Your HSA card covers medical care in the tax law’s sense of the term: amounts paid to diagnose, treat, or prevent disease, or to affect a structure or function of the body.1Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses In practice that reaches further than most people expect — doctor visits, dental work, prescriptions, over-the-counter medicine, vision and hearing care, medical equipment, and even travel to a specialist. It does not reach general wellness, cosmetic upgrades, or most insurance premiums. Spending HSA money outside the qualified list adds the amount to your taxable income and adds a 20% penalty on top.
Doctors, Dentists, and Mental Health Providers
Professional care is the largest bucket. Your card pays co-pays, deductibles, and coinsurance for physicians, surgeons, and specialists, along with hospital stays. Dental care qualifies broadly: cleanings, X-rays, fillings, extractions, braces, and dentures. Mental health treatment counts too, including sessions with psychiatrists, psychologists, and licensed therapists, as well as psychoanalysis. Chiropractic adjustments and acupuncture are on the list.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
The through-line is that the service treats or prevents a condition. Purely cosmetic dental work, teeth whitening being the standard example, does not qualify.
Prescription and Over-the-Counter Medicine
Since 2020, the CARES Act has let you buy over-the-counter drugs and menstrual care products with HSA funds without a prescription. Pain relievers, allergy medicine, cold remedies, and similar OTC products go on the card with no doctor’s note.3Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
Insulin qualifies whether or not you have a prescription. Medicated creams and ointments that treat a specific condition qualify. The line is medical purpose versus personal care: a medicated first-aid ointment is in, ordinary toothpaste and cosmetics are out.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Vision and Hearing
Eye exams, prescription eyeglasses, and contact lenses qualify. If you wear contacts, saline solution and enzyme cleaners are covered. Corrective eye surgery, including LASIK and radial keratotomy, qualifies because it treats defective vision.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
On the hearing side, exams, hearing aids, and the batteries, repairs, and maintenance those devices need all qualify.
Reproductive Health and Menstrual Products
Birth control pills prescribed by a doctor, pregnancy test kits, and ovulation monitors are qualified purchases. Breast pumps and lactation supplies qualify, though extra bottles used only for food storage do not.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Menstrual care products — tampons, pads, liners, and cups — are permanently qualified under the CARES Act. No documentation needed.3Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
Medical Equipment and Supplies
Durable equipment used to manage a health condition qualifies. That covers wheelchairs, walkers, and crutches; blood sugar test kits, blood pressure monitors, and other diagnostic devices; artificial limbs; and the cost of buying, training, and caring for a guide dog or other service animal. Everyday first-aid supplies like bandages and thermometers qualify too.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
The item has to serve a medical purpose rather than general comfort. That distinction is what pushes vitamins and exercise gear off the list in most cases and keeps a glucose monitor on it.
Home Modifications for a Disability
If you, your spouse, or a dependent needs changes to the home for a medical reason, those modifications can qualify. Changes that typically do not raise a home’s value — entrance ramps, widened doorways, bathroom grab bars, lowered kitchen cabinets, stairway modifications, and installed porch lifts — qualify in full.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
When a modification does raise property value, such as an elevator, only the portion of the cost that exceeds the value increase qualifies. Pay $10,000 for a change that lifts your home’s value by $4,000, and $6,000 counts as a medical expense. Purely aesthetic upgrades tacked onto a medical project do not.
Travel and Lodging to Reach Care
Getting to a provider counts. Bus, train, and plane fares qualify, and so do ambulance charges. If you drive your own car, you can track actual gas and oil costs or use the IRS standard medical mileage rate, which is 20.5 cents per mile for 2026.4Internal Revenue Service. Notice 2026-10 – 2026 Standard Mileage Rates Parking and tolls qualify either way.
When care requires overnight travel, lodging qualifies up to $50 per night per person. A parent staying with a sick child can count up to $100 per night for the two of them. Meals on the trip do not qualify.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Insurance Premiums: Mostly No, With Exceptions
Health insurance premiums generally do not qualify. Four situations are carved out where you can pay premiums with HSA funds tax-free:
- COBRA continuation coverage after leaving a job.
- Health coverage paid for while you are receiving federal or state unemployment compensation.
- Medicare premiums once you turn 65, including Part A, Part B, Part D, and Medicare Advantage. Medigap supplemental policies do not qualify.
- Qualified long-term care insurance, up to age-based annual limits that for 2026 run from $500 at age 40 and under to $6,200 above age 70.
Paying any other premium from your HSA triggers the tax and penalty described below.
What Your HSA Card Will Not Cover
The IRS excludes anything “merely beneficial to general health.”2Internal Revenue Service. Publication 502 – Medical and Dental Expenses That knocks out a familiar list:
- Cosmetic procedures such as face lifts, hair transplants, electrolysis, liposuction, and teeth whitening, unless the procedure corrects a deformity from a congenital condition, accident, or disfiguring disease.
- Gym memberships and general fitness programs, even if your doctor recommends staying active.
- Vitamins and supplements taken for overall health, and vacations of any kind.
Some borderline items can qualify when a doctor documents a specific medical need — exercise equipment prescribed to treat a diagnosed condition, for example. A written letter of medical necessity from your provider is what backs up the expense if the IRS asks.
The Penalty for Non-Qualified Purchases
Use HSA funds for anything outside the qualified list and the amount is added to your taxable income for the year, with an additional 20% tax on top.5Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans For someone in the 22% federal bracket, a $1,000 non-qualified charge can cost about $420 in combined taxes.
The 20% add-on does not apply after you turn 65, if you become disabled, or upon death. In those cases the withdrawal is still taxed as ordinary income, but the extra penalty drops away.
Records to Keep
You do not send receipts with your tax return, but you have to be able to show three things if questioned: the withdrawal paid for a qualified medical expense, the expense was not reimbursed by insurance or any other source, and you did not also claim it as an itemized deduction.5Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Keep itemized receipts, explanation-of-benefits statements, and any letters of medical necessity for purchases that sit close to the line.
The IRS can audit for three years after filing, and up to six if it suspects a substantial understatement. Holding HSA records for at least six years is a sensible cushion.