Your HealthEquity card covers IRS-qualified medical, dental, vision, and prescription expenses, plus a broad list of over-the-counter products and menstrual care items. What exactly it pays for depends on which account it is linked to (HSA, FSA, HRA, or Dependent Care FSA) and, for employer-funded plans, how your employer configured the benefit.1HealthEquity. Account Comparison
The baseline for eligibility is Section 213(d) of the tax code, which defines “qualified medical expenses.” HealthEquity maintains a searchable list at healthequity.com/hsa-qme, where items are tagged “Rx” if a prescription is required and “LMN” if they need a Letter of Medical Necessity from a licensed provider.2HealthEquity. HSA Qualified Medical Expenses
Doctor, Dentist, Pharmacy, and Optical Purchases
The routine stuff is all in bounds. Doctor visits, co-payments, deductibles, hospital bills, non-cosmetic surgeries, immunizations, flu shots, physical exams, and X-rays qualify, along with prescription medications (including antidepressants and other mental health prescriptions).3HealthEquity. Qualified Medical Expenses Durable medical equipment is covered too: hearing aids, motorized wheelchairs, CPAP machines, crutches, and blood-sugar test kits and strips.2HealthEquity. HSA Qualified Medical Expenses
Dental cleanings, fillings, root canals, braces, orthodontia, dentures, dental implants, and dental sealants are eligible. Teeth whitening and bleaching are not.2HealthEquity. HSA Qualified Medical Expenses
For vision, you can use the card for eye exams, prescription eyeglasses, prescription contact lenses, prescription sunglasses, contact lens solution, reading glasses (even without a prescription), and vision correction surgeries including LASIK. Non-prescription contact lenses do not qualify.4HealthEquity. HSA and FSA for Vision Care
Over-the-Counter Items
Since the CARES Act took effect (retroactively to January 1, 2020), OTC medications no longer need a prescription to qualify, and menstrual care products are permanently eligible.5HealthEquity. CARES Act HSA6IRS. IRS Outlines Changes to Health Care Spending Available Under CARES Act That opens the card up to a long list of drugstore purchases:
- Pain relievers such as ibuprofen and acetaminophen
- Allergy medications, antihistamines, and nasal sprays
- Cough suppressants, decongestants, and cold remedies
- Antacids and acid reducers
- Tampons, pads, liners, cups, and sponges
- Bandages, antibiotic ointments, thermometers, and premade first-aid kits
- Broad-spectrum (UVA/UVB) sunscreen with SPF 15 or higher
- OTC acne washes and gels
- OTC sleep aids
OTC birth control and condoms are also on HealthEquity’s eligible list, consistent with IRS guidance covering condoms and OTC oral contraceptives (including emergency contraceptives).2HealthEquity. HSA Qualified Medical Expenses7IRS. Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
Mental Health, Alternative Care, and Pregnancy
Mental health services are broadly eligible when tied to a diagnosed condition such as anxiety, depression, or PTSD rather than general stress relief.8HealthEquity. Ways Your HSA Can Support Your Mental Health That covers talk therapy, behavioral counseling, sessions with a psychologist or psychoanalyst, psychiatric office visits, psychiatric medications, psychiatric hospitalization, and drug addiction treatment. Some counseling may require a Letter of Medical Necessity. Marriage counseling and life coaching do not qualify unless a provider documents that they are medically necessary.2HealthEquity. HSA Qualified Medical Expenses
Among alternative and rehabilitative treatments, acupuncture, chiropractic care, and physical therapy are eligible without extra paperwork. Massage therapy, acupressure, reflexology, and yoga each need a Letter of Medical Necessity, and massages for relaxation or general wellbeing do not qualify. The pattern: treatment for a diagnosed condition tends to qualify; general wellness does not.2HealthEquity. HSA Qualified Medical Expenses
Pregnancy and fertility spending is covered generously. Prenatal and obstetrical care, midwife treatment, prenatal vitamins, childbirth and hospital bills, in vitro fertilization, artificial insemination, and fertility and ovulation monitors all qualify. Egg and embryo storage fees and egg donor fees may require a Letter of Medical Necessity.9HealthEquity. Dobbs Decision HSA FSA Reproductive Healthcare Nursing supplies, breast pumps, nursing bras, storage bottles and bags, lactation consultants, and breastfeeding classes are eligible. Baby bottles, baby formula, infant diapers, and maternity clothes are not.2HealthEquity. HSA Qualified Medical Expenses
What the Card Will Not Pay For
Cosmetic procedures, teeth whitening, veneers, diet foods, hair regrowth products, and general household items are out.3HealthEquity. Qualified Medical Expenses10IRS. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness, and General Health11HealthEquity. Navigate IRS Guidance Medical Wellness
Health insurance premiums generally cannot be paid with the card. The exceptions for HSA funds are COBRA premiums, premiums paid while receiving unemployment compensation, and Medicare Parts A, B, C, and D premiums for account holders age 65 and older.12HealthEquity. 17 Awesome Ways to Spend Your HSA
Spending HSA funds on a non-qualified expense triggers income tax plus a 20% penalty. Once you turn 65, the 20% penalty is waived, but income tax still applies.3HealthEquity. Qualified Medical Expenses
How the Account Type Changes What Is Covered
The IRS list of qualified medical expenses is broadly consistent across HSAs, FSAs, and HRAs, but the account structure matters.
