What Can I Spend HSA Money On and What Doesn’t Qualify

You can spend HSA money on almost any expense that diagnoses, treats, or prevents a specific medical condition. That is the IRS test, and it is wider than most account holders realize: doctor visits, therapy, dental and vision care, hearing aids, prescriptions, over-the-counter medicine, menstrual products, medical equipment, certain home modifications, service animals, and travel to get care all qualify for tax-free withdrawals.¹ General wellness spending, cosmetic procedures, and everyday toiletries do not.

Doctors, Therapy, Dental, Vision, and Hearing

Care from doctors, surgeons, specialists, and psychiatrists is eligible, and so is preventive care like annual physicals and vaccinations. Mental health treatment counts in full: sessions with psychologists, licensed therapists, and counselors who are treating a diagnosed condition such as depression, anxiety, or substance abuse. The counseling has to address a medical or mental health condition, though. Marriage counseling and life coaching on their own do not qualify.

Dental work follows the same principle. Cleanings, fillings, X-rays, crowns, extractions, root canals, and braces are all eligible because they treat or prevent oral disease.² Teeth whitening and other purely cosmetic procedures do not. The line is clinical need versus appearance.

Vision expenses cover eye exams, prescription eyeglasses, and contact lenses, including the saline solution and enzyme cleaner that go with contacts. Corrective procedures like laser eye surgery and radial keratotomy also qualify because they treat defective vision.²

Hearing costs get the same treatment. The purchase price of hearing aids, the batteries they run on, and any repair or maintenance are all reimbursable.² This is one category people tend to underuse, and the savings matter given how much hearing aids cost.

Prescriptions, OTC Drugs, and Menstrual Products

Prescription medications and insulin are straightforward qualified expenses. What surprises many account holders is that over-the-counter drugs no longer need a prescription to qualify. The CARES Act, signed into law in March 2020, permanently removed the prescription requirement. Pain relievers, allergy medication, cold medicine, and antacids can all be bought tax-free directly from your HSA.

The same law added menstrual care products to the eligible list. Tampons, pads, liners, cups, and similar items qualify without a prescription or letter of medical necessity.

Medical supplies like bandages, thermometers, and blood pressure monitors also qualify as long as they serve a health-related purpose. Keep receipts. Your HSA administrator or the IRS could later ask you to show that a purchase was medical, and a receipt paired with the item description makes that easy.

Vitamins and Supplements

General multivitamins taken for overall health do not qualify, because the IRS treats them as dual-purpose items. A vitamin or supplement prescribed for a specific diagnosed condition can be eligible with a Letter of Medical Necessity from your doctor: vitamin D for a documented deficiency, iron for anemia, or calcium for osteoporosis. Prenatal vitamins are one exception that qualifies without a note, because the IRS treats pregnancy as a health condition.

Equipment, Home Modifications, and Service Animals

HSA funds can pay for medically necessary equipment and for changes to your home. If you install a wheelchair ramp, grab bars, or a porch lift, the full cost qualifies as a medical expense as long as the improvement does not increase your home’s value. If it does add value, only the difference between what you paid and the increase in property value is eligible.² Accessibility improvements like ramps and widened doorways rarely raise market value, so in practice the full cost is usually deductible.

Service animals are another expense people overlook. Buying, training, and maintaining a guide dog or other service animal for a person with a physical disability is a qualified medical expense, and that includes ongoing food, grooming, and veterinary care.² Emotional support animals and therapy pets do not qualify. The animal has to be trained to perform specific tasks tied to a disability.

Travel and Lodging for Medical Care

Getting to a doctor or hospital is itself a qualified expense. You can use HSA funds for bus fare, taxi or rideshare costs, ambulance fees, parking, and tolls when the trip is primarily for medical care. If you drive your own car, the IRS allows a standard medical mileage rate of 20.5 cents per mile for 2026.³

Lodging during medical travel is eligible but capped at $50 per night per person. If a parent travels with a sick child, that is up to $100 per night total. Meals are not covered.² The lodging has to be essential to the care. Staying in a hotel because your specialist is in another city qualifies. Extending the trip for sightseeing does not.

Acupuncture, Chiropractic, and Massage

Acupuncture is a qualified medical expense with no special documentation required. Chiropractic care qualifies the same way.² The IRS is more flexible here than people expect.

Massage therapy is different. It generally falls under general health rather than medical care. To make it eligible you need a Letter of Medical Necessity from a licensed provider stating that massage treats a specific diagnosed condition such as chronic back pain or recovery from surgery. The letter should describe the diagnosis, the recommended treatment duration, and how massage addresses the condition. Without that documentation, the expense is not qualified.

Paying for a Spouse or Dependent

Your HSA is not limited to your own bills. You can use it for qualified medical expenses incurred by your spouse, even if your spouse is not on your health plan.⁴ The same applies to anyone you claim as a tax dependent, typically children or other relatives who receive more than half their financial support from you.

The IRS also allows HSA distributions for people you could have claimed as dependents even if you did not. This comes up when a qualifying relative filed their own joint return or had income above the exemption threshold.⁵ Domestic partners get no special carve-out. A domestic partner’s expenses qualify only if that partner meets the IRS definition of a tax dependent.

What Does Not Qualify

A few categories trip people up consistently:

Gym memberships and fitness classes. Considered general health maintenance, not treatment of a specific condition, no matter how beneficial the exercise is.
Cosmetic procedures. Teeth whitening, elective cosmetic surgery, and anything done purely for appearance. If a procedure has both a cosmetic and medical purpose, only the portion addressing the medical need is eligible.
Toiletries and personal care. Toothpaste, toothbrushes, deodorant, shampoo, and similar everyday items are not medical expenses. Medicated versions, like prescription shampoo for a scalp condition, can qualify.
General vitamins and supplements. Only eligible with documentation tying them to a specific medical condition.
Medigap premiums. Most Medicare premiums are eligible after age 65, but Medicare supplemental insurance premiums specifically cannot be paid with HSA funds.

When in doubt, apply the IRS test: does the expense diagnose, treat, or prevent a specific disease or condition? If the honest answer is that it just makes you healthier in general, it does not qualify.

After Age 65

Once you turn 65, the account gets more flexible. The 20% penalty for non-medical withdrawals disappears.⁵ You can pull money out for any purpose and simply pay ordinary income tax on it, similar to a traditional 401(k) or IRA. Medical withdrawals still come out tax-free, so there is still a reason to use the money for healthcare first.

One of the most valuable post-65 uses is Medicare premiums. Part A, Part B, Part C (Medicare Advantage), and Part D prescription drug coverage all qualify as tax-free medical expenses. Medigap is the exception noted above. Given that Medicare premiums add up to thousands of dollars a year, an HSA can function as a dedicated, tax-free retirement healthcare fund if you let it grow.

You cannot contribute new money to an HSA once you enroll in Medicare, even if you are still working. The account itself stays open and keeps growing tax-free, but no new contributions are allowed after Medicare enrollment begins.

The Penalty for Non-Qualified Withdrawals

If you take HSA money for something that is not a qualified medical expense and you are under 65, the consequences are steep. The withdrawal is added to your taxable income for the year, and you owe an additional 20% penalty tax on top of that.⁵ For someone in the 22% federal tax bracket, that is roughly 42 cents of every dollar lost to taxes and penalties.

Three situations eliminate the 20% penalty: reaching age 65, becoming disabled, or death (in which case the account passes to a beneficiary). In all three, non-medical withdrawals are still taxed as ordinary income, but the extra penalty goes away. You report HSA distributions on Form 8889, filed with your annual tax return.

The simplest defense is a receipt for every HSA purchase. If the IRS questions a distribution years later, a receipt showing you bought prescription medication or paid a medical copay resolves it. Many HSA administrators now offer receipt uploads inside their apps, which makes the habit almost effortless.

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
3
Internal Revenue Service. 2026 Standard Mileage Rates
4
Internal Revenue Service. Individuals Who Qualify for an HSA
5
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans