25 Eligible Expenses Tips for Health Savings Accounts (2026)

The definitive guide for what is and isn't an eligible HSA expense is IRS Publication 502. Reviewing this document annually ensures you're up-to-date with current rules and helps avoid audit confusion.

Keep every receipt, Explanation of Benefits (EOB), and doctor's note related to your HSA spending. Digital copies are ideal for easy access and audit defense, important for self-employed individuals managing their own books.

Knowing your HDHP deductible helps you anticipate out-of-pocket costs that your HSA is designed to cover before your insurance kicks in, allowing for better budgeting and contribution planning.

Your HSA can cover qualified medical expenses for your spouse and any tax dependents, even if they aren't on your specific HDHP. This is a powerful way to maximize tax-advantaged healthcare for your entire family.

If you can afford to pay for current medical expenses out-of-pocket, invest your HSA funds. This allows them to grow tax-free, becoming a significant resource for retirement healthcare costs, much like a 401(k).

If your employer offers a Limited-Purpose FSA (LPFSA) for dental and vision, use it first for those specific expenses. This preserves your HSA funds for broader medical needs or investment growth, avoiding double-dipping.

HSA funds can be used to pay for COBRA premiums or qualified long-term care insurance premiums, offering a tax-free way to maintain coverage during job transitions or plan for future care needs.

Routine dental cleanings, cavity fillings, orthodontia, eye exams, glasses, contact lenses, and even LASIK surgery are all eligible HSA expenses. Many people overlook these common needs.

Therapy, counseling, psychiatric care, and substance abuse treatment are qualified medical expenses. This is important for employees prioritizing holistic well-being.

These alternative treatments are eligible if prescribed by a medical professional for a specific condition. Always get a Letter of Medical Necessity to be safe.

Thanks to recent changes, most OTC medicines (e.g., pain relievers, cold medicine, allergy meds) are HSA eligible without a doctor's prescription, simplifying everyday healthcare costs.

Testing kits, treatment, and even certain preventative items related to COVID-19 are eligible HSA expenses, providing crucial support during public health crises.

For new and expecting parents, breast pumps, bottles, and other lactation support items are eligible expenses, providing significant relief during a costly time.

Custom orthotics or even over-the-counter shoe inserts are eligible if prescribed by a physician for a specific medical condition, such as plantar fasciitis.

Programs and aids designed to help you stop smoking, if medically advised, are eligible expenses. This includes nicotine patches, gum, and counseling.

Weight loss programs are eligible if undertaken for the treatment of a specific disease diagnosed by a physician (e.g., obesity, hypertension, heart disease), not for general health improvement.

Everyday first-aid supplies are eligible, covering minor injuries and preventative care. While small, these add up over time and should be tracked.

Sunscreen with an SPF of 30 or higher is eligible if used to prevent sun damage for a specific medical condition, like a skin sensitivity or history of skin cancer. A doctor's note is advisable.

Beyond the lenses themselves, the solutions and cases needed for proper contact lens care are eligible expenses, covering routine vision maintenance.

Items like crutches, walkers, wheelchairs, blood pressure monitors, and even certain diagnostic devices are eligible if medically necessary.

Mileage, taxi fares, bus fares, and ambulance services to and from medical care are eligible. This includes travel for appointments, treatments, and even prescription pickups.

If you must travel out of town for medical care, the cost of lodging (up to $50 per night per person) for the patient and a companion is eligible.

The costs of buying, training, and maintaining a service animal for a specific medical condition (e.g., guide dog for blindness) are eligible expenses.

Prescription birth control and over-the-counter contraception, including condoms, are eligible HSA expenses, supporting family planning and reproductive health.

Qualified long-term care services, such as nursing home care, home health care, or adult day care for a chronically ill individual, are eligible expenses.