HSA eligibility decision directory

Must be performed by a licensed chiropractor. Treatments must be for a medical condition, not general wellness.

Must be performed by a licensed acupuncturist for a medical condition.

Must be prescribed by a physician and performed by a licensed physical therapist.

Must be a visit to a licensed physician (MD, DO) or qualified healthcare provider for medical care. Visits for non-medical purposes do not qualify.

Must be for medical care at a licensed urgent care facility. The visit must be for diagnosis or treatment of a medical condition.

No prior authorization or referral needed for HSA eligibility. Any emergency room visit for medical care qualifies.

Transportation must be primarily for and essential to medical care. Ambulance rides for convenience when other transportation would be adequate do not qualify.

Must be a licensed medical specialist. A referral from your primary care doctor is not required for HSA eligibility, though your insurance plan may require one for coverage.

Must be for a medical condition. Purely cosmetic treatments are not eligible.

Must be medically necessary. Elective cosmetic surgery is generally not eligible.

Must be for medical care. Charges for personal items (TV rental, phone) or non-medical services during the stay are not eligible.

Anesthesia must be administered as part of a qualifying medical or dental procedure. Standalone sedation for non-medical purposes does not qualify.

Requires a doctor's prescription or letter of medical necessity. Must be for a diagnosed medical condition.

Requires a Letter of Medical Necessity (LMN) from a licensed provider (MD, DO, NP, or PA) for a specific diagnosed condition with ICD-10 codes. The LMN must state the gym membership is medically necessary for treatment or immediate prevention of the condition. Typically valid for 12 months.

Requires a Letter of Medical Necessity (LMN) from a licensed provider (MD, DO, NP, or PA) for a specific diagnosed condition. The LMN must state personal training is medically necessary for treatment. Typically valid for 12 months.

Only eligible if correcting a deformity from disease, accident, or birth defect.

Requires a doctor's diagnosis of a specific disease (obesity, diabetes, etc.) and a letter of medical necessity. Food costs are never eligible.

$2,000–$11,000+ (total out-of-pocket for delivery)

$300–$5,000 (IUI); $15,000–$25,000 (IVF per cycle)

Requires a Letter of Medical Necessity from a licensed provider for a specific diagnosed condition. The provider must confirm the equipment is medically necessary for treatment - not just general fitness. Services like Truemed handle the LMN process at checkout.

Requires a doctor's diagnosis of a medical condition causing hair loss and a prescription or letter of medical necessity.

Clearly eligible when medically necessary (before cancer treatment, etc.). Elective freezing is uncertain - consult a tax advisor.

$500–$3,000

$0–$6,000 (often covered by insurance under ACA)

$100–$300 per session

$100–$350 per session

Must be a trained service animal for a diagnosed disability. Emotional support animals and pets do not qualify.

$20–$100 per visit; $1,500–$4,000/year

Must be done for medical reasons - specifically to prevent lead poisoning in a child. Documentation of elevated blood lead levels or medical recommendation is needed.

Requires a doctor's recommendation. The primary reason for the school or tutoring must be the diagnosed learning disability.

$100,000–$1,000,000+ (total; most covered by insurance)

If primary reason is medical care: full cost is eligible. If primary reason is personal: only the medical care portion qualifies.

Only the medical care portion is generally eligible. Full cost may qualify if the resident is chronically ill and requires substantial medical care.

Services must be medical in nature. General housekeeping or companionship care is not eligible unless incidental to medical care.

Must be a qualified long-term care policy. Only eligible up to the IRS age-based annual limit.

$5,000–$50,000+ (often covered by insurance under the Women's Health and Cancer Rights Act)

Requires a medical diagnosis of dyslexia and doctor's recommendation for treatment.

Not eligible for cosmetic hair restoration. May qualify only if hair loss results from disease or injury.

Requires a prescription from a licensed provider for a medical condition.

Must be provided by a licensed practitioner for a diagnosed medical condition. General self-improvement hypnosis is not eligible.

$15,000–$25,000 per fresh cycle; $3,000–$7,000 per frozen transfer

$15,000–$50,000+ (total; varies by insurance coverage)

$100–$350 per visit

$2,000–$6,000 (total midwife-attended birth)

Services must be medical in nature and provided by a licensed nursing professional.

$20–$300 per visit (varies by type and insurance)

$50–$400 per visit

$0–$100 per visit (varies by insurance and platform)

Must be for medical symptoms. Purely cosmetic spider vein treatment may not qualify.

$200–$1,500 per unit of blood (varies by type and facility)

Varies widely - typically covered by recipient's insurance, but out-of-pocket costs are HSA-eligible

Must be about a chronic condition you or your dependent has. Only admission fees qualify - not travel, meals, or lodging.

$10–$75 per request

IRS standard medical mileage rate; actual fare costs

Varies by plan - $1,600–$8,050+ (HDHP deductible range for 2024)

$50–$300 per series

$100–$500 per program

The care must be legal where provided. Keep the itemized provider bill and subtract insurance or other reimbursement.

