HSA Approved Items List PDF: What You Can Buy

Your Complete Guide to HSA-Approved Purchases

Searching for an HSA approved items list PDF is one of the most common things people do after opening a Health Savings Account – and for good reason. The IRS allows HSA funds to cover a surprisingly wide range of products, from prescription medications and dental work to sunscreen and first-aid supplies. Knowing what qualifies before you check out can save you from accidental penalties and help you capture the full tax advantage your account offers. (This article is educational and is not tax advice; confirm your own situation with a tax professional and your HSA administrator.)

The rules governing HSA-eligible expenses come primarily from Internal Revenue Code Section 213(d) and IRS Publication 502. The CARES Act of 2020 further expanded eligibility to include many over-the-counter medications and menstrual care products without a prescription. Below, we walk through every major category so you can shop with confidence – and we flag the important caveat up front: eligibility can depend on your specific plan and situation, so treat any downloadable list as a starting point, not the final word.

Is There an Official HSA Approved Items List PDF?

Here is the honest answer many pages skip: the IRS does not publish a single, official “HSA approved items list PDF” checklist. What it publishes is Publication 502, a detailed narrative document that explains which medical and dental expenses qualify, and Section 213(d), the underlying statute. Because the definition is principle-based rather than a fixed catalog, no PDF can be truly exhaustive or perfectly current.

In practice, the most useful lists come from two places. First, your HSA administrator – Fidelity, Optum Bank, HealthEquity, and others each publish their own eligible-expense summaries, often as downloadable PDFs, and update them annually. Second, retailer and third-party databases (such as the FSA Store) maintain searchable, tagged inventories. When those lists disagree with each other, IRS Publication 502 and your administrator’s determination are what actually govern your account, so verify there before relying on any generic PDF you found online.

What Counts as an HSA-Eligible Expense

The IRS defines a qualified medical expense as any cost incurred to diagnose, cure, mitigate, treat, or prevent disease, or to address a condition that affects any structure or function of the body. That language is broad, but the IRS also explicitly excludes expenses that are merely beneficial to general health, such as gym memberships or most nutritional supplements.

Eligible expenses fall into several major buckets: medical services, prescription drugs, over-the-counter medications, dental and vision care, mental health services, and qualifying medical equipment and supplies. Each category has its own nuances, which we cover section by section below.

Over-the-Counter Medications and Products

Since the CARES Act took effect in 2020, over-the-counter medications no longer require a prescription to be HSA eligible. This includes pain relievers like ibuprofen and acetaminophen, allergy medications such as cetirizine and loratadine, cold and flu remedies, antacids, and anti-diarrheal products.

Menstrual care products – tampons, pads, menstrual cups, and liners – also qualify under the same law. Sunscreen with an SPF of 15 or higher is eligible as well, since the FDA classifies it as an over-the-counter drug. First-aid supplies, including bandages, antiseptic wipes, and thermometers, round out the most popular OTC category.

Items that do not qualify without a Letter of Medical Necessity include general vitamins, weight-loss supplements, and cosmetic products. Note an important 2024 development: the IRS (news release IR-2024-65) warned that a Letter of Medical Necessity alone cannot turn a general-wellness or nutrition purchase into a qualified medical expense – there must be a genuine, diagnosed condition being treated. For more on the vitamin question specifically, see our article on whether vitamins are HSA eligible.

Prescription Medications

All prescription drugs prescribed by a licensed healthcare provider are HSA eligible, with the exception of medications imported illegally from other countries. This includes brand-name and generic drugs, specialty medications, insulin (which does not require a prescription to qualify), and compound prescriptions.

Keep your pharmacy receipts as documentation. If your HSA administrator issues a debit card, pharmacy purchases typically auto-adjudicate against your plan’s eligible-item database, reducing the chance of an accidental non-qualified purchase. If a charge is flagged, save the receipt and any supporting paperwork so you can substantiate it later.

Dental and Vision Expenses

Dental care is one of the largest HSA-eligible categories. Covered expenses include exams, cleanings, fillings, crowns, bridges, dentures, orthodontics (including braces and clear aligners), root canals, extractions, and periodontal treatment. Teeth-whitening procedures, however, are considered cosmetic and do not qualify. For a deeper look, visit our guide on using your HSA for dental.

Vision expenses include eye exams, prescription eyeglasses and sunglasses, contact lenses and solution, LASIK surgery, and reading glasses. Non-prescription blue-light-blocking glasses generally do not qualify unless a provider documents medical necessity.

Medical Services and Procedures

Office visits, specialist consultations, urgent care, emergency room visits, lab work, imaging (X-rays, MRIs, CT scans), physical therapy, chiropractic care, acupuncture, and mental health services – including therapy and psychiatry – are all HSA-qualified expenses. Hospital stays, surgeries, and ambulance transportation qualify too.

Telehealth visits are eligible, and many HSA plans now integrate directly with telehealth platforms. Preventive care services such as annual physicals and vaccinations also qualify. Because coverage details and any temporary telehealth safe-harbor rules can change year to year, confirm the current treatment with your plan.

Medical Equipment and Devices

Durable medical equipment prescribed or recommended by a healthcare provider is generally HSA eligible. Common examples include blood pressure monitors, glucose monitors and test strips, crutches, wheelchairs, hearing aids, CPAP machines and supplies, and breast pumps.

Wearable health devices like the Oura Ring or continuous glucose monitors may qualify if a provider documents medical necessity – general-fitness wearables purchased for wellness generally do not. Read our article on Oura Ring HSA eligibility for the specifics.

