What Can You Use Your HSA to Pay For: Premiums, Dental, and Travel

You can use your HSA to pay for a wide range of medical costs tax-free: doctor and hospital bills, prescriptions and over-the-counter medicine, dental and vision care, mental health treatment, medically necessary equipment, and a short list of insurance premiums. The IRS rule underneath all of it is simple to state and easy to trip over. The expense has to treat or prevent a specific medical condition. General wellness spending doesn’t qualify, and pulling money out for anything the IRS doesn’t consider a qualified medical expense means income tax plus a 20% penalty.¹

Doctors, Hospitals, and Professional Care

Fees paid to doctors, surgeons, specialists, and other licensed practitioners for treating or preventing a medical condition are the core of qualified spending.² Annual physicals, lab work, diagnostic imaging, hospital stays, and nursing care all fall inside the rules without much argument.

Home nursing counts when the work is medical: administering medication, monitoring vitals, dressing a wound. If a nurse cooks or cleans for you, that portion of the bill isn’t a medical expense even though a nurse is doing it.

Gym memberships are where the line shows itself. A membership for general fitness doesn’t qualify. A specific exercise program your doctor prescribes to treat a diagnosed condition, backed by a letter of medical necessity tying it to that diagnosis, can.

Prescriptions, Over-the-Counter Medicine, and Health Products

Prescription drugs and insulin are eligible.¹ Over-the-counter medications are too, without any prescription requirement, after the CARES Act permanently expanded the list. Menstrual care products — pads, tampons, cups — qualify under the same change.³ That language now sits in the statutory definition of a qualified medical expense.⁴

Common supplies that qualify: bandages, first-aid kits, digital thermometers, crutches, blood pressure monitors. Sunscreen counts too if it’s broad-spectrum with SPF 15 or higher. Paying with an HSA debit card creates the transaction record for you, which is worth something at tax time.

Dental and Vision Care

Vision spending covers eye exams, prescription eyeglasses, contact lenses and cleaning solutions, and corrective procedures like LASIK.⁵ Over-the-counter reading glasses are eligible whether or not you have a prescription.

Dental follows the same principle as everything else. Cleanings, fluoride treatments, X-rays, fillings, extractions, root canals, braces, and dentures qualify. Cosmetic dental work doesn’t. A crown to repair a cracked tooth is treatment. Porcelain veneers because you don’t like your smile are not.

Mental Health and Alternative Treatments

Therapy with a licensed psychologist, psychiatrist, or clinical social worker qualifies when it treats a diagnosed mental health condition. Inpatient substance use treatment, including residential rehabilitation, is fully eligible.²

Acupuncture and chiropractic care are the alternative treatments people most often ask about, and both qualify when they address a specific condition. Some less obvious costs qualify for the same reason: the IRS allows lead-based paint removal when a child in the household has lead poisoning, because it directly treats the medical condition.

Service Animals and Home Modifications

If you have a physical, sensory, or mental disability, the full cost of buying and maintaining a trained service animal counts. That includes the purchase price, food, grooming, training fees, and veterinary care. The animal has to be trained to perform tasks tied to the disability, like a guide dog or a dog trained to detect low blood sugar. An emotional support animal without specialized task training doesn’t meet this standard.⁶

Home modifications made for a disability can be eligible. The IRS lists ramps, widened doorways, bathroom grab bars, modified kitchen cabinets, porch lifts, and modified stairways as improvements that typically don’t add to a home’s value, so the full cost qualifies. Elevators are the exception: they generally do increase property value, so only the portion of the cost that exceeds the added value counts.⁷

Family Members You Can Cover

Your HSA can pay for qualified expenses for you, your spouse, and your dependents. A qualifying child must be under 19 at year-end, or under 24 if a full-time student.⁸ A qualifying relative can also be covered if they meet the IRS residency and support tests.⁴

One point catches people out: whether you have self-only or family HDHP coverage affects how much you can contribute, not whose expenses you can pay. Even with a self-only plan, you can spend HSA funds tax-free on your spouse’s or dependent’s qualified medical costs. The person just has to meet the IRS definition at the time the expense is incurred.

Insurance Premiums: The Four Exceptions

As a rule, you can’t use an HSA to pay health insurance premiums. The statute names four exceptions.⁴

COBRA continuation coverage after you lose employer-sponsored insurance.
Health coverage premiums during any period you’re receiving federal or state unemployment compensation.
Medicare premiums once you turn 65, including Parts A, B, C (Medicare Advantage), and D. Medigap supplemental policies are specifically excluded by statute.
Qualified long-term care insurance premiums, up to age-based annual limits. For 2026, the limits run from $500 at age 40 and under to $6,200 above age 70, with the common 61-to-70 bracket capped at $4,960 per person.

Outside those four, premiums don’t qualify. Your regular HDHP premium, a standalone dental plan, a vision plan — none of it can come out of the HSA tax-free.

Medical Travel and Lodging

Getting to care is itself an eligible expense. For 2026, HSA funds can cover transportation at the IRS medical mileage rate of 20.5 cents per mile, plus parking and tolls.⁹ Bus fare, train tickets, and ambulance costs qualify too.

If treatment requires travel away from home, lodging qualifies up to $50 per night per person. A companion counts, so a parent with a child could use $100 per night. The stay has to be essential to the care and can’t include any significant element of vacation or recreation. Meals during medical travel don’t qualify.⁷

What Doesn’t Qualify, and What It Costs You

Cosmetic procedures, general wellness spending, most insurance premiums, everyday toiletries, and meals all sit outside the rules. Pull money out for any of it and the withdrawal gets added to your taxable income, plus a 20% additional tax.¹

The 20% goes away at age 65, or if you become disabled, or at death. After 65, non-medical withdrawals still get taxed as ordinary income, but the surcharge is gone. Qualified medical withdrawals stay tax-free at any age.

Records and the No-Deadline Reimbursement Rule

The IRS doesn’t ask you to itemize HSA spending on your return. If you’re audited, though, you have to prove every distribution went to a qualified expense. Keep receipts, insurer explanation-of-benefits statements, and HSA bank statements. Three years is the standard IRS lookback, and suspected fraud extends it indefinitely.⁷

There is no deadline to reimburse yourself. Pay a medical bill out of pocket today, let the HSA grow through investments for years, and pull the money out tax-free later to reimburse the original expense. The IRS confirmed this in Notice 2004-50, stating that “there is no time limit on when the distribution must occur.”¹⁰ The conditions: the expense was incurred after the HSA was established, you haven’t already been reimbursed from another source, and you didn’t claim it as an itemized deduction.¹¹ A drawer of old medical receipts is a tax-free withdrawal waiting to happen.

1
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
2
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
3
Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
4
Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
5
U.S. Office of Personnel Management. Health Savings Accounts
6
Internal Revenue Service. Fact Sheet for Service Animals for Taxpayers with Disabilities
7
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
8
Office of the Law Revision Counsel. 26 USC 152 – Dependent Defined
9
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate
10
Internal Revenue Service. IRS Notice 2004-50
11
Internal Revenue Service. Distributions for Qualified Medical Expenses