Keep an itemized statement and proof of payment for medical care provided by the practitioner.

Keep lodging receipts and appointment records. Apply the current federal per-night limit and the additional rules for a necessary companion before treating any amount as qualified.

The service must be medical care from an osteopath. Keep the itemized provider statement and proof of payment.

Keep the physician prescription or statement, the institute's itemized bill, and proof of the unreimbursed amount.

Obtain the facility's written medical-cost allocation and keep the agreement and payment records. Do not treat the full entrance or monthly fee as qualified.

Do not use HSA funds for an unrelated surrogate's compensation or medical care. Separate medical expenses for you, your spouse, or your tax dependent may follow their own rules.

Do not use HSA funds for funeral, burial, or cemetery costs.

Do not use HSA funds for ordinary maternity clothing. Use the pregnancy-support-belt decision for a medically indicated support garment.

Confirm that the arrangement meets the federal DPC definition, identify who paid the fee, and keep the agreement and payment record. Employer-paid fees are not your expense. Separately verify whether monthly fees preserve your eligibility to contribute.

Identify the exact exception before using HSA funds. Keep premium statements and proof of COBRA, unemployment status, age, or long-term-care eligibility as applicable. Medigap is not included.

$75–$200 per cleaning

$100–$400 per filling

$800–$1,700 per crown

$700–$1,500 (plus crown)

$3,000–$6,000 per implant

$3,000–$8,000 (full treatment)

$1,000–$3,500 per set

$200–$3,000+ per procedure

$25–$250 per set

Not eligible. Teeth whitening is classified as cosmetic by the IRS.

$3,000–$8,000 (full treatment)

Generally ineligible. May qualify only if used to restore a damaged tooth (not cosmetic improvement).

Not eligible. Toothbrushes (electric or manual) are considered personal hygiene, not medical equipment.

$20–$40 (OTC); $300–$800 (custom)

Requires a dentist or orthodontist prescription specifically for dental/orthodontic treatment.

Not eligible when purely cosmetic. Restorative procedures that also happen to improve appearance ARE eligible.

$20–$50 per treatment

$3–$8 per pack

$100–$500 per retainer

$30–$60 per tooth

$2,000–$5,000 per bridge

$50–$500+ depending on type

$20–$40 (OTC); $300–$800 (custom replacement)

Must be performed by a licensed optometrist or ophthalmologist. No prescription or referral needed for the exam itself.

Must have a valid prescription from an optometrist or ophthalmologist. Non-prescription fashion frames or blue-light glasses without a prescription are not eligible.

Must have a valid prescription from an eye care provider. Cosmetic (plano) contact lenses without a prescription are not eligible.

Must be specifically for contact lens care. General saline spray (e.g., nasal saline) purchased separately is a different eligible expense category.

Must be performed by a licensed ophthalmologist or eye surgeon. A pre-operative exam confirming candidacy is standard.

No prescription required since the CARES Act of 2020. Must be reading glasses with magnification - plain fashion frames are not eligible.

No prescription required for OTC eye drops since the CARES Act of 2020. Prescription eye drops (for glaucoma, infections, etc.) require a valid prescription.

Not eligible. Insurance premiums and warranty plans are generally not HSA-qualified expenses.

$5–$30 per box

$50–$250 per visit

$100–$600+ per pair

Must be prescribed by an optometrist or ophthalmologist for a diagnosed vision disorder.

Must have a valid prescription from a licensed healthcare provider and be dispensed by a licensed pharmacy.

$5–$30 per item

$50–$300+ per month (without insurance)

$8–$30 per bottle

Requires a doctor's prescription or letter of medical necessity for a specific diagnosed condition.

Keep the itemized receipt and proof of payment, plus a prescription or Letter of Medical Necessity that covers this product and purchase date. For an Equip purchase using Truemed's reimbursement flow, complete the health survey on the purchase date and follow the merchant's current instructions. A document added later can complete your record only if it actually covers the purchase; it is not automatically retroactive.

$5–$40 per month

Keep the valid prescription and itemized pharmacy receipt, and subtract any insurance or other reimbursement. For a compounded product, confirm that it was prescribed for you and dispensed by a state-licensed pharmacy. HSA eligibility does not establish FDA approval, product quality, or legality.

$5–$20 per box

$0–$50/month (pills); $0–$1,300 (IUD insertion)

$20–$50/month (OTC); $100–$500 (programs)

$5–$20 per bottle

Requires a letter of medical necessity from a doctor for a specific diagnosed condition.

Not eligible. CBD is not classified as a medicine by the FDA (except Epidiolex for epilepsy).

$5–$30 (OTC); $50–$500/month (prescription)

$5–$20 per product

$10–$40 per month

$50–$350 per two-pack (varies by brand and insurance)

$5–$20 per test

$10–$30 (test strips); $100–$300 (fertility monitors)

Generally not eligible. Specialty medical formulas may qualify with a doctor's prescription for a diagnosed condition.

