What Can You Buy With an HSA Debit Card: Eligible Expenses and Limits

You can use an HSA debit card to pay for a wide range of medical costs: prescription and over-the-counter drugs, doctor and hospital visits, dental and vision care, mental health treatment, medical equipment, certain insurance premiums, and even travel to appointments. The IRS ties eligibility to its definition of medical care under Section 213(d), which covers anything that diagnoses, treats, prevents, or alleviates a physical or mental condition.¹ Purchases that are cosmetic, hygienic, or aimed at general wellness fall outside that line, and swiping the card for them creates a tax bill.

Over-the-Counter Medicines and Supplies

Since the CARES Act took effect in 2020, over-the-counter medicines no longer need a prescription to qualify.² Pain relievers, cold medicine, allergy pills, and antacids can all go on the card without extra paperwork.

First-aid supplies are eligible too. Bandages, sterile gauze, medical tape, elastic wraps, and braces or splints count, as do home diagnostic tools like thermometers, blood pressure monitors, pulse oximeters, and glucose test kits.³ Personal protective equipment such as face masks, hand sanitizer, and sanitizing wipes qualifies under IRS guidance treating those items as expenses for disease prevention.

The product has to serve a medical purpose. A medicated shampoo prescribed for a scalp condition is eligible; regular shampoo is not. Sunscreen used for skin cancer prevention qualifies. General toiletries never do.

Prescription Drugs and Medical Equipment

Any drug prescribed by a licensed provider is eligible, from antibiotics to blood pressure medication to specialty treatments. Insulin qualifies whether or not it was obtained with a prescription.³

Durable medical equipment is often where the tax savings matter most:

Mobility aids: crutches, walkers, and wheelchairs needed for an injury or disability.³
Respiratory equipment: CPAP machines, nebulizers, oxygen tanks, and associated tubing or masks.
Hearing aids, including batteries and maintenance.⁴

Keep the receipt and any provider documentation for equipment purchases in case the IRS asks about them later.

Vision and Dental Care

Vision expenses go well beyond a routine eye exam. Prescription eyeglasses (frames and lenses), contact lenses, saline solution, and enzyme cleaner are all eligible. Corrective eye surgery, including LASIK and other laser procedures, is fully covered.³

On the dental side, the IRS covers cleanings, fillings, extractions, crowns, bridges, dentures, and X-rays. Orthodontic work like braces qualifies when it corrects a dental problem rather than serving a purely cosmetic purpose, and many orthodontists accept HSA debit cards directly for monthly installments. Teeth whitening is cosmetic and never qualifies.

Doctor Visits, Hospital Stays, and Mental Health

Most out-of-pocket costs in a medical setting are eligible: office visit copays, specialist fees, urgent care charges, outpatient surgery, lab work, imaging like X-rays and MRIs, and hospital stays.³ If insurance leaves you with a balance after a procedure, the card can cover the remainder.

Mental health care is treated the same as physical care. Sessions with psychologists, psychiatrists, licensed therapists, and clinical social workers all qualify, as do inpatient programs for substance abuse or behavioral health conditions.⁴ The expense needs to relate to treating a diagnosed condition rather than general personal growth or life coaching.

Medical Travel and Lodging

Getting to and from care is itself eligible, and many HSA holders miss it. You can reimburse yourself for mileage driven to appointments, the pharmacy, or a hospital at the IRS standard medical rate of 20.5 cents per mile for 2026.⁵ Parking fees and tolls during medical trips also count.

If treatment requires an overnight stay away from home and you’re not staying in a hospital, lodging qualifies up to $50 per person per night.³ A parent traveling with a child can claim up to $100 per night for two people. Meals during medical travel are not eligible.

Family Health and Preventive Products

Menstrual care products, including pads, tampons, liners, and cups, became eligible under the CARES Act in 2020.² Pregnancy test kits, breast pumps, and nursing supplies also qualify.³

Prenatal vitamins prescribed by a provider are eligible because they address a specific medical need. General multivitamins for overall wellness are not. That distinction between treating a condition and supporting general health runs through nearly every HSA eligibility question, and it trips people up more than any other rule.

Insurance Premiums You Can Pay With HSA Funds

HSA funds generally cannot pay health insurance premiums, but the statute carves out four exceptions:⁶

COBRA continuation coverage after job loss or reduced hours.
Health coverage while collecting unemployment compensation under federal or state law.
Qualified long-term care insurance, up to an age-based annual limit that increases each year.¹
Medicare premiums after age 65, including Part A, Part B, Part D, and Medicare Advantage. Medigap (Medicare supplement) policies are not eligible.⁷

The Medicare exception is one reason HSAs work well as a retirement planning tool. Many people build up a balance during working years and draw from it to cover Medicare costs tax-free later.

What You Cannot Buy With an HSA Debit Card

If a product or service is primarily for general health, cosmetic improvement, or personal comfort rather than treating or preventing a medical condition, it is not a qualified expense.⁸ Common items people assume are eligible but aren’t:

Cosmetic procedures: Botox, teeth whitening, liposuction, breast augmentation, and hair removal, unless they correct a deformity from a congenital condition, injury, or disfiguring disease.
Vitamins and supplements taken for general wellness. They become eligible only when a provider recommends them to treat a specific diagnosed condition.
Toiletries and personal care: toothbrushes, toothpaste, soap, shampoo, deodorant, and moisturizer.
Gym memberships and fitness programs, even if your doctor tells you to exercise more.
Most insurance premiums, outside the four exceptions above.

Dual-purpose items like a mattress or air purifier typically require a letter of medical necessity from your provider explaining that the item treats a specific diagnosis. Without that letter, the expense is treated as non-qualified.

What Happens if You Use the Card on Something Ineligible

A non-qualified purchase is treated as ordinary taxable income, and if you’re under 65, the IRS adds a 20 percent penalty on top of the tax.⁶

After age 65, the 20 percent penalty goes away, but the distribution is still added to your taxable income if it wasn’t spent on a medical expense.⁶ At that point, a non-medical withdrawal is taxed similarly to a traditional IRA withdrawal. Qualified medical expenses remain tax-free at any age.

If you accidentally swipe the card for something non-qualified, you can often fix it by repaying the amount to your HSA before filing your tax return for that year. Check with your administrator on their process for correcting a mistaken distribution.

Keeping Records

Your HSA administrator does not verify that each swipe was for an eligible expense. That responsibility is yours at tax time and if the IRS audits your return. Save itemized receipts for every HSA purchase and keep them for at least three years, the standard IRS lookback period for most returns.³

Your records should show what you bought, when you bought it, and that the expense wasn’t reimbursed by insurance or claimed as a deduction elsewhere.⁷ For anything in a gray area, get a letter of medical necessity from your provider that includes your diagnosis, the recommended item or treatment, and why it’s medically needed. That letter is your best protection if the IRS ever questions the expense.

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
3
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
4
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
5
Internal Revenue Service. 2026 Standard Mileage Rates Notice 2026-10
6
Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
7
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
8
eCFR. 26 CFR 1.213-1 – Medical, Dental, Etc., Expenses