HSA, Health FSA, and HRA Eligible Expenses

HSA, Health FSA, and HRA Eligible Expenses2020-04-02T13:26:58-04:00

There are hundreds of eligible expenses for tax-free purchase with a Health Savings Account (HSA), Flexible Spending Account (FSA), and Health Reimbursement Arrangement (HRA) — including prescriptions, doctor’s office copays, health insurance deductibles, and coinsurance.

Many over-the-counter (OTC) treatments are also eligible, though keep in mind that many require a prescription, letter of medical necessity (LMN), or doctor’s directive. And, of course, there are a variety of items that are not generally eligible for reimbursement you should know.

To help you keep track, we put together the HSA, FSA, and HRA Eligible Expenses list below. We’ve also put together summaries of Dependent Care Assistance Program (DCAP) and Commuter Benefits Account eligible expenses as well.

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HSA, FSA, and HRA Eligible Expenses

ExpenseHSA / HRA / Health FSA EligibilityCategoriesSupplementary Documentation Required
Acne treatmentYesOTC, Cosmetic
AcupunctureYesMedical
Adaptive equipmentYes, if for a major disability, such as spinal cord injury. If so, would require an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Adjustable bedYes, with an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Air conditionerGenerally, no, unless the primary purpose is to treat or alleviate a medical condition. If so, would require an LMN.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Air fare to medical providerGenerally, no. There must be a medical reason why care had to be obtained from a location that necessitated the air travel.Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Air purifierMaybe. It must be recommended by a medical practitioner to treat a specific medical condition, such as a severe allergy. If so, would require an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Alcohol wipesYesOTC
Alcoholism treatmentYes. Amounts paid for in-patient treatment (including meals and lodging) at therapeutic center for alcohol addiction and outpatient therapy sessions will qualify, as will transportation expenses associated with attending meetings of an Alcoholics Anonymous or similar group in the community.Medical
Allergy medicineYesOTC, Prescription, Allergy
Allergy treatment product (non-drug); household improvement to treat allergiesGenerally, no. Pillows, vaccums, and some other non-drug allergy treatment products may be eligible for reimbursement with a LMN. It is recommended that you contact your plan administrator for details specific to your plan.AllergyLetter of Medical Necessity, Doctor's Directive, or Prescription required
Alternative healer, dietary substitute, and drugs and medicineMaybe, if provided by a licensed professional to treat a specific medical condition.Medical, Professional ServicesLetter of Medical Necessity, Doctor's Directive, or Prescription required
AmbulanceYesMedical
AnalgesicYesOTC
AnesthesiaYes, if used in conjunction with operations that are legal, eligible and aren't cosmetic procedures.Medical
Annual retainer fee/ Concierge medicineMaybe, if the fee goes toward an actual eligible medical expense.Fees/Financial
AntacidYesOTC
Anti-diarrhea medicineYesOTC
Anti-fungal medicineYesOTC
Anti-itch lotion and creamYesOTC, Cosmetic
Antibiotic ointmentYesOTC
AntihistamineYesOTC, Allergy
AntisepticYesOTC
Arch and insole supportYesOTC
Artificial inseminationYesMedical, Baby/Maternity
Artificial limbYesMedical
AspirinYesOTC
Asthma preparationYesOTC, Prescription
Athlete's foot treatmentYesOTC
Baby formulaYes, if for a special formula to treat an illness or disorder and not for nutritional needs. The difference in cost between the special formula and routine baby formula can be reimbursed. Requires an LMN.OTC, Baby/MaternityLetter of Medical Necessity, Doctor's Directive, or Prescription required
Baby nursing servicesNo, not for a healthy baby with the exception of nursing services provided at a hospital for a newborn covered by the plan.Professional Services, Baby/Maternity
Baby-sitting and child careNoProfessional Services, Baby/Maternity, Child Care
Bandages, gauze and dressingYesOTC
Bariatric surgeryYesMedical
Bathtub rail, grips and safety itemsYesOTC
Bed panYesOTC
Birth-control pills, procedure and supplyYes, including condoms, ovulation kits, norplant insertion or removal, and abortions.OTC, Medical
Birthing classYes. Childbirth classes are eligible. Expenses for parenting/newborn care classes and sibling classes do not qualify.Medical, Baby/Maternity
Blood glucose test kit and test stripsYesOTC
Blood pressure monitoring deviceYesOTC
Blood storageMaybe. Temporary storage may qualify where the blood is stored for a specific planned use, such as during a scheduled elective surgery.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Body scan, MRI and similar diagnostic technologyYesMedical
Braille books and magazinesYes, if for a visually impaired person, but only amounts above the cost of regular printed material will qualify.VisionLetter of Medical Necessity, Doctor's Directive, or Prescription required
Breast pump and lactation devicesYesOTC, Baby/Maternity
Breast reconstruction surgery following mastectomyYes, if the surgery was done following a mastectomy due to cancer.Medical
Calcium supplementYes, with prescription.OTCPrescription required
Cane, walkingYesOTC
Car modificationYes, if for physically handicapped persons. If so, would require an LMN. Expenses of operating the car do not qualify.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Chelation therapyYes, if used to treat a medical condition, such as lead poisoning.Medical
ChiropractorYesMedical
Cholesterol diagnostic testYesOTC
CircumcisionYesMedical
COBRA premiums> HSA: Yes, post-tax COBRA premiums qualify for reimbursement.