$5–$15 per tube

$5–$15 per pack

$5–$20

$5–$25 (OTC); $100–$500 (in-office removal)

$5–$15 (OTC); $20–$50 (prescription patches)

$5–$15 per tube/bottle

$5–$15 (OTC); $10–$100 (prescription)

$5–$25 per product

$3–$10 per bottle

$10–$30 (OTC); $100–$200 (professional treatment)

$3–$8 per tube

$5–$15 per box

$5–$15 per bottle

Prescription products: eligible with a valid prescription. OTC: must have a Drug Facts label with active drug ingredients.

Requires a doctor's prescription or letter of medical necessity for a diagnosed iron deficiency or anemia.

Do not use HSA funds when the substance's use violates federal law.

$100–$300 per session

$150–$500 per visit

$5,000–$30,000+ per program

$5,000–$50,000+ (inpatient); $1,000–$10,000 (outpatient programs)

Keep the legal invoice and treatment records showing that the legal work was necessary to authorize mental-health treatment. Separate unrelated legal services.

The service must be medical care. Keep the provider statement and proof of the unreimbursed amount.

$50–$500+ depending on tests

Must be ordered by a physician or qualified healthcare provider for diagnostic purposes. X-rays taken as part of a non-medical procedure are not eligible.

Must be ordered by a physician for diagnostic or monitoring purposes. Elective scans not ordered by a doctor may not qualify.

Must be ordered by a physician for diagnostic or monitoring purposes.

$10–$25 (at-home rapid); $0–$150 (lab PCR)

Must be ordered by a physician for a medical purpose. Consumer ancestry/entertainment DNA kits are not eligible.

$150–$1,000 depending on type and number of allergens tested

Best when ordered by a physician for a specific medical reason. Self-referred screening scans may not qualify.

$20–$500+ depending on tests

Not eligible. Paternity testing is not considered medical treatment by the IRS.

$100–$1,000 depending on type

$50–$250 per evaluation

Must be performed by a licensed physician or qualified healthcare provider. No prescription needed - annual physicals are inherently medical in nature.

Must be a medically recognized vaccine administered by a licensed provider. No prescription needed for standard vaccinations.

$50–$300 per exam

$5–$50 per item

$8–$60

$25–$100

$20–$400 (monitor); $30–$100/month (supplies)

$50–$300+ per month

$20–$100 (crutches); $50–$500+ (walkers/wheelchairs)

$1,000–$6,000 per pair

$30–$80 (manual); $150–$500 (electric)

Requires a diagnosis of sleep apnea (typically from a sleep study).

Requires a letter of medical necessity from a doctor for a diagnosed respiratory condition (asthma, allergies, COPD, etc.).

Requires a letter of medical necessity for a diagnosed medical condition.

Not eligible. Fitness trackers are classified as general wellness devices, not medical equipment.

Requires a letter of medical necessity for a diagnosed condition like varicose veins, DVT, or lymphedema.

$100–$500 (manual); $2,000–$30,000+ (power)

$30–$200 (machine); $10–$50 (supplies/medication)

$10–$50/month (supplies); $100–$300 (lactation consultant)

$15–$200 (OTC); $200–$800 (custom)

$5–$50

Generally not eligible. The IRS does not classify monitoring services as medical expenses.

$5–$30 per product

Requires a prescription or letter of medical necessity from a doctor. Only the cost exceeding normal footwear is eligible.

$15–$80

$30–$150 (standard); $100–$400 (rollator)

Typically requires a doctor's order or prescription for home use.

$50–$300+ per month

$200–$500+ per month

$5,000–$100,000+ depending on type and technology

The modification must be primarily for medical purposes. The eligible amount is the cost minus any increase to the home's value.

Only the modification cost is eligible, not the vehicle. Must be for a diagnosed physical disability.

$3–$15 per bandage

$10–$80

$30–$100+ per month

$0.50–$3 per mask (bulk pricing varies)

Typically requires a prescription or doctor's order for supplemental oxygen.

$15–$60

Requires a prescription from an orthopedist or other qualified doctor.

$10–$100 (home use); $50–$300 (clinical grade)

$10–$30 per pair

Typically prescribed by an orthopedist, chiropractor, or physical therapist.

Requires a doctor's prescription. Hair loss must be caused by a disease or medical treatment (e.g., chemotherapy, alopecia).

$3–$10 per box

Requires a prescription from a podiatrist or doctor for diabetes-related foot conditions.

Only the amount exceeding the cost of regular print versions is eligible. Full cost of Braille equipment is eligible.

Keep the itemized purchase or repair receipt and documentation that the equipment accommodates the hearing or speech disability.

Ordinary baby diaper service is not eligible. For disease-related incontinence products, use the incontinence-supplies decision and keep medical documentation.