- For 2026 the HSA contribution limit rises to $4,400 for self-only coverage and $8,750 for family coverage, with an extra $1,000 catch-up for those 55 and older.
- HSA-qualified expenses cover most medical, dental, and vision care, plus prescription and (since the CARES Act) over-the-counter drugs and menstrual products without a prescription.
- Some items — supplements, air purifiers, massage, weight-loss programs — qualify only with a letter of medical necessity from a clinician.
- Cosmetic procedures, gym memberships, general wellness supplements, toiletries, and most insurance premiums are not HSA eligible.
- Keep a receipt for every expense; the burden is on you to prove an expense was qualified if the IRS ever asks.
- This is general education, not tax advice — verify specifics with your plan administrator or a tax professional.
Knowing exactly what your health savings account can and cannot pay for saves you from denied claims, tax headaches, and missed savings opportunities. The list of HSA eligible expenses is extensive, covering everything from doctor visits and prescriptions to over-the-counter medications and menstrual products. With the 2026 contribution limit rising to $4,400 for individuals and $8,750 for families, there is real money at stake — and every qualified dollar you spend comes out of pre-tax income.
The IRS has not changed the fundamental definition of a qualified medical expense for 2026. The core rules still trace back to Internal Revenue Code Section 213(d), the CARES Act expansions from 2020 remain permanently in effect, and the contribution and high-deductible health plan (HDHP) limits have simply been adjusted upward for inflation. This is general education, not tax advice; verify anything unusual with your plan administrator or a tax professional before you spend. For the full mechanics of how the account itself works, see our complete HSA guide.
2026 HSA Contribution and HDHP Limits
Before diving into eligible expenses, here are the key 2026 numbers, set by the IRS in Revenue Procedure 2025-19. The HSA contribution limit is $4,400 for individual (self-only) coverage and $8,750 for family coverage. The catch-up contribution for those 55 and older remains $1,000. To be HSA-eligible, your HDHP must have a minimum deductible of $1,700 (individual) or $3,400 (family) and out-of-pocket maximums no higher than $8,500 (individual) or $17,000 (family).
| 2026 HSA / HDHP figure | Self-only | Family |
|---|---|---|
| HSA contribution limit | $4,400 | $8,750 |
| Catch-up (age 55+) | +$1,000 | +$1,000 |
| HDHP minimum deductible | $1,700 | $3,400 |
| HDHP out-of-pocket maximum | $8,500 | $17,000 |
These numbers are adjusted annually for inflation. The contribution limits represent the combined total from both employee and employer contributions, so if your employer seeds your account, that money counts against the cap. Each figure stepped up from 2025 (when the limits were $4,300 and $8,550), which means a little more pre-tax room this year for the expenses below.
Medical Services and Treatments
The broadest category of HSA eligible expenses covers medical services provided by licensed healthcare professionals. Office visits to primary care physicians and specialists are covered, including copays, coinsurance, and amounts applied to your deductible. Hospital services — inpatient stays, outpatient procedures, emergency room visits, and ambulance services — qualify.
Diagnostic tests and imaging, including blood work, X-rays, MRIs, CT scans, and ultrasounds, are covered. Medically necessary surgical procedures qualify. Physical therapy, occupational therapy, speech therapy, and chiropractic care are eligible. Mental health services including therapy, counseling, and psychiatric care are covered, as is substance abuse treatment.
Prescription and Over-the-Counter Medications
All prescription medications filled at a licensed pharmacy are HSA eligible. Since the CARES Act of 2020, over-the-counter medications are also eligible without a prescription. The expanded list includes pain relievers (acetaminophen, ibuprofen, aspirin, naproxen), allergy medications (cetirizine, loratadine, fexofenadine, diphenhydramine), cold and flu remedies, cough suppressants and expectorants, digestive aids (antacids, acid reducers, anti-diarrheal medications), and anti-itch and topical pain creams.
First aid supplies including bandages, gauze, antiseptic, medical tape, and wound-care products qualify. Sunscreen with SPF 15 or higher is eligible. Menstrual care products — tampons, pads, menstrual cups, and period underwear — are permanently eligible under the CARES Act.
Dental Expenses
Dental care is one of the most comprehensive HSA-eligible categories. Preventive care (cleanings, exams, X-rays, fluoride treatments), restorative work (fillings, crowns, bridges, root canals), periodontal treatments, oral surgery, dental implants, dentures, and orthodontic treatment (braces, Invisalign, retainers) all qualify. Dental sedation and anesthesia are covered as part of a procedure. The main dental exclusion is purely cosmetic work such as teeth whitening. For more detail, see our HSA dental guide.