> HRA: Maybe, depending on your plan.

> Health FSA: No.
Premiums, Fees/Financial
Coinsurance amounts, copays and deductiblesYes, if the underlying service/item qualifies.Medical, Prescription, Dental, Vision, Fees/Financial
Cold and flu medicineYesOTC
Cold sore remedyYesOTC
Cold/hot packYes. Hot water bottles and heating pads generally will not qualify.OTC
Colon cleansingYes, with an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Commode, bedside or portableYesMedical
Compression hosieryMaybe. Won't qualify if used for personal or preventative reasons. Some will be OTC, but others will need an LMN depending upon the level of compression (i.e., hose that would never be used except to provide medical care would qualify without an LMN).OTCLetter of Medical Necessity, Doctor's Directive, or Prescription required
Contact lens care productYes. Materials such as saline solution and enzyme cleaner are qualified, as well as lens storage cases.OTC, Vision
Contact lens/eyeglass replacement insurance> HSA & Health FSA: No. A fee paid to cover the insurance cost of replacement if the lens or glasses are lost or damaged would not qualify. In contrast, the cost of the replacement lens or glasses will qualify.

> HRA: Dependant upon your company's plan. Check with your HR representative or plan administrator.
Premiums, Fees/Financial
Contact lensesYesVision
Controlled substances in violation of federal lawNo. If the substance violates federal law, the expense would not qualify even if a state law allows its use with a physician's prescription (e.g., medical marijuana).Miscellaneous
CopayYes, if the underlying service/item qualifies.Medical
Corn and callous cushion and padYesOTC
Corn and callous remover or medicationYesOTC
Cosmetic procedureGenerally, no. There is an exception, however, for procedures necessary to correct a deformity arising from a covered surgery, congenital abnormality, personal injury or trauma, or disfiguring disease - these may qualify.CosmeticLetter of Medical Necessity, Doctor's Directive, or Prescription required
Cough medicineYesOTC
CounselingMaybe, if provided to treat a medical or mental condition and rendered by a licensed provider.Medical, Professional ServicesLetter of Medical Necessity, Doctor's Directive, or Prescription required
CPAP (continuous positive airway pressure) deviceYesMedical
CrutchesYes, whether purchased or rented.Medical
DecongestantYesOTC
DefibrillatorYes.Medical
Dental insurance premiums> HSA & Health FSA: No.

