What Qualifies for HRA Reimbursement: Eligible and Excluded Expenses

A Health Reimbursement Arrangement will pay you back, tax-free, for expenses that meet the Internal Revenue Code’s Section 213(d) definition of medical care: costs that diagnose, treat, prevent, or mitigate disease, or affect a structure or function of the body.¹ That covers most of what people think of as health care, plus dental, vision, prescriptions, many over-the-counter items, and travel to get care. HRA eligible expenses also depend on your employer’s plan document, which can narrow the federal list but cannot go beyond it. Read the plan alongside this overview before you submit anything you are unsure about.

What Counts as a Medical Expense

The core of any HRA is standard medical care. Primary care visits, specialist consultations, hospital stays, lab work, imaging like X-rays and MRIs, and surgical procedures all qualify. So does mental health care, including therapy, psychiatric treatment, and psychoanalysis. Care from chiropractors and acupuncturists is reimbursable too.²

Getting to that care counts as well. The IRS sets a standard mileage rate for medical travel each year, and for 2026 the rate is 20.5 cents per mile.³ Parking and tolls tied to a medical visit are reimbursable at cost. The trip has to be primarily for medical care, not for general health or a personal errand attached to an appointment.

Dental and Vision Care

Dental work is one of the most commonly submitted categories. Preventive services (cleanings, fluoride treatments, dental X-rays), restorative work (fillings, crowns, root canals), and orthodontic treatment like braces and aligners all qualify, because orthodontia corrects a functional problem rather than a cosmetic one.

Vision follows the same logic. Eye exams, prescription glasses, contact lenses, and lens cleaning solutions are reimbursable. LASIK and similar corrective surgeries qualify because they treat a diagnosed vision condition.¹

Prescriptions, Over-the-Counter Items, and Menstrual Products

Prescription medications used to treat a diagnosed condition are eligible, and this is rarely contested. Over-the-counter medicines changed in 2020: Section 3702 of the CARES Act dropped the old requirement that OTC drugs needed a doctor’s prescription to be reimbursed.⁴ Pain relievers, allergy medicine, and cold remedies now come straight out of the HRA.

The same law added menstrual care products to the list of qualifying expenses. Tampons, pads, liners, cups, and similar products are reimbursable for expenses paid after December 31, 2019.⁴

Medical supplies and equipment with a clear medical purpose qualify without a prescription. Bandages, thermometers, blood sugar test kits, and crutches are typical examples.

What Your HRA Will Not Cover

The most common reason a claim gets denied is that the expense feels health-related but does not meet the federal medical care definition. The IRS draws a firm line between treating a condition and improving general wellness.

Cosmetic procedures. Face lifts, hair transplants, teeth whitening, veneers, and liposuction are out. The one exception is cosmetic work needed to correct a deformity from a congenital condition, an accident, or a disfiguring disease.¹
Gym memberships and fitness classes. Even with a doctor’s recommendation to exercise, health club dues and general fitness programs are not reimbursable.²
Nutritional supplements and vitamins. Supplements taken for general health do not qualify. They become eligible only when a doctor prescribes them to treat a specific diagnosed condition.²
Personal hygiene products. Toothpaste, deodorant, and general skincare items are not medical expenses.

When you are unsure, the test is simple. Does the expense treat, prevent, or diagnose a specific medical condition? If the honest answer is that it just makes you feel healthier in general, it will not qualify.

Whose Expenses You Can Submit

Your HRA can pay for more than your own care. Federal law allows tax-free reimbursement for your spouse, your dependents, and your children who have not turned 27 by the end of the tax year.⁵ That age-27 cutoff is specific to HRAs and other employer health plans, and is separate from the age-26 rule for staying on a parent’s insurance.

Other people may qualify if they meet the IRS definition of a “qualifying relative.” You have to provide over half of the person’s financial support for the year, and the person must either have a specified family relationship to you (parent, sibling, niece, nephew, in-law, and others) or live with you as a member of your household for the full year.⁶

If You Also Have a Health Savings Account

One boundary worth flagging: a standard HRA that reimburses any medical expense will disqualify you from contributing to an HSA. The IRS treats a general-purpose HRA as “other health coverage” that conflicts with the rule that your High Deductible Health Plan be your only coverage below the deductible.⁷

Two plan designs preserve HSA eligibility. A limited-purpose HRA reimburses only dental, vision, preventive care, and telehealth expenses, so it does not touch general medical costs below the deductible. A post-deductible HRA reimburses nothing until the HDHP’s minimum annual deductible has been met.⁷ If your employer offers both an HRA and an HSA-eligible HDHP, ask your benefits administrator which flavor of HRA you have before you contribute to the HSA. Getting it wrong creates unexpected tax liability.

Submitting a Claim

Every claim needs documentation strong enough to prove the expense was a qualifying medical cost. That means the date of service, the provider’s name, a description of the service or item, and the amount paid. A credit card receipt showing only a total and a merchant name is not enough. Submit an itemized receipt or an Explanation of Benefits from your insurance carrier.

Most administrators take claims through an online portal or a mobile app, though some still accept paper forms. Plan on roughly one to two weeks between submission and payment, usually by direct deposit.

There is a real cost to submitting expenses that turn out to be ineligible. If a non-qualifying reimbursement is paid and never corrected, it becomes taxable income. Keep clean records, and when you are not sure whether something qualifies, check IRS Publication 502 before you submit.²

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses
2
Internal Revenue Service. Publication 502 – Medical and Dental Expenses
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
Office of the Law Revision Counsel. 26 USC 105 – Amounts Received Under Accident and Health Plans
6
Office of the Law Revision Counsel. 26 USC 152 – Dependent Defined
7
Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans