care, therapy, medical devices, and since 2020, over-the-counter medications and feminine hygiene products—but it excludes cosmetic procedures, gym memberships, and most wellness items. Because HSA rules are IRS-governed, not insurance-company rules, a cost may be eligible for HSA withdrawal even if your health plan does not cover it.

The IRS Section 213(d) standard

HSA eligibility flows directly from federal tax law, not from your health plan or insurance carrier. The IRS defines a qualified medical expense as one incurred “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.”

This is broad enough to capture thousands of items, but it excludes general health and wellness—you cannot use an HSA for gym memberships, vitamins, or cosmetic procedures—unless those items serve a specific medical purpose. The IRS publishes no official “approved list,” which is why edge cases matter: you often have to read the statute or ask a tax professional to be sure.

Prescription drugs and over-the-counter medications

Prescription drugs are unambiguously eligible. Any medication prescribed by a licensed physician and dispensed by a pharmacy qualifies.

Over-the-counter medications became eligible in 2020 under the CARES Act. This includes:

• Pain relievers (ibuprofen, acetaminophen, aspirin).
• Cold and allergy medications (antihistamines, decongestants, cough syrups).
• Antacids and digestive aids.
• Topical ointments for wounds or rashes.
• Sleep aids.
• Motion sickness and nausea remedies.

Before 2020, you needed a prescription for these items to claim them against an HSA. Now you do not, though you should keep receipts showing the medical purpose.

Vitamins and supplements are not eligible unless a physician prescribes them to treat a specific diagnosed condition (e.g., iron supplement for anemia). Generic wellness vitamins do not qualify, even if they support general health.

Dental and vision expenses

Dental expenses are broadly eligible:

• Fillings, crowns, root canals, cleanings.
• Braces and orthodontics.
• Extractions and implants.
• Gum disease treatment.
• Routine exams and X-rays.

Even cosmetic dental work (teeth whitening, veneers for purely aesthetic reasons) is not eligible. But functional improvements—braces that correct bite, crowns that restore a broken tooth—qualify.

Vision expenses include:

• Eye exams and refraction.
• Glasses and contact lenses.
• Lens solution and cases.
• Surgery to correct vision (LASIK, PRK).
• Lazy eye treatment.

Cosmetic glasses or sunglasses are not eligible, even with a prescription, unless they serve a medical function (e.g., UV protection prescribed for a photosensitivity disorder).

Mental health and therapy

Therapy and counseling expenses are eligible:

• Psychologist or therapist visits (copays, coinsurance, and out-of-pocket fees).
• Psychiatrist visits (including medication management).
• Treatment for depression, anxiety, ADHD, eating disorders, or substance abuse.
• Inpatient rehabilitation for mental health or addiction.

However, therapy for personal growth, career coaching, or general wellness—not treating a diagnosed condition—is not eligible.

Medical devices and equipment

Eligible devices include:

• Hearing aids and batteries.
• Crutches, wheelchairs, and mobility aids.
• CPAP machines for sleep apnea.
• Blood glucose monitors and supplies (test strips, lancets).
• Blood pressure monitors.
• EpiPens and inhalers.
• Insulin pumps and continuous glucose monitors.
• Orthopedic braces, splints, and compression sleeves.
• Canes and walkers.
• Bathroom safety equipment (grab bars, shower seats) if installed for a medical condition.

The common thread: the device must treat or manage a diagnosed medical condition, not merely promote general wellness.

Expenses that often trip up taxpayers

Fitness and wellness: Gym memberships, yoga classes, and fitness equipment are not eligible unless a physician prescribes them as treatment for a specific condition (documented in writing). If your doctor orders “cardiac rehab twice weekly,” that counts; a general gym membership does not.

Cosmetic procedures: Botox, face lifts, hair transplants, and teeth whitening are not eligible unless they correct a defect from disease or injury. Cosmetic breast surgery is not eligible; reconstruction after mastectomy is.

Sunscreen and insect repellent: Not eligible, even though they prevent disease. They are considered general health products.

Maternity and childbirth: Eligible. Prenatal care, ultrasounds, delivery, hospital stays, and postpartum care all qualify. Fertility treatments (IVF, egg freezing) also qualify.

Weight loss programs: Not eligible unless prescribed to treat a diagnosed disease (e.g., obesity-related diabetes or hypertension). Commercial weight loss programs do not qualify on their own.

Abortion and contraception: Eligible (post-ACA clarification). Contraception prescribed for contraception qualifies. Abortion and related care qualifies.

Long-term care: Eligible if the person is chronically ill or disabled and requires substantial supervision. Nursing home care, in-home nursing, and adult day care services may qualify.

Reimbursement and record-keeping

You can withdraw funds from your HSA for any eligible expense at any time—there is no deadline. Many people use their HSA strategically: they pay out of pocket in early years, keep receipts, and reimburse themselves decades later, letting the account grow tax-free. This is legal and common.

However, you must be able to prove the expense was eligible. The IRS does not require you to submit receipts when you make a withdrawal, but if audited (especially for large HSA accounts), you must show that the amounts withdrawn matched actual eligible expenses. Keep receipts for at least three years; the IRS can challenge older ones.

HSA contributions and income limits

While not strictly about eligible expenses, remember that contributions to an HSA are limited: $4,150 per individual or $8,300 per family in 2024 (adjusted annually for inflation). You must be enrolled in a high-deductible health plan to contribute. Those limits do not restrict how much you can withdraw for eligible expenses—only how much you can contribute per year.

Coordination with other accounts

If you also have a flexible spending account (FSA) or dependent care FSA, you cannot use both for the same expense in the same year—that is “double dipping.” But you can use an HSA for expenses not covered by an FSA, and you can alternate between years.

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