HSA
An HSA covers the full IRS-defined list. You own the account, funds roll over indefinitely, and the account follows you when you change jobs. Your employer cannot restrict what counts as a qualified expense. HSA funds can also pay for qualified expenses of your spouse and tax dependents.1HealthEquity. Account Comparison13HealthEquity. HSA Getting Started
FSA
A healthcare FSA covers eligible medical, dental, and vision expenses. It is employer-owned, and unused funds may be forfeited at the end of the plan year (some plans offer a grace period or limited carryover). Your full annual election is available on day one of the plan year, and funds can be used for your spouse and dependents.14HealthEquity. FSA Healthcare Card Getting Started15HealthEquity. 16 Great Ways to Spend Your FSA
Limited Purpose FSA
A Limited Purpose FSA is restricted to dental and vision expenses so it can be paired with an HSA. Eye exams, contacts, glasses, orthodontia, and dental procedures qualify. General medical expenses do not.16HealthEquity. Limited Purpose FSA
HRA
HRAs are funded by the employer, and the employer has wide latitude to decide which expenses beyond the legal minimums are eligible. Deductibles, coinsurance, and copays are common inclusions, but you need to check your plan documents for specifics.1HealthEquity. Account Comparison
Dependent Care FSA
If your card is linked to a Dependent Care FSA, it does not pay for medical care at all. It covers childcare and eldercare: daycare, preschool, summer day camp, before and after school programs, babysitter costs, and elder daycare for a qualifying dependent (a child under 13, a disabled spouse, or an adult dependent unable to care for themselves).17HealthEquity. Dependent Care Flexible Spending Account Overnight camps, tuition for kindergarten and above, and entertainment expenses are not eligible.18HealthEquity. Dependent Care Expenses
Using the Card at Checkout
The HealthEquity card is a Visa debit card, but run it as “credit” at the terminal. No PIN is required for standard transactions.19HealthEquity. HSA Healthcare Card Getting Started It works at doctor’s offices, pharmacies, and merchants that use an Inventory Information Approval System (IIAS), which automatically flags eligible versus ineligible items at the register. Participating merchants are listed at sigis.org.
The card will not work at gas stations, restaurants, ATMs, or other non-health merchants, and it does not allow cash back. There is a $5,000 daily spending limit, and you cannot spend more than your available balance.19HealthEquity. HSA Healthcare Card Getting Started
Pharmacies have the highest automatic-approval rate. At a store without IIAS capability, the card may be declined even for a legitimately eligible item. If that happens, pay out of pocket and file a reimbursement claim through the HealthEquity portal or mobile app with an itemized receipt.14HealthEquity. FSA Healthcare Card Getting Started
Keeping Receipts
Not every transaction is auto-substantiated. When one is not, HealthEquity will request documentation. For FSA, HRA, and Dependent Care accounts, the IRS requires that every expense be verified. HSA claims do not carry the same mandatory documentation requirement from HealthEquity, but the IRS can still ask for proof that funds were spent on qualified expenses, so save your receipts.20HealthEquity. Claim Submission and Documentation3HealthEquity. Qualified Medical Expenses
A valid receipt shows the provider’s name, a description of the service or item, the date of service, the patient’s name, and the amount owed.21Macomb County. HealthEquity Helpful Tips for Using Your Card If you miss the documentation window, you may need to repay the account by personal check or offset the amount with another qualified expense. For FSA cardholders, unresolved transactions can lead to card suspension.22Rutherford County. HealthEquity HCFSA and DCFSA Quick Start Guide