Are Hearing Aids HSA Eligible? OTC Devices, Spouses, and Medicare

Yes, hearing aids are HSA eligible. The IRS treats hearing loss as a physical condition and lists hearing aids among the medical expenses you can pay for with tax-free distributions from a Health Savings Account, along with batteries, repairs, and ongoing maintenance.¹ Prescription devices, over-the-counter models, and the audiology services that go with them all qualify.

What Hearing-Related Expenses Qualify

The eligible list runs wider than the device itself. You can use HSA funds for:

The hearing aids, including a second set or a replacement pair¹
Batteries, repairs, and maintenance to keep the device working¹
Audiology exams, fittings, and programming, which qualify as payments for medical services¹
Special telephone equipment for someone who is deaf or hard of hearing, including TTY and TDD devices and their repair¹
Buying, training, and maintaining a service animal that assists a hearing-disabled person, including food, grooming, and veterinary care¹
Lip reading instruction for a hearing-disabled person¹

IRS Publication 502 doesn’t name every possible expense. If something hearing-related isn’t specifically listed, the general test is whether it addresses the diagnosis, treatment, or mitigation of a disease or physical condition.²

Over-the-Counter Hearing Aids Count Too

Since the FDA authorized over-the-counter hearing aids for adults with mild to moderate hearing loss in 2022, you can buy them without a prescription at pharmacies and electronics retailers. Publication 502 refers to “the cost of a hearing aid” without distinguishing prescription from over-the-counter, so both are HSA eligible.¹

OTC hearing aids typically cost a few hundred dollars per pair, compared with several thousand for premium prescription devices. If your loss is mild, your HSA balance may cover the whole purchase. Batteries and repairs for OTC devices follow the same eligibility rules as prescription models.

Paying for a Spouse or Dependent’s Hearing Aids

An HSA isn’t limited to your own care. You can pay for qualified medical expenses, including hearing aids, for your spouse, your tax dependents, and anyone who would qualify as your dependent except that they filed a joint return, had gross income above the exemption threshold, or you could be claimed on someone else’s return.³ For children of divorced or separated parents, the child is treated as a dependent of both parents for HSA purposes, regardless of which parent claims the child on their tax return.4

The expense still has to meet the IRS definition of medical care.²

When Insurance Pays Part of the Cost

If your health insurance covers part of a hearing aid purchase, your HSA can pay whatever you still owe. Copayments, coinsurance, and amounts applied to your deductible all qualify when they relate to medical care. What HSA funds cannot cover is any portion that insurance has already paid. The IRS requires that qualified medical expenses “not be compensated for by insurance or otherwise.”⁵

So if hearing aids cost $3,000 and insurance covers $1,500, the remaining $1,500 is HSA eligible. The same logic applies to audiology appointments and fitting fees: any copay or deductible amount left after insurance is fair game.

How to Pay With Your HSA

Most HSA administrators issue a debit card linked to your account. Swipe it at the audiologist’s office, hearing aid retailer, or pharmacy the same way you would any other card, and the funds come straight from your HSA balance.

If you don’t have a card, or the provider doesn’t accept it, pay out of pocket and reimburse yourself later. Log into your administrator’s portal, upload an itemized receipt, and request a distribution. The reimbursement lands in your linked bank account.

No Deadline for Reimbursement

There is no time limit for paying yourself back. As long as you incurred the expense after your HSA was established, you can pay out of pocket today and request reimbursement months or years later.⁵ Meanwhile the balance keeps growing tax-free through interest or investments. You do need to hold onto the receipt for the entire delay period; without documentation, you can’t prove the distribution was qualified.

Expenses Before the Account Was Open

One timing rule matters here. You cannot use HSA funds for medical expenses you incurred before opening the HSA. Only expenses incurred after the account is established qualify for tax-free distributions.⁵ If hearing aids are on the horizon and you don’t have an HSA yet, open the account first.

Recordkeeping

You don’t submit receipts with your tax return, but you do need to keep records showing three things: the distribution paid for a qualified medical expense, the expense wasn’t already covered by insurance or another source, and you didn’t also claim it as an itemized deduction.⁵

In practice, save the itemized receipt from your audiologist or hearing aid provider. A credit card statement alone won’t work because it doesn’t describe what you bought. A useful receipt shows the provider’s name, the date, a description of the product or service, and the amount. Store these digitally or in a folder. The general statute of limitations for tax returns is three years from filing, so keep HSA records at least that long. If you’re delaying reimbursement, hold the receipt until three years after the return that eventually reports the distribution.

What Happens if You Misuse HSA Funds

Withdrawals for anything that isn’t a qualified medical expense are added to your taxable income for the year and hit with an additional 20 percent tax.⁵ For someone in the 22 percent federal bracket, that means roughly 42 cents of every misused dollar goes to taxes and penalties.

The 20 percent additional tax disappears once you turn 65, become disabled, or pass away. After 65, non-medical withdrawals are still taxed as ordinary income, but the extra penalty no longer applies.⁵ Hearing aids qualify at any age, so proper documentation keeps this penalty off the table.

Medicare Changes What You Can Do

Enrolling in any part of Medicare ends your ability to contribute to an HSA. Federal law reduces your contribution limit to zero starting the first month you are entitled to Medicare benefits.⁶ You can keep spending whatever balance is already there on qualified expenses, including hearing aids, but no new money goes in.

Retroactive Medicare coverage catches many people off guard. Applying for Social Security after age 65 automatically enrolls you in Medicare Part A, and that coverage can be backdated up to six months. Any HSA contributions made during the retroactive window become excess contributions and can trigger tax consequences. If you plan to apply for Social Security or Medicare after 65, stop HSA contributions at least six months before your application date.

1
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
2
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
3
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans>
4
Internal Revenue Service. Instructions for Form 8889 (2025)
5
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
6
Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts