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Gym Memberships & Your HSA

How to Use Your HSA for a Gym Membership

Yes, you can pay for your gym membership with HSA funds. You need a Letter of Medical Necessity. Here is exactly how it works, who qualifies, and how much you save.

Quick Answer

Gym memberships are HSA-eligible with a Letter of Medical Necessity (LMN) from a licensed provider. Without an LMN, the IRS considers gym costs a general health expense - not a qualified medical expense. Services like Truemed and Flex make getting an LMN fast and affordable.

Why Gym Memberships Are Not Eligible by Default

IRS Publication 502 defines qualified medical expenses as costs "primarily for the prevention or alleviation of a physical or mental defect or illness." The IRS has consistently ruled that gym memberships, even when recommended by a doctor, are a general health expense - not a medical expense.

The logic: everyone benefits from exercise, so a gym membership is not inherently medical. The IRS applies the "but for" test - would you have purchased the membership regardless of a medical condition? If yes, it does not qualify.

This changes when a licensed provider determines that exercise is medically necessary to treat a specific diagnosed condition. That determination is documented in a Letter of Medical Necessity.

When Gym Memberships ARE HSA-Eligible

A gym membership becomes a qualified medical expense when all three conditions are met:

1. You have a diagnosed medical condition

A licensed provider has diagnosed a specific condition (obesity, diabetes, heart disease, depression, etc.) with ICD-10 codes.

2. A provider prescribes exercise as treatment

The provider determines that a gym membership is medically necessary to treat or prevent your specific condition - not just general wellness.

3. You have a Letter of Medical Necessity

The LMN documents the diagnosis, ICD-10 codes, treatment plan, and the provider's determination that gym access is medically necessary.

What Is a Letter of Medical Necessity (LMN)?

An LMN is a formal document from a licensed healthcare provider (MD, DO, NP, or PA) that states a specific expense is medically necessary for your treatment. For gym memberships, the LMN must include:

  • Your diagnosis with specific ICD-10 codes
  • Provider's determination that exercise is medically necessary for your condition
  • Treatment plan specifying frequency and type of exercise
  • Duration - typically 12 months, renewable annually
  • Provider credentials - name, license number, signature, and date

Qualifying Conditions

These are the most common conditions that qualify for a gym membership LMN. This is not exhaustive - your provider determines medical necessity based on your health profile.

ConditionICD-10 Codes
Obesity (BMI 30+)E66.01, E66.09
Type 2 DiabetesE11.x
Cardiovascular DiseaseI25.10, I10
HypertensionI10
Major Depressive DisorderF32.x, F33.x
Generalized Anxiety DisorderF41.1
Chronic PainG89.29, M54.5
Metabolic SyndromeE88.81
Musculoskeletal DisordersM79.1, M54.x
Sleep DisordersG47.x

How to Get an LMN: Truemed vs Flex

Two services dominate the gym-HSA space. Both connect you with a licensed provider who evaluates your health and issues an LMN if you qualify.

FeatureTruemedFlex
LMN Fee$30 one-time4% per transaction
ProcessOnline health surveyOnline health survey
TurnaroundMinutes to 24 hoursMinutes to 24 hours
Partner Network30+ gym brandsEquinox (exclusive)
EquipmentPeloton, Tonal, Hyperice, and moreNot currently
Payment MethodHSA/FSA card at checkoutHSA/FSA card at checkout
Funding$34M Series A (a16z)Private
Best ForMost gyms + fitness equipmentEquinox members

Cost comparison: For a $200/month Equinox membership, Flex charges $8/month (4%). Through Truemed (if Equinox were available), you would pay $30 once for 12 months. For non-Equinox gyms, Truemed is the primary option.

Which Gyms Accept HSA/FSA Payments?

Truemed Partner Gyms (30+)

Barry's
CorePower Yoga
SoulCycle
24 Hour Fitness
CrossFit affiliates
YMCA
Club Pilates
SPENGA
F45 Training
Life Time
Orangetheory Fitness
Title Boxing Club
Rumble Boxing
Pure Barre
CycleBar
StretchLab
Solidcore
Anytime Fitness

Plus additional regional and boutique gyms. Check Truemed's website for the full list.

Equinox + Flex (Exclusive Partnership)

As of February 2026, Equinox partners exclusively with Flex for HSA/FSA payments. Equinox members pay with their HSA/FSA card directly through the Equinox billing system after qualifying through Flex's health survey.

Any Gym With Direct Reimbursement

Even if your gym is not a Truemed or Flex partner, you can still use HSA funds. Get an LMN from your own provider, pay for the membership, and submit the receipt plus LMN to your HSA administrator for reimbursement.

How Much You Save

When you pay for a gym membership with pre-tax HSA dollars, you avoid federal income tax, state income tax (in most states), and FICA taxes (7.65%). Here is what that looks like at different tax brackets:

$50/month gym at 22% bracket

$132

saved per year

$150/month gym at 24% bracket

$432

saved per year

$250/month gym at 32% bracket

$960

saved per year

Savings shown are federal income tax only. If your HSA contributions are made through payroll deduction, you also save on FICA (7.65%). State income tax savings vary. California, New Jersey, and New Hampshire do not give state tax benefits for HSA contributions.

