Yes, Plan B is covered by an HSA. Emergency contraception is a qualified medical expense, so you can use pre-tax HSA dollars to buy Plan B over the counter without a prescription or prior approval. Brand-name Plan B usually runs $40 to $50 per dose, and paying with HSA funds lowers your real cost by the taxes you avoid.
The prescription requirement for over-the-counter medications went away when the CARES Act took effect for purchases after December 31, 2019.1Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act IRS Publication 502 lists birth control pills among qualified medical expenses, and emergency contraceptives fall under the same category.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Paying With Your HSA Card at the Pharmacy
Most administrators issue a debit card linked to your HSA. Swipe it at the pharmacy and the store’s point-of-sale system checks the product against an inventory database to confirm it qualifies. Retailers that use the Inventory Information Approval System (IIAS) verify eligible products automatically, and the transaction usually goes through with no extra step.
Some stores have not implemented IIAS, and your HSA card may be declined there even though Plan B is eligible. If that happens, pay with a personal card or cash and reimburse yourself from the HSA afterward.
Reimbursing Yourself if You Paid Out of Pocket
You can withdraw an amount equal to what you spent on Plan B from your HSA tax-free, as long as the purchase happened after you opened the account. There is no deadline for claiming the reimbursement.3Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans You could buy Plan B today and take the distribution months or years from now. Some people leave HSA funds invested and reimburse themselves later to get more tax-free growth.
Most administrators accept reimbursement requests through an online portal where you upload the receipt. Processing time depends on the administrator.
One rule matters here: you cannot reimburse the same expense from more than one tax-advantaged account. If insurance, an FSA, or an HRA already paid for the Plan B purchase, you cannot also take a distribution from your HSA for it.4Treasury.gov. Revenue Ruling 2004-45 – Health Savings Accounts Interaction With Other Health Arrangements
Receipts to Keep
The IRS does not want receipts submitted with your return, but you have to produce them if audited.3Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Save an itemized receipt that shows:
- the product name identifying the specific medication
- the date of purchase
- the amount paid
- the retailer name
Hold the receipt for at least three years after you file the tax return for the year you take the distribution.5Internal Revenue Service. How Long Should I Keep Records If you delay reimbursement, that three-year clock does not start until you actually claim the distribution, which could be well after the purchase date. Digital copies are fine as long as they are legible.
You also report HSA distributions on Form 8889 each year your account had contributions or distributions, even when every dollar went to qualified expenses.6Internal Revenue Service. Instructions for Form 8889
Buying Plan B for a Spouse or Dependent
Your HSA can pay for qualified medical expenses of your spouse or any tax dependent, not only your own.7Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts So you can use HSA funds to buy Plan B for either.
Adult children are the trap. Health insurance often covers a child through age 26, but that does not make the child a tax dependent. If you cannot claim the child on your federal return, you cannot use your HSA for their medical expenses. An adult child in that situation could open their own HSA if enrolled in a qualifying high-deductible health plan.
Generics and Other Emergency Contraceptives
Plan B One-Step is the best-known brand, but generic versions with the same active ingredient (levonorgestrel) sell for roughly $11 to $45. Take Action, My Way, Aftera, and EContra all work the same way and are HSA-eligible as over-the-counter medications.
Ella (ulipristal acetate) is a prescription emergency contraceptive that works up to five days after unprotected sex, versus three days for levonorgestrel options. As a prescribed drug, it has always been HSA-qualified.7Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
The IRS issued guidance in late 2024 confirming that over-the-counter oral contraceptives, including emergency contraceptives, count as preventive care for HDHP purposes. Your HDHP may cover Plan B before you meet the deductible without putting your HSA eligibility at risk.8Internal Revenue Service. Notice 2024-75 – Preventive Care for Purposes of Qualifying as a High Deductible Health Plan
What Happens if You Use HSA Funds on Something That Does Not Qualify
A distribution that does not go to a qualified medical expense is added to your taxable income and hit with an additional 20% tax.7Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts On a $50 purchase the IRS later treats as improper, you would owe income tax on the $50 plus a $10 penalty.
Three situations remove the 20% additional tax, though the distribution stays taxable:
- you are 65 or older
- you are disabled
- the distribution goes to a beneficiary after the account holder’s death
Plan B itself is not one of these gray-area purchases. It is a straightforward qualified expense, so as long as you keep the receipt, a distribution to pay for it carries no tax and no penalty.