- An HSA can pay for the IRS's qualified medical expenses (Publication 502): doctor visits, prescriptions, dental, vision, mental health, and much more.
- Since the CARES Act, over-the-counter medicines and menstrual products are HSA-eligible without a prescription.
- Most insurance premiums are NOT eligible, but there are exceptions — COBRA, coverage while on unemployment, long-term care insurance (age-limited), and Medicare premiums once you turn 65 (Medigap/Medicare Supplement premiums do not qualify).
- Using HSA funds for non-qualified expenses before age 65 triggers income tax plus a 20% additional tax (IRS Publication 969); after 65 the 20% tax no longer applies but income tax still does.
- For 2026 the IRS allows HSA contributions up to $4,400 (self-only) and $8,750 (family), plus a $1,000 catch-up at age 55+.
- This is general education, not tax advice — verify eligibility and limits with a tax professional and your HSA administrator.
Health Savings Accounts offer remarkable flexibility, but most account holders barely scratch the surface of eligible expenses. If you have ever wondered what can HSA be used for, the answer may surprise you — the IRS allows hundreds of qualified medical expenses ranging from routine doctor visits to acupuncture and even some home modifications. Understanding the full scope of HSA-eligible purchases can save you a meaningful amount each year in after-tax spending. Because eligibility rules and dollar limits are set by the IRS and updated over time, treat this as a general guide and confirm specifics with a tax professional.
How HSA Eligibility Is Determined
The IRS defines qualified medical expenses in Publication 502. In broad terms, any expense whose purpose is to diagnose, cure, mitigate, treat, or prevent disease — or to affect a structure or function of the body — can qualify. The expense must be primarily for medical care, not general health or cosmetic purposes, and it cannot have been reimbursed by insurance or another plan.
Since the CARES Act of 2020, over-the-counter medications no longer require a prescription to be HSA-eligible. This single change dramatically expanded the list of everyday items you can purchase with pre-tax dollars, including pain relievers, allergy medications, and digestive aids. The same law made menstrual care products permanently eligible.
Doctor Visits, Hospital Stays, and Medical Services
The most straightforward HSA expenses include office visit copays, specialist consultations, lab work, X-rays, MRIs, and surgical procedures. Hospital stays, ambulance fees, and emergency room visits also qualify. If your high-deductible health plan leaves you with significant out-of-pocket costs, your HSA can cover every dollar until you meet your deductible — and beyond.
Preventive care services such as annual physicals, cancer screenings, and vaccinations are eligible as well. Mental health services, including therapy sessions and psychiatric care, fall under qualified medical expenses too. For a broader view of managing these costs, see our healthcare costs guide.
Prescription Medications and Over-the-Counter Drugs
All prescription medications are HSA-eligible, from antibiotics to specialty drugs. Thanks to the CARES Act, you can also use HSA funds for OTC drugs without a prescription. This includes ibuprofen, acetaminophen, antihistamines, cough suppressants, antacids, and topical pain relievers.
Menstrual care products — tampons, pads, liners, and menstrual cups — became permanently eligible under the same legislation. If you are curious about specific product eligibility, our guide on what you can use your HSA card for breaks down common purchases.
Dental and Vision Expenses
Dental care is one of the most popular uses for HSA funds. Cleanings, fillings, crowns, root canals, braces, dentures, and dental implants all qualify. Cosmetic dental procedures like teeth whitening, however, do not meet the IRS standard.
Vision expenses are equally broad. Eye exams, prescription glasses, contact lenses, contact lens solution, and laser eye surgery (LASIK and PRK) are all eligible. Prescription sunglasses qualify, but non-prescription sunglasses typically do not — though standard sunscreen is eligible as a preventive care item.
Mental Health and Therapy
Mental health treatment is covered under HSA rules. Psychotherapy, counseling sessions, psychiatric evaluations, and prescribed medications for anxiety, depression, ADHD, and other conditions all qualify. Substance abuse treatment programs, including inpatient rehabilitation, are eligible expenses as well.
Some lesser-known mental health expenses also qualify, such as service animals prescribed for psychological conditions and certain biofeedback devices recommended by a healthcare provider.
Alternative and Specialized Treatments
The IRS recognizes several alternative medicine treatments as qualified expenses. Acupuncture is explicitly listed as eligible. Chiropractic care qualifies when performed by a licensed practitioner. Physical therapy, occupational therapy, and speech therapy are covered when prescribed or recommended by a physician.
Other specialized treatments that answer the question of what can HSA be used for include fertility treatments (IVF, hormone therapy), hearing aids and hearing-related exams, and prosthetic devices. Weight-loss programs may qualify if a doctor diagnoses a specific medical condition such as obesity, hypertension, or heart disease — though ordinary gym or health-club dues and diet food remain non-eligible even then.
Medical Equipment and Supplies
Durable medical equipment prescribed by a healthcare provider is HSA-eligible. This category includes crutches, wheelchairs, walkers, blood pressure monitors, glucose monitors, nebulizers, and CPAP machines. Disposable supplies like bandages, thermometers, and first-aid kits also qualify.
Home modifications may be eligible when medically necessary. Wheelchair ramps, grab bars in bathrooms, and widened doorways can qualify if a physician certifies the modification is needed for a medical condition. Per Publication 502, the qualifying amount is generally the cost of the improvement minus any increase it adds to your property’s value, and accessibility modifications that do not raise the home’s value are typically counted in full.
Long-Term Care
Qualified long-term care services for a chronically ill individual — the kind of custodial and skilled care needed when someone cannot perform daily activities without help — are HSA-eligible under Publication 502. Premiums for a qualified long-term care insurance contract are also eligible, but only up to an age-based dollar limit that the IRS sets and adjusts each year (the older the insured person, the higher the allowable amount). Confirm the current-year limit before you reimburse a long-term care premium from your HSA.
What Cannot Be Paid With HSA Funds
Not everything health-related qualifies. Cosmetic procedures performed solely to improve appearance — such as teeth whitening, elective facelifts, and most Botox treatments — are not eligible unless they address a specific medical condition. Gym memberships and general fitness programs do not qualify, nor do nutritional supplements unless prescribed by a doctor for a diagnosed condition. For details on whether supplements are HSA eligible, consult our dedicated guide.
Insurance premiums generally cannot be paid with HSA funds, with a few important exceptions: COBRA continuation coverage, health coverage while you are receiving unemployment compensation, qualified long-term care insurance premiums (up to age-based limits), and Medicare premiums for Part A, Part B, Part C (Medicare Advantage), and Part D once you are age 65 or older. One point that trips people up: Medicare Supplement (Medigap) premiums are NOT HSA-eligible, even though the underlying Medicare premiums are. Premiums for other coverage that does not fall into these exceptions are not qualified expenses.
Frequently Asked Questions
Can I use my HSA for family members?
Yes. You can use HSA funds to pay for qualified medical expenses for your spouse and tax dependents, even if they are not covered by your high-deductible health plan. The key requirement is that the individual must be your tax dependent as defined by the IRS.
What happens if I use HSA money for non-qualified expenses?
If you withdraw HSA funds for non-qualified expenses before age 65, you will owe income tax on the amount plus a 20% additional tax, per IRS Publication 969. After age 65 (or in the case of disability or death), the 20% additional tax no longer applies, but you still owe ordinary income tax on non-qualified withdrawals — making the HSA function similarly to a traditional IRA at that point.
Do I need to save receipts for HSA purchases?
The IRS does not require you to submit receipts with your tax return, but you should retain documentation of every HSA expense. In the event of an audit, you will need to prove that withdrawals were used for qualified medical expenses. Many advisors recommend keeping records for at least several years, and some suggest keeping them for as long as the account is open. Learn more about documentation standards in our HSA reimbursement guide.
Are over-the-counter medications HSA eligible without a prescription?
Yes. Since the CARES Act was signed into law in March 2020, OTC medications and menstrual care products are HSA-eligible without a prescription. This change is permanent and applies to both HSAs and FSAs.
Can I use HSA funds for my adult children?
You can use HSA funds for adult children only if they qualify as your tax dependents under IRS rules. Once a child is no longer your dependent — the age-26 rule for staying on a parent’s insurance is separate from the tax-dependency test that governs HSA eligibility — you generally cannot use your HSA for their expenses. Confirm dependency status with a tax professional.
Can I pay Medicare or Medigap premiums from my HSA?
Once you are 65 or older, you can use HSA funds to pay Medicare Part A, B, C, and D premiums. Medicare Supplement (Medigap) premiums, however, are not HSA-eligible. Verify your specific situation with a tax professional.
Making the Most of Your HSA
Knowing what can HSA be used for is the first step toward maximizing your account’s value. For 2026, the IRS allows individual (self-only) contributions up to $4,400 and family contributions up to $8,750, with an additional $1,000 catch-up contribution for those 55 and older. Every dollar you contribute reduces your taxable income, grows tax-free, and can be withdrawn tax-free for qualified expenses. These limits are adjusted annually, so confirm the current figures before you max out.
Consider keeping a running list of eligible expenses and saving receipts digitally. Some account holders choose to pay medical expenses out of pocket now and reimburse themselves from their HSA years later — there is no time limit on reimbursement as long as the expense occurred after the HSA was established and you keep the documentation. For step-by-step guidance on getting started, read our guide on how to open an HSA. As always, consult a tax professional for advice tailored to your specific situation.
Disclaimer: This article is general educational information, not tax or medical advice. An HSA can pay for the IRS’s qualified medical expenses (Publication 502) — doctor visits, prescriptions, dental, vision, mental health, OTC drugs and menstrual products, long-term care, and, once you turn 65, Medicare Part A/B/C/D premiums (but not Medigap). Non-qualified withdrawals before age 65 trigger income tax plus a 20% additional tax (Publication 969). For 2026 the contribution limits are $4,400 self-only and $8,750 family, plus a $1,000 catch-up at 55+. These rules and figures change; verify eligibility and current limits with your HSA administrator and a qualified tax professional before you rely on them.
Sources
- IRS — Publication 502, Medical and Dental Expenses (qualified expense definitions, long-term care, home modifications)
- IRS — Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (20% additional tax; premium exceptions; 2026 contribution limits)
- CARES Act of 2020 — over-the-counter drugs and menstrual care products made HSA/FSA eligible without a prescription
- IRS — annual inflation-adjusted HSA contribution limits and long-term care premium deduction limits