HRA eligible expenses are the medical costs your employer’s Health Reimbursement Arrangement will pay you back for tax-free, drawn from the list the IRS recognizes under Section 213(d) of the Internal Revenue Code. That federal list is broad: doctor visits, prescriptions, dental and vision care, mental health treatment, many over-the-counter products, medical travel, and more. Two things narrow it in practice. Your employer’s plan document can cover a subset of what federal law allows, and the type of HRA you have (traditional, Individual Coverage, QSEHRA, or Excepted Benefit) changes whether items like insurance premiums are reimbursable.
The IRS Baseline for Any HRA
Every HRA starts from the same statute. Section 213(d) defines a qualified medical expense as a cost for diagnosing, treating, or preventing disease, or one that affects a structure or function of the body.1Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses That wording is intentionally wide, picking up obvious items like surgery and lab work alongside acupuncture, chiropractic care, hearing aids, and guide dogs.
IRS Publication 502 is the practical companion to the statute. It lists hundreds of qualifying items alphabetically, and most plan administrators use it when approving or denying a claim. One timing rule to know: you generally cannot get reimbursed for prepaid care that will be delivered well beyond the end of the current year, with limited exceptions for long-term care insurance and lifetime care arrangements.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Federal law sets the ceiling, not the floor. Your Summary Plan Description is the document that tells you what your specific plan actually covers.
Medical, Dental, and Vision Care
The expenses most people think of first are squarely eligible. Office visits, specialist consultations, hospital stays, diagnostic tests, X-rays, and ambulance transportation all qualify. Preventive care like annual physicals, immunizations, and cancer screenings is covered. Prescription drugs are reimbursable under essentially every HRA design.
Dental care runs well beyond emergencies. Cleanings, fillings, extractions, root canals, dentures, and orthodontic treatment such as braces are all reimbursable when performed by a licensed provider. Preventive services like fluoride treatments and sealants qualify too.
Vision expenses include eye exams, prescription eyeglasses, contact lenses, prescription sunglasses for sight correction, and corrective procedures like LASIK. The expense has to correct or treat a vision problem rather than serve a purely cosmetic purpose.
Over-the-Counter Products and Menstrual Care
Before 2020, most over-the-counter medications required a doctor’s prescription to qualify. The CARES Act permanently eliminated that requirement. Pain relievers, cold and flu medicine, allergy medications, antacids, and similar pharmacy staples are now reimbursable without a prescription.3Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
The same legislation added menstrual care products to the eligible list. Tampons, pads, liners, cups, and similar items all qualify.3Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act Medical devices you can buy without a prescription, like bandages, thermometers, blood pressure monitors, and first aid supplies, are also reimbursable. These everyday items add up, and many people leave money on the table by not submitting claims for them.
Mental Health, Substance Abuse, and Long-Term Care
Mental health treatment is fully eligible under Section 213(d). Psychiatric care, sessions with a psychologist, and psychoanalysis all qualify. Inpatient treatment at a residential facility for alcohol or drug addiction is covered, including the cost of meals and lodging at the treatment center.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses Legal fees necessary to authorize treatment for a mental illness can also be reimbursed.
Long-term care qualifies under specific conditions. The services must be for a chronically ill individual who either cannot perform at least two daily living activities without help (eating, bathing, dressing, transferring, toileting, or continence) or who requires substantial supervision due to severe cognitive impairment. A licensed practitioner must prescribe a plan of care.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses Nursing home costs qualify when the principal reason for being there is medical care, including meals and lodging in that situation.
Medical Travel and Home Modifications
Transportation to and from medical appointments is eligible, and most people overlook it. For 2026, the IRS standard mileage rate for medical travel is 20.5 cents per mile.4Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents Parking fees and tolls incurred while traveling for care count too, as do bus, taxi, and ambulance fares.
Home modifications made for a medical reason can qualify. Installing wheelchair ramps, widening doorways, adding grab bars in bathrooms, or lowering kitchen cabinets for someone with a disability are all potentially reimbursable. The IRS applies a specific calculation: if the modification increases your home’s value, only the portion of the cost that exceeds the increase in property value counts as a medical expense. If the modification does not increase property value at all, the full cost qualifies. Ongoing maintenance of the modification remains eligible as long as the medical need still exists.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
What Doesn’t Qualify
Cosmetic procedures are the biggest category of exclusions. The statute specifically bars any procedure aimed at improving appearance that does not meaningfully promote proper body function or treat illness. Facelifts, teeth whitening, hair transplants, and elective liposuction all fall outside the definition of medical care. There is an exception: cosmetic procedures that correct a deformity from a congenital abnormality, an accident or trauma, or a disfiguring disease do qualify.1Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
General wellness and personal care items also miss the mark. Gym memberships, health club dues, personal training sessions, and vitamins taken for general health rather than to treat a diagnosed condition are not eligible. Toothpaste, soap, sunscreen used for daily grooming, and similar hygiene products do not qualify.
Gray-Zone Items and Letters of Medical Necessity
Some expenses sit between medical care and personal use. Weight loss programs, ergonomic office equipment, air purifiers, and certain nutritional supplements can go either way. They only qualify when a licensed healthcare provider determines the expense is medically necessary to treat a specific diagnosed condition.
A Letter of Medical Necessity bridges that gap. It must come from your doctor or other licensed provider, and it should include your diagnosis, the specific treatment or product recommended, and an explanation of why it is medically necessary for your condition. The core test is sometimes called the “but for” standard: you would not be purchasing the item if not for the medical condition. Without this letter, plan administrators will deny the claim. Getting the letter before you make the purchase saves the hassle of appealing a denial after the fact.
How Your HRA Type Changes the Answer
Not all HRAs work the same way. The type your employer offers determines what the funds can be used for, how much is available, and whether insurance premiums qualify.
- Traditional (integrated) HRA. The most common design. Your employer pairs it with a group health plan, and funds reimburse out-of-pocket medical costs. Health insurance premiums are not eligible. The employer sets the annual allowance with no statutory cap.
- Individual Coverage HRA (ICHRA). The employer reimburses you for individual health insurance premiums and other medical expenses. You must carry your own health plan, such as a Marketplace policy, to participate. There is no minimum or maximum annual contribution limit set by law.5HealthCare.gov. Individual Coverage Health Reimbursement Arrangements
- Qualified Small Employer HRA (QSEHRA). Available only to employers with fewer than 50 full-time employees that do not offer group health coverage. For 2026, the maximum annual reimbursement is $6,450 for self-only coverage and $13,100 for family coverage.6Internal Revenue Service. Rev. Proc. 2025-19
- Excepted Benefit HRA (EBHRA). A smaller supplemental account that can reimburse out-of-pocket medical expenses plus premiums for dental, vision, and other “excepted benefit” plans. The employer must also offer a group health plan, though employees don’t have to enroll in it. The 2026 annual cap is $2,200.6Internal Revenue Service. Rev. Proc. 2025-19
Knowing which type you have matters. An expense that is reimbursable under an ICHRA, like your monthly health insurance premium, may not be reimbursable under a traditional HRA. Check your plan documents if you’re unsure which type your employer offers.
Whose Expenses Your HRA Can Cover
HRA reimbursements aren’t limited to your own expenses. Eligible individuals include your spouse, your tax dependents, and your children under age 27 at the end of the tax year, even if they are not your tax dependents.7Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans For divorced or separated parents, a child is treated as the dependent of both parents for HRA purposes, regardless of who claims the exemption. Spouses and dependents of deceased employees are also eligible for reimbursement.
Proving the Expense and Meeting the Deadline
To get reimbursed, you need documentation that proves three things: what the expense was, when it was incurred, and who received the care. An itemized receipt or an Explanation of Benefits from your insurer typically covers all three. The receipt should show the provider’s name, the date of service, a description of the service or product, and the amount you paid. The patient’s name must be visible to confirm the expense belongs to an eligible individual.
If you incur an eligible expense near the end of your plan year, you don’t necessarily have to submit the claim before the plan year closes. Most HRA plans include a run-out period, an administrative window after the plan year ends during which you can still submit claims for expenses incurred during that plan year. A common run-out window is 90 days, so a plan year ending December 31 would allow claims through March 31. Your plan documents will specify the exact deadline. Missing that deadline means losing the reimbursement, so save receipts as you go rather than scrambling at year-end. If your plan administrator ever audits your account, you’ll need the same documentation you submitted with the original claim.