What Can I Use HSA Funds For? Premiums, Long-Term Care & More

You can use HSA funds for a wide range of qualified medical, dental, vision, and hearing expenses, most prescription and over-the-counter products, travel to get care, and a short list of specific insurance premiums, all free of federal income tax when the rules are met.¹ The list is broader than most account holders realize, and it covers your spouse and tax dependents too, even when they aren’t on your high-deductible plan.²

Medical Care and Travel to Get It

The core of HSA-eligible spending is care from licensed providers. Doctor visits, specialist consultations, hospital stays including room and board, surgery, lab work, X-rays, and ambulance rides all qualify. Physical therapy prescribed for an injury or chronic condition counts, and so does psychiatric care from psychologists or psychiatrists. Acupuncture and chiropractic services are eligible.¹

Travel to get medical care qualifies too. You can reimburse yourself for mileage driven to appointments at 20.5 cents per mile for 2026, plus parking and tolls.³ Over a year of specialist visits, those miles add up.

Dental, Vision, and Hearing

Dental is one of the most common HSA uses because health plans often cover it poorly. Cleanings, fillings, crowns, bridges, dentures, braces, aligners, and dental implants are all eligible.¹ A single implant can run $3,000 to $6,000, so paying with pre-tax dollars makes a real difference.

On the vision side, eye exams, prescription eyeglasses (frames and lenses), contact lenses, and contact lens supplies like saline solution all qualify. LASIK and other corrective surgery is eligible.¹ Regular sunglasses are not, even with a prescription, though specialized tinted lenses prescribed for a specific medical condition may qualify with documentation from your eye care provider.

Hearing aids, along with their batteries, repairs, and maintenance, count.¹ Given that a pair can cost several thousand dollars and is rarely covered well by insurance, this is worth knowing.

Prescriptions and Over-the-Counter Products

Prescription medications, brand-name and generic, are a core HSA expense. Insulin qualifies whether or not you have a prescription.¹

The CARES Act permanently expanded eligibility starting in 2020, so you can buy over-the-counter medications with HSA funds without a doctor’s prescription. Pain relievers, cold medicine, allergy treatments, antacids, and first-aid supplies are all fair game. Menstrual care products, including tampons, pads, liners, and cups, also qualify.⁴

Vitamins and supplements taken for general health don’t qualify. They can be eligible only if a doctor prescribes them for a specific diagnosed condition, and you’ll want a letter of medical necessity to back that up.

Spouse and Dependents Are Covered Too

One of the most underused features of an HSA: your funds can pay qualified medical expenses for your spouse and your tax dependents, even if they aren’t enrolled in your high-deductible plan.² If your spouse has their own employer plan, you can still reimburse their copays, prescriptions, and dental work from your HSA tax-free.

The IRS extends this to anyone who qualifies as your dependent for tax purposes, plus certain people you could have claimed as a dependent except for specific filing technicalities, such as the person filing a joint return or having too much income.⁵ For divorced or separated parents, a child is treated as the dependent of both parents for HSA purposes, regardless of who claims the exemption.

Insurance Premiums: A Short List of Exceptions

You generally cannot use HSA funds to pay health insurance premiums. The statute carves out only a few situations:²

COBRA continuation coverage after leaving a job
Health plan premiums while you’re receiving unemployment compensation under federal or state law
Medicare premiums (Parts A, B, C, and D) once you reach age 65
Qualified long-term care insurance premiums, up to age-based limits

Standard employer-sponsored plan premiums, ACA Marketplace premiums, and Medicare supplemental (Medigap) policies are all off-limits.² The Medigap exclusion surprises people who assume all Medicare-related costs qualify after 65. They don’t. But Medicare Advantage (Part C) premiums do, along with standard Part B and Part D premiums.

Long-Term Care Premiums and Services

Qualified long-term care insurance premiums are eligible up to an annual cap that rises with age. For 2026, the cap starts at $500 if you’re 40 or under and climbs to $6,200 if you’re 71 or older, with tiers in between at $930 (41–50), $1,860 (51–60), and $4,960 (61–70).

Actual long-term care services can be paid with HSA dollars when they qualify as medical expenses. Skilled nursing facility costs, home health aide services, and other medically necessary long-term care fall under the general qualified medical expense rules in Publication 502.¹ Nursing home bills in particular can be substantial, so the tax-free treatment matters.

What Doesn’t Qualify

The IRS draws a clear line between medical care and personal care. These common expenses are not eligible:

Cosmetic procedures like face-lifts, hair transplants, and liposuction, unless they correct a deformity from a congenital abnormality, accident, or disfiguring disease¹
Teeth whitening and other purely aesthetic dental work¹
Gym memberships and health club dues, even when a doctor recommends exercise
Personal hygiene items like toothpaste, deodorant, and cosmetics⁶
General-health vitamins and supplements not tied to a specific diagnosed condition

The penalty for getting this wrong is steep. If you withdraw HSA money for a non-qualified expense before age 65, the amount is added to your taxable income and you pay an additional 20% tax on top. On a $1,000 non-qualified withdrawal in the 22% bracket, you’d lose $420 to taxes and penalties. After age 65, the 20% penalty goes away, but the distribution is still taxed as ordinary income, so the HSA essentially functions like a traditional IRA for non-medical spending.²

For gray-area items like a mattress for back pain or an air purifier for allergies, a letter of medical necessity from your doctor can make the difference. The letter should describe your condition, explain why the item is medically necessary, and be signed and dated. The test the IRS applies is whether you would have bought the item regardless of the condition. If yes, it probably doesn’t qualify.

You Can Reimburse Yourself Years Later

The IRS sets no time limit on when you reimburse yourself for a qualified medical expense. You can pay out of pocket today, save the receipt, let your HSA grow, and take the money out tax-free years later, as long as the expense was incurred after the HSA was established.⁵

Two catches. Expenses incurred before you opened the HSA never qualify, no matter how long you wait.⁵ And if you plan to delay reimbursement, your recordkeeping has to be airtight. Save the receipt, an explanation of benefits from your insurer showing the expense wasn’t reimbursed, and a note of the date you incurred the cost.

Recordkeeping and Form 8889

You don’t attach receipts to your return, but you must be able to produce them if audited. Keep itemized receipts showing the date of service, the provider’s name, and a description of the expense. Hold onto them for at least three years from the date you file the return reporting the distribution.⁷ If you’re using the delayed-reimbursement approach, keep receipts for as long as you plan to wait.

Anyone who takes a distribution from an HSA during the year must file Form 8889 with their tax return. The form reports contributions, distributions, and whether the distributions went toward qualified medical expenses.⁸ You file it even if you’d otherwise have no reason to file a return that year.

What Happens to the Account at Death

If your spouse is the named beneficiary, the account simply becomes their HSA and operates under the normal rules. A non-spouse beneficiary is treated very differently: the account stops being an HSA on the date of death, and the fair market value is included in the beneficiary’s taxable income that year, reduced only by any of the deceased’s qualified medical expenses that were incurred before death and paid within one year of the date of death.² Naming a spouse beneficiary, when that fits your situation, is the cleanest outcome.

1
Internal Revenue Service. Publication 502 – Medical and Dental Expenses
2
Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
3
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents per Mile, Up 2.5 Cents
4
Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
5
Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans
6
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
7
Internal Revenue Service. Topic No. 305, Recordkeeping
8
Internal Revenue Service. Instructions for Form 8889