The One Big Beautiful Bill: What Actually Happened

There is widespread confusion about the One Big Beautiful Bill Act (signed July 2025) and gym memberships. Here is the truth:

✗

The bill did NOT make gym memberships a qualified HSA expense

Early drafts included "physical activity expenses" up to $500/year as qualified medical expenses. This was stripped from the final bill.

✓

The bill DID expand HSA eligibility in other ways

Telehealth access before deductible, direct primary care compatibility, and higher contribution limits for 2026+. Read the full breakdown.

The LMN pathway described in this guide is the only current way to use HSA funds for gym memberships. This could change with future legislation, but as of 2026, no bill has changed the IRS position on fitness expenses.

Other HSA-Eligible Fitness Expenses

Gym memberships are just one piece of the fitness-HSA picture. Here are other fitness-related expenses and their eligibility:

Physical Therapy

With a doctor's prescription

Peloton & Exercise Equipment

With an LMN via Truemed

Personal Training

With an LMN for a diagnosed condition

Weight Loss Programs

Doctor-prescribed for a diagnosis

Chiropractic Care

Licensed chiropractor visits

Acupuncture

Licensed acupuncturist visits

Massage Therapy

With a prescription for a medical condition

Step-by-Step: Pay for Your Gym With HSA

  1. 1

    Check if your gym is a partner

    Search Truemed or Flex for your gym. If it is a partner, you can pay with HSA/FSA directly at checkout.

  2. 2

    Complete the health survey

    Answer questions about your medical history. A licensed provider reviews your responses and determines if you qualify for an LMN.

  3. 3

    Receive your LMN

    If approved, you get a Letter of Medical Necessity within minutes to 24 hours. This is valid for 12 months.

  4. 4

    Pay with your HSA/FSA card

    For partner gyms, pay at checkout with your HSA/FSA card. For non-partner gyms, pay out-of-pocket and submit the receipt plus LMN for reimbursement.

  5. 5

    Keep your documentation

    Save your LMN, receipts, and payment records. Your HSA administrator may request these during an audit.

Frequently Asked Questions

Can I use my HSA for a gym membership?▼
Yes, but only with a Letter of Medical Necessity (LMN) from a licensed healthcare provider. The IRS considers gym memberships a "general health" expense by default. An LMN proves the membership is treating a specific diagnosed condition like obesity, Type 2 diabetes, or cardiovascular disease.
How do I get a Letter of Medical Necessity for my gym?▼
Two main options: (1) Ask your doctor to write one linking your gym membership to a diagnosed condition with ICD-10 codes. (2) Use a service like Truemed ($30 one-time fee) or Flex (4% monthly fee at Equinox) that connects you with a licensed provider through an online health survey. Both are faster than a doctor visit.
Which gyms accept HSA/FSA payments?▼
Through Truemed: Barry's, CorePower Yoga, SoulCycle, 24 Hour Fitness, CrossFit affiliates, YMCA, Club Pilates, SPENGA, F45, Life Time, and 20+ more. Equinox partners exclusively with Flex for HSA/FSA payments. Most local gyms can also be reimbursed directly from your HSA if you have a valid LMN.
Did the One Big Beautiful Bill make gym memberships HSA-eligible?▼
No. Early drafts of the One Big Beautiful Bill Act included a provision to add fitness expenses as qualified HSA expenses. That provision was stripped from the final version signed in July 2025. Gym memberships still require a Letter of Medical Necessity to qualify.
What is the "but for" test?▼
The IRS uses the "but for" test to determine eligibility: would you have purchased the gym membership regardless of your medical condition? If the answer is yes, it does not qualify. Your LMN should state that the membership is specifically prescribed to treat your diagnosed condition - not just for general fitness.
What conditions qualify for an LMN?▼
Common qualifying conditions include obesity (BMI 30+), Type 2 diabetes, cardiovascular disease, hypertension, depression and anxiety disorders, chronic pain conditions, metabolic syndrome, and musculoskeletal disorders. Your provider determines medical necessity based on your specific health profile.
How much can I save using HSA for my gym?▼
At a 24% marginal tax rate, a $150/month gym membership ($1,800/year) saves you $432 in federal taxes. At the 32% bracket, that jumps to $576. If your HSA contributions are made through payroll deduction, you also avoid FICA taxes (7.65%), increasing your savings further.
Is personal training HSA-eligible?▼
Yes, with a Letter of Medical Necessity. If a licensed provider prescribes personal training as part of a treatment plan for a diagnosed condition, the cost qualifies as an HSA-eligible expense. The same LMN pathway applies as gym memberships.
How long does an LMN last?▼
A Letter of Medical Necessity is typically valid for 12 months. You will need to renew it annually. Some providers and services like Truemed handle renewals automatically. Keep your LMN on file - your HSA administrator may request it during an audit.
Can I use my FSA for a gym membership too?▼
Yes. The same rules apply to both HSAs and FSAs - you need a valid Letter of Medical Necessity. Truemed and Flex support both HSA and FSA payments. The key difference is FSA funds expire annually, so plan your gym spending accordingly.

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