Can I Pay for Mental Health Care Using my FSA or HSA?

Mental health care is crucial to maintaining overall wellness. Perhaps now more than ever, it’s important to remember that your emotional and mental health are just as important as your physical health.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) survey on mental health, 47.6 million adults in the United States live with a mental illness, or nearly one in five people over age 18. As many as 30% of those who have a mental health condition don’t seek treatment, and a common obstacle to mental health care is the cost.

The good news is that you can pay for many mental health treatments and services (including some forms of online therapy) with your flexible spending account (FSA) or your health savings account (HSA), to offset out-of-pocket expenses.

In this post, we’ll go into more detail about what mental health services and products qualify for coverage with FSA and HSA funds.

One of the key treatment modalities for people dealing with mental health conditions is to receive counseling from a psychologist or psychiatrist, which we commonly refer to as therapy. However, there may be a few steps to take before your therapy sessions will be covered by FSA or HSA funds.

If you have symptoms that may be related to an undiagnosed mental health condition, the first health care provider you will likely want to see is your primary care physician. Your physician can rule out other possible health issues and then provide a Letter of Medical Necessity for psychological or psychiatric care. Your doctor may then refer you to a licensed psychologist for counseling, or a psychiatrist who can prescribe medications to treat your symptoms and/or offer behavioral therapy or psychoanalysis.

The treatment provided by a psychologist or psychiatrist is eligible for FSA or HSA reimbursement if the purpose of the treatment is for medical care and not for the general improvement of mental health. For this reason, things like marriage counseling or couples’ therapy are not eligible for FSA and HSA coverage.

In the past couple of months (and in the last few weeks, given the recent COVID-19 pandemic), the number of people seeking online therapy or teletherapy has increased. Teletherapy or telepsychiatry is when you conduct an appointment with your therapist, psychologist, or psychiatrist via telephone or video call using a HIPAA-compliant digital technology platform.

Online therapy typically replaces what would be a normal psychological or psychiatric therapy session at your mental health care provider’s office, so the same rules apply when it comes to HSA and FSA coverage—there must be medical necessity stated by your physician for it to be covered.

There are many treatments beyond prescription medications and office-based or online therapy programs that patients with mental health conditions may need. Addiction treatment for alcohol or substance use is one example of a specialized treatment, which can often be paid for with an FSA or HSA.

Inpatient or residential treatment programs at addiction treatment facilities and outpatient therapy sessions will qualify for FSA and HSA reimbursements, as well as transportation expenses associated with attending meetings of an Alcoholics Anonymous, Narcotics Anonymous, or similar group in the community. Smoking cessation counseling also qualifies for FSA or HSA reimbursement.

Acupuncture is another form of therapy that makes the list of FSA and HSA eligible expenses, as long as the individual has a Letter of Medical Necessity from their doctor, indicating it is an effective treatment for their mental health condition. See this blog post for other alternative treatment options covered by your pre-tax funds.

Similarly, hypnotherapy can be used to treat addiction, eating disorders, phobias, traumas, and many other mental health conditions. This is an alternative treatment that uses the practice of hypnosis to treat various conditions, and it is an eligible FSA or HSA expense as long as the individual consults their physician and receives a Letter of Medical Necessity for hypnotherapy.

In the past decade, an array of apps have been created to offer online therapy in various forms, including through text message, voice message, and video chat. Anyone can sign up for these services and most promise to offer therapy sessions with licensed therapists and counselors.

These online therapy apps can be a helpful option for those who may feel intimidated by in-person therapy sessions, those who live in remote areas, those whose work schedule makes appointments difficult, and for those who cannot afford traditional therapy sessions that may not be covered by insurance.

In some cases, these online therapy app fees can be covered with FSA or HSA funds, but it varies widely depending on the benefits provider and the app chosen. It’s best that individuals ask their benefits provider if the online therapy app they want to use might be eligible for reimbursement with FSA or HSA funds, and they should save their receipts from the service fees in case they are eligible.

Meditation is often considered a helpful practice for anyone, including those dealing with mental health issues like anxiety and depression. In one comprehensive study, researchers from Johns Hopkins University looked at almost 19,000 meditation studies and found that a selection of those studies which met their study criteria showed that mindfulness meditation may help reduce the effects of stress, anxiety, depression, and pain.

If an employee is new to meditation or wants to try it but isn’t sure how, there are now many meditation apps available that offer guidance for a range of meditation types. Many of these meditation apps are also free to use, which makes them even more accessible.

As of now, meditation apps are not eligible for FSA or HSA coverage, but given that there are many affordable and free options, individuals may be able to find one that suits their needs without spending much at all!