Vision Expenses
Vision care is fully covered. Eye exams, prescription eyeglasses (frames and lenses), prescription sunglasses, contact lenses, contact lens solution, and corrective eye surgery (LASIK, PRK) all qualify. Reading glasses, even without a prescription, are eligible. Prescription eye drops for conditions such as glaucoma or chronic dry eye are covered.
Medical Equipment and Supplies
Durable medical equipment prescribed by a healthcare provider qualifies. Common examples include crutches, wheelchairs, walkers, blood pressure monitors, blood glucose monitors and test strips for diabetics, CPAP machines and supplies for sleep apnea, hearing aids and batteries, and breast pumps and lactation supplies. Thermometers, pulse oximeters, and home diagnostic test kits are also eligible.
Items That Require Documentation
Some items qualify only with a letter of medical necessity (LMN) from your healthcare provider — a short note tying the purchase to a diagnosed condition. These include dietary supplements and vitamins prescribed for diagnosed conditions, air purifiers for respiratory conditions, humidifiers for diagnosed respiratory or skin conditions, massage therapy prescribed for a medical condition, orthopedic shoes and custom orthotics, and weight-loss programs prescribed for diagnosed obesity. Keep the LMN with your receipts in case the IRS ever asks you to substantiate the expense.
What Is Not HSA Eligible
Several categories remain excluded regardless of circumstances. Cosmetic procedures (teeth whitening, cosmetic surgery, elective skin treatments), gym memberships and fitness equipment, general wellness supplements and vitamins, toiletries and personal-care items (toothbrushes, shampoo, deodorant), health insurance premiums (with limited exceptions for COBRA, coverage while receiving unemployment, Medicare, and qualified long-term care), childcare and babysitting, household items such as mattresses and standard appliances, and non-medical expenses of any kind are all excluded. If you use HSA funds on a non-qualified expense before age 65, the amount is taxed as income and hit with a 20% penalty, so it pays to check first.
Frequently Asked Questions
Did the HSA rules change for 2026?
The core list of eligible expenses did not change for 2026. The CARES Act expansions (OTC medications and menstrual products without a prescription) remain permanently in effect from 2020. The main 2026 changes are the higher contribution limits ($4,400 self-only and $8,750 family) and the inflation-adjusted HDHP deductible and out-of-pocket thresholds.
Can I use my HSA for telehealth visits?
Yes. Telehealth and virtual-care visits are HSA-eligible medical services. Copays and consultation fees for telehealth appointments qualify the same as in-person visits.
Are COVID-19 tests and treatments still HSA eligible?
Yes. COVID-19 testing, treatment, and vaccines remain qualified medical expenses. Home test kits, PCR tests, and related medical consultations are all HSA eligible.
Can I use my HSA for fertility treatments?
Yes. Fertility treatments including IVF, IUI, fertility medications, egg freezing for medical reasons, and related diagnostic testing are qualified medical expenses. These are often high-cost procedures, making the HSA tax savings particularly valuable.
Do I have to spend my HSA in the same year I contribute?
No. Unlike a flexible spending account, an HSA has no “use it or lose it” deadline. Unused funds roll over year to year and stay yours, so you can let the balance grow and even invest it. You can also reimburse yourself years later for a qualified expense, as long as you keep the receipt.
This article is general information, not tax or financial advice. HSA eligibility depends on IRS rules and your plan’s terms and can change; contribution and HDHP figures shown are the IRS amounts for 2026. Verify any specific expense with your plan administrator or a qualified tax professional, and keep receipts to substantiate every distribution.
The Bottom Line
The list of HSA eligible expenses is broad and covers nearly every medical, dental, and vision expense you are likely to encounter. The CARES Act permanently expanded it to include OTC medications and menstrual products, and the higher 2026 contribution limits mean more pre-tax dollars available to put toward them. Maximize your HSA by knowing what qualifies, keeping documentation for every expense, and taking full advantage of the range of eligible items available through your healthcare spending account.
Sources
- Internal Revenue Service — Revenue Procedure 2025-19 (2026 HSA contribution limits, HDHP minimum deductibles, and out-of-pocket maximums)
- Internal Revenue Service — Publication 502, Medical and Dental Expenses
- Internal Revenue Service — Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
- Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 — permanent OTC drug and menstrual product eligibility