What Is Not HSA Eligible

The HSA approved items list PDF is only useful if you also know what falls outside it. Common non-eligible expenses include cosmetic surgery and procedures, health club or gym dues, general-purpose toiletries (toothpaste, deodorant, shampoo), non-prescription supplements taken for general wellness, and health insurance premiums (with limited exceptions such as COBRA, long-term care premiums, Medicare premiums after age 65, and premiums while receiving unemployment benefits).

Using HSA funds for non-qualified expenses triggers income tax on the withdrawn amount plus a 20 percent penalty if you are under 65. After age 65, the penalty is waived, but the withdrawal is still taxed as ordinary income. For the full mechanics, see our guide to HSA withdrawal rules.

HSA Contribution Limits for 2026

To maximize your purchasing power, contribute as much as the IRS allows. For 2026, the limits are $4,400 for self-only coverage and $8,750 for family coverage. Account holders aged 55 and older can add a $1,000 catch-up contribution. (For reference, the 2025 limits were $4,300 self-only and $8,550 family.) These figures are adjusted for inflation annually, so confirm the current-year amounts on IRS.gov or with your administrator before you contribute. Contributions are tax-deductible, growth is tax-free, and qualified withdrawals are tax-free – a triple tax advantage no other account offers.

Understanding how to pair your HSA with other accounts can stretch your dollars further. Our HSA and FSA comparison explains how these accounts can work side by side, and our healthcare costs guide covers broader strategies for managing medical spending.

How to Use an HSA Approved Items List

Most HSA administrators publish their own eligible-expense lists, and the IRS maintains Publication 502 as the definitive narrative reference. When shopping, look for the “HSA/FSA Eligible” tag on retailer websites – Amazon, Walmart, and CVS all offer filters for eligible items. If a purchase is flagged at checkout, keep your receipt and Letter of Medical Necessity (if applicable) so you can submit a manual claim or respond to an audit.

For a quick-reference download, many HSA providers – including Fidelity, Optum Bank, and HealthEquity – offer their own HSA approved items list PDF documents on their websites. These lists are updated annually to reflect any IRS rule changes, but they are the provider’s interpretation, not IRS law, so when a purchase is borderline, verify with your administrator and Publication 502.

Recordkeeping and Substantiation

An HSA puts the burden of proof on you, the account holder. Keep receipts, Explanation of Benefits statements, prescriptions, and any Letter of Medical Necessity for every distribution – the IRS can request documentation years later, and there is no expiration on that ability. A common best practice is to save digital copies (a photo or scan) in one folder organized by tax year, and to keep them for at least three years after you file the relevant return, with longer retention being safer. Good records are what let you defend an eligible purchase if your account is ever reviewed.

Frequently Asked Questions

Where can I find an official HSA approved items list PDF?

The IRS does not publish a single PDF checklist. Instead, IRS Publication 502 defines eligible expenses in detail. Your HSA provider likely offers a downloadable summary on its website, and retailers like the FSA Store maintain searchable databases of eligible products. When lists conflict, defer to Publication 502 and your administrator.

Are COVID-19 tests and masks HSA eligible?

Yes. The IRS confirmed that COVID-19 home tests, personal protective equipment such as masks, and hand sanitizer purchased for the primary purpose of preventing the spread of COVID-19 are qualified medical expenses.

Can I use my HSA for my spouse or dependents?

You can use HSA funds for qualified medical expenses incurred by your spouse or any tax dependent, even if they are not covered by your high-deductible health plan. Keep documentation showing the relationship and the medical expense.

Do I need a prescription for over-the-counter items?

Since the CARES Act of 2020, most OTC medications are HSA eligible without a prescription. However, items that are not classified as medications – such as general vitamins and supplements – still require a documented medical need (and often a Letter of Medical Necessity) to qualify, and per IRS IR-2024-65 that letter must reflect treatment of a real diagnosed condition.

Are menstrual products really HSA eligible now?

Yes. The CARES Act added menstrual care products – tampons, pads, cups, and liners – to the list of qualified expenses, and no prescription is required.

What happens if I accidentally buy a non-eligible item?

The amount is added to your taxable income and, if you are under 65, subject to a 20 percent penalty. Some plans allow you to correct a genuine mistaken distribution by returning the funds before your tax-filing deadline – check with your administrator.

Keep Your List Handy and Shop Smarter

Having an HSA approved items list PDF saved to your phone or bookmarked in your browser makes every pharmacy run and online order more efficient. When in doubt, check IRS Publication 502, ask your HSA administrator, or consult a tax professional before making a large purchase. The right preparation turns your HSA into one of the most powerful savings tools in your financial toolkit. Explore our HSA benefits overview and HSA withdrawal rules for even more ways to get the most from your account.

Sources

• IRS Publication 502, Medical and Dental Expenses – irs.gov
• Internal Revenue Code Section 213(d), definition of qualified medical care
• CARES Act of 2020 – over-the-counter drug and menstrual care product eligibility
• IRS news release IR-2024-65 and the IRS FAQ on medical expenses related to nutrition, wellness, and general health (March 2024)
• IRS Revenue Procedure setting the 2026 inflation-adjusted HSA contribution limits ($4,400 self-only / $8,750 family; $1,000 catch-up at 55+)
• HSA administrator eligible-expense lists (Fidelity, Optum Bank, HealthEquity)