What Can I Use My HSA For? Eligible Expenses, Premiums, and Records

You can use your HSA to pay for a wide range of medical, dental, vision, and pharmacy costs for yourself, your spouse, and anyone you claim as a tax dependent. The IRS defines qualified expenses as costs for diagnosing, treating, or preventing disease, or for affecting a structure or function of the body.¹ Spending HSA money on anything outside that definition triggers income tax plus a 20% penalty.

Medical Care and Treatment

Most care ordered or provided by a licensed health professional qualifies. That includes:

Hospital stays, outpatient procedures, and related facility fees²
Doctor visits, specialist consultations, and laboratory work²
Psychiatric care, psychologist visits, and counseling for a diagnosed condition²
Physical therapy prescribed to restore function after an injury or illness
Chiropractic and acupuncture fees²
Hearing aids, their batteries, and repair costs²
Diagnostic devices like blood sugar monitors and blood pressure cuffs²
Qualified long-term care services as defined in federal law¹

The common thread is medical necessity. Care needs to treat, diagnose, or prevent a health condition rather than improve appearance. For services that could look discretionary, a doctor’s written recommendation tying the treatment to a specific condition strengthens the case.

Prescriptions and Over-the-Counter Products

Prescription medications qualify. Since the CARES Act took effect in 2020, over-the-counter medications also qualify without a prescription, so pain relievers, cold medicine, and antihistamines are all fair game.³ The same law added menstrual care products (tampons, pads, liners, cups, and similar items) to the list of qualified expenses.⁴

Other everyday health products that qualify include thermometers, bandages, antiseptic wipes, burn ointments, pregnancy test kits, and smoking cessation aids like nicotine patches. If an item serves a medical, diagnostic, or therapeutic purpose, it is likely eligible.

Vitamins, nutritional supplements, and herbal products are the main gray area. They do not qualify unless a doctor prescribes them to treat a specific diagnosed condition.² The same rule applies to special foods bought for a weight-loss program: they only qualify when treating a physician-diagnosed disease. For any dual-purpose item, a written recommendation from your doctor linking the purchase to a specific condition is the safest paper trail.

Vision and Dental Care

Eye care is one of the most common HSA uses. Routine eye exams, prescription eyeglasses, contact lenses, and contact lens solution all qualify. Corrective eye surgery, including LASIK and radial keratotomy, is also eligible because it treats defective vision.²

On the dental side, HSA funds cover cleanings, X-rays, fillings, extractions, dentures, sealants, fluoride treatments, and braces. Orthodontic work qualifies because it corrects structural issues in the mouth and jaw. Cosmetic work is the exclusion in both categories: teeth whitening and cosmetic veneers do not qualify because they improve appearance without treating a disease or restoring function.²

Travel to and From Medical Care

Getting to appointments is itself a qualified expense. Bus, taxi, train, and plane fare all count when the trip is primarily for medical care.² Driving yourself, you can either deduct your actual gas and oil costs or use the IRS standard medical mileage rate, which is 20.5 cents per mile for 2026.⁵ Parking fees and tolls qualify on top of either method.

If you need to travel away from home for care, lodging costs can also qualify, up to $50 per night per person. That cap applies to each person traveling, so a parent accompanying a sick child could claim up to $100 per night. The lodging must be primarily for medical care, not lavish, and cannot have a significant vacation element. Meals during medical travel are not eligible.²

Insurance Premiums You Can Pay With an HSA

HSA funds generally cannot be used to pay health insurance premiums. Federal law carves out four exceptions:⁴

COBRA continuation coverage premiums after leaving a job
Health plan premiums during any period you collect federal or state unemployment compensation
Qualified long-term care insurance premiums, up to an age-based annual limit
Medicare premiums after age 65, including Part A, Part B, Part D, and Medicare Advantage. Medigap (Medicare supplement) premiums do not qualify

Outside these four categories, paying premiums with HSA dollars is treated as a non-qualified distribution, meaning income tax plus the 20% penalty.⁶

Whose Expenses You Can Cover

Your HSA is not limited to your own care. You can use the funds to pay qualified expenses for your spouse and anyone you claim as a tax dependent.⁶ Federal law also extends coverage to people who would qualify as your dependent except that they filed a joint return, earned too much income, or could be claimed on someone else’s return.⁴

Adult children trip up many families. Your health plan may cover a child up to age 26, but that does not automatically mean you can pay their medical bills with your HSA. The child still needs to meet the IRS definition of a tax dependent: living with you for more than half the year, not providing more than half their own support, and under age 19 (or under 24 as a full-time student). An adult child working full-time and supporting themselves is not eligible for HSA reimbursement even while on your insurance plan.⁶

None of these people needs to be enrolled in your HDHP. The test is your tax relationship, not their insurance.

What Doesn’t Qualify

Some of the most common items people assume are eligible but are not:

Cosmetic surgery that improves appearance without treating a disease or restoring function²
Gym memberships and general exercise costs, even with a doctor’s recommendation. They only qualify if prescribed solely to treat a specific diagnosed disease such as obesity or heart disease⁷
Teeth whitening, which the IRS treats as cosmetic²
Vitamins and nutritional supplements without a physician’s prescription for a specific condition²
Marital counseling, which is not considered a medical expense⁷
Health insurance premiums outside the four categories above

The dividing line is whether the spending treats, diagnoses, or prevents a specific medical condition. General wellness spending does not qualify unless tied to a physician-diagnosed disease, even when it clearly benefits your health.

What Happens If You Spend HSA Money on Something Else

Use HSA money for something outside the qualified list and the amount is added to your gross income for that tax year. On top of ordinary income tax, you owe an additional 20% penalty on the non-qualified amount.⁴ A $1,000 non-qualified withdrawal costs $200 in penalty plus whatever you owe at your marginal rate.

Three events eliminate the 20% penalty:

Reaching age 65. Non-qualified withdrawals after that point are taxed as ordinary income only, similar to a traditional retirement account⁴
Disability of the account holder
Death of the account holder

Withdrawals for qualified medical expenses stay completely tax-free at any age. The penalty applies only to non-medical spending.

Keeping Records

The IRS does not require you to submit receipts with your return, but you need records ready if the return is questioned. For each HSA withdrawal, save documentation showing:

The date of service or purchase
The provider or merchant name
A description of the service or product
The amount paid

Keep these records for at least three years after filing the return that includes the distribution, and longer if you plan to reimburse yourself later for expenses from earlier years. HSA custodians often provide electronic transaction summaries, but holding onto the original receipts and invoices gives you stronger backup during an audit. You report all HSA activity on IRS Form 8889, which you file with your annual tax return.⁸

1
Office of the Law Revision Counsel. 26 U.S. Code 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Publication 502, Medical and Dental Expenses
3
Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
4
Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts
5
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate
6
Internal Revenue Service. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
7
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
8
Internal Revenue Service. About Form 8889, Health Savings Accounts