> HRA: Yes. Amounts that an HRA participant pays post-tax as premium for insurance to cover dental care are reimbursable from an HRA.
Premiums, Fees/Financial, Dental
Dental treatmentYesDental
Denture adhesiveYesOTC, Dental
DenturesYesDental
Dependent day care expenseNoFees/Financial, Child Care
DermatologistYes, with an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Diabetic suppliesYesOTC
Diagnostic item/serviceYesMedical
Diaper rash ointment and creamYesOTC, Baby/Maternity, Cosmetic
Diapers or diaper service for adultsYesOTC, Professional Services
Diapers or diaper service for infants or childrenNoBaby/Maternity, Child Care
Diet foodsNoDietary
Dietary or nutritional supplementGenerally, no. The cost of dietary supplements, nutritional supplements, vitamins, herbal supplements, and natural medicines does not qualify if they are merely beneficial for general health (e.g., one-a-day vitamins) or used as meal replacement.DietaryLetter of Medical Necessity, Doctor's Directive, or Prescription required
DNA collection and storageGenerally, no. Temporary storage may qualify under some circumstances, such as where the DNA is collected as part of the diagnosis, treatment, or prevention of an existing or imminent medical condition.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
DoulaMaybe, if the doula is a licensed health care professional rendering medical care.Medical, Baby/MaternityLetter of Medical Necessity, Doctor's Directive, or Prescription required
Drug addiction treatmentYes. Amounts paid for in-patient treatment (including meals and lodging), at therapeutic center for drug addiction and outpatient therapy sessions will qualify, as will transportation expenses associated with attending meetings of a Narcotics Anonymous or similar group in the community.Medical
Drug overdose treatmentYesMedical
Drugs and medicinesGenerally, yes, with a prescription. Expenditures for drugs that are for cosmetic purposes or are illegally procured do not qualify.OTC, Prescription
Ear drops and medicationYesOTC
Ear plugsGenerally, no, unless recommended by a medical practitioner for a specific medical condition (for example, to protect surgically implanted ear tubes).MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Ear wax removal productYesOTC
Egg donor feesYesMedical, Baby/Maternity
Eggs and embryos, storage feesMaybe. Temporary storage may qualify where the eggs or embryos are stored as part of a fertility program for immediate conception.Medical, Baby/MaternityLetter of Medical Necessity, Doctor's Directive, or Prescription required
Electrolysis or hair removalNoMiscellaneous
EpipenYesMedical, Allergy
Exercise equipment, program and gym or health club membershipGenerally, no. Only if required to treat an illness (such as obesity) or injury diagnosed by a physician. When treatment is no longer needed for the condition, the fees would no longer qualify.Wellness, Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Orthopedic insertYesOTC
Orthopedic shoesMaybe. It must be recommended by a medical practitioner to treat a specific medical condition.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
OrthoticsYesOTC
Osteopath feeYesMedical
Out of country or foreign services or itemsMaybe. Services, over the counter items, and prescriptions can be reimbursed by manual claim only when the service, item, or prescription is one that is also legal in the United States.Medical, OTC, Prescriptions, Professional Services
Ovulation monitorYesMedical
Oxygen and oxygen equipmentYesMedical
Pain relieverYesOTC, Prescription
Parking fees while receiving medical careYesMedical
PediatricianYesMedical
Personal trainer feeGenerally, no. Only if required to treat an illness (such as obesity or rehabilitation after back surgery) diagnosed by a physician. When treatment is no longer needed, the fees would no longer qualify.Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Physical examYesMedical
Physical therapyYesMedical
Plan B/Morning After PillYesOTC
Porcelain veneersNoDental
Pre-paymentGenerally, no. Pre-payments for services/items that have not yet been incurred/obtained are not reimbursable. The two exceptions are for orthodontia and for labor/delivery charges.Fees/Financial
Pregnancy test kitYesOTC
Prescription drugYes, though expenditures for drugs that are for cosmetic purposes or are illegally procured (such as imported from Canada) do not qualify.PrescriptionPrescription required
Prescription drug discount programNo. If an individual pays a fee to get a card that provides for a discount on all drugs, the fee would not qualify. In contrast, the discounted cost of a prescribed drug generally will qualify.Fees/Financial
Preventive care screeningYes, if the tests are designed to assess symptoms of a medical diagnosis, including clinic and home testing kits.Medical, OTC
ProbioticGenerally, no.If the probiotic was recommended by a physician to treat a specific medical condition, then it would qualify.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
ProsthesisYes, for artificial limbs and breast prosthesis, following a mastectomy for cancer.Medical
Psychiatric careYesMedical
Psychoanalysis or PsychologistYesMedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Reading glassesYesOTC, Vision
RogaineGenerally, no. May qualify if it is recommended by a medical practitioner for a specific medical condition.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Safety glassesGenerally, no. Non-prescription safety glasses would generally not qualify unless recommended by a physician to alleviate an eye condition.MiscellaneousPrescription required
Sales taxYes. Sales tax on medical services and products would qualify.Medical
Seasonal Affective Disorder (SAD) LightYes, with prescription.OTCPrescription required
Shipping and handling feeYes, if the underlying service/item qualifies.Fees/Financial
Shower chairYesOTC
Sinus medicationYesOTC
Skin moisturizerNoCosmetic
Sleeping aidYesOTC
Smoking cessation medicineYesOTC
Smoking cessation programYesOTC
Sore throat pain reliefYesOTC
Special foodNo. Costs of special foods to treat a specific disease do not qualify. Thus, the costs of food associated with a gluten-free or salt-free diet would not qualify, since they also meet normal nutritional needs.Dietary
Special needs or educationYes. Costs (tuition, meals, lodging) of attending a special school for treatment of a mentally impaired or physically disabled person qualify if the main reason for using the school is its resources for relieving the disability. This includes teaching Braille to a visually impaired person, teaching lip reading to a hearing impaired person, giving remedial language training to correct a condition caused by a birth defect, and expenses paid on a doctor's recommendation to treat a learning disability caused by a mental or physical impairment.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Speech therapyYesMedical
Sperm storage feeMaybe. Temporary storage may qualify where the sperm is stored as part of a fertility program for immediate conception.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Stem cell, harvesting and/or storage ofGenerally, no. Temporary storage may qualify under some circumstances, such as where the stem cells are collected to treat a specific and imminent medical condition.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Sterilization procedure such as tubal ligation or vasectomyYesMedical
Sterilization reversalYesMedical
Student health feeNo, a fee that is simply the cost of belonging to the program won't qualify. Expenses for specific medical services might qualify.Premiums, Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Sun tan lotion without sunscreenNoCosmetic
Sunburn cream and ointmentYesOTC
SunglassesYes, if they are prescription sunglasses. Non-prescription sunglasses or sunglass clip-ons would generally not qualify unless recommended by a physician to alleviate an eye condition.VisionLetter of Medical Necessity, Doctor's Directive, or Prescription required
SunscreenYesOTC, Cosmetic
Support, splint and back braceYesOTC
Surgery and operationYes, if legal and non-cosmetic.Medical
Surrogate expenseGenerally, no, even if they are for medical care of the surrogate or her unborn child. The procedure must be performed upon the participant, his or her spouse, or eligible dependent in order to be medical care.Fees/Financial, Baby/Maternity
SyringeYesOTC
Taxi or Uber fare to medical providerYesMedical
Teeth whiteningNoDental
Teething medicationYesOTC, Baby/Maternity
Telephone for hearing impaired personYes, for the expenses of buying and repairing special telephone equipment for a hearing impaired person.Medical
TherapyYes, if it is provided to treat a medical or mental condition and rendered by a licensed provider. Therapy for general improvement of mental health, relief of stress, or personal enjoyment do not qualify.Medical
Thermometer and fever stripsYesOTC
Toiletries and cosmeticsNo. Cosmetics are articles used primarily for personal purposes, such as cleansing, beautifying, promoting attractiveness, or altering the appearance. Examples include skin moisturizers, perfumes, lipsticks, fingernail polishes, makeup, shampoos, hair colors, and deodorants.Cosmetic
Tooth extractionYesDental
Toothache relieverYesOTC, Dental
ToothbrushNo, even if a dentist recommends a special kind (such as electric or battery-powered ones) to treat a medical condition like gingivitis.Dental
TransplantYes. Includes surgical, hospital, and laboratory services, and transportation expenses for organ donors.Medical
Transportation expense for person to receive medical careYes, if the expenses are primarily for and essential to medical care. These include car expenses, bus, taxi, train, plane, and ferry fares, and ambulance services. Instead of actual car expenses, a standard mileage rate (re-stated each year) for use of a car to obtain medical care is allowed. Parking fees and tolls can also qualify.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Transportation of someone other than the person receiving medical careYes, in some limited cases. Transportation expenses of the following persons will qualify: (1) parent who must go with a child who needs medical care; (2) nurse or other person who gives injections, medications, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone; and (3) individual who travels to visit a mentally ill dependent, if such visits are recommended as part of treatment.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Truss, hernia beltYesOTC
Ultrasound, pre-natalYesMedical, Baby/Maternity
Varicose veins, treatment ofGenerally, no, if the procedure merely improves appearance and doesn't meaningfully promote the proper function of the body or prevent or treat illness or disease.Professional Services, Cosmetic, MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Veterinary feeYes, if the veterinary fees are incurred for the care of a guide dog or other service animal used by a disabled person.Vision, MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Vision care, including vision correction procedureYesVision
Vision discount programNo. If an individual pays a fee to get a card that provides for a discount on vision services, the fee would not qualify. In contrast, the discounted cost of the vision services generally will qualify.Vision
Vision insurance premiums> HSA & Health FSA: No

> HRA: Yes. Amounts that an HRA participant pays post-tax as premium for insurance to cover vision care are reimbursable from an HRA.
Premiums, Vision, Fees/Financial
VitaminsNo, if they are used to maintain general health. Under narrow circumstances, vitamins might qualify if recommended by a medical practitioner for a specific medical condition (for example, a prescribed dosage of Vitamin B-12 daily to treat a specific vitamin deficiency).OTC, WellnessLetter of Medical Necessity, Doctor's Directive, or Prescription required
Vitamins, pre-natalYesOTC, Baby/Maternity
WalkerYesMedical
WarrantyNoFees/Financial
Wart remover treatmentYesOTC
Water PikYes, with an LMN.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Weight loss medicationYesOTC, Prescription
Weight loss procedure or surgeryYesMedical
Weight-loss programYes, if the weight-loss program is recommended by a physician to treat an existing disease (such as obesity, heart disease, or diabetes).The costs of food associated with a weight-loss program would not qualify, since it meets normal nutritional needs.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
WheelchairYesMedical
WigMaybe, if the wig is for a patient who has lost all of his or her hair from disease or treatment (e.g., chemotherapy or radiation).MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Witch HazelYesOTC
X-ray feeYesMedical

HSA, FSA, and HRA Eligible Expenses

Examples of items generally eligible under HSAs, FSAs, and HRAs:

  • Acupuncture
  • Alcoholism treatment
  • Ambulance
  • Artificial limb
  • Automobile modifications for a physically handicapped person
  • Birth control pills
  • Blood pressure monitoring device
  • Braille books & magazines (above the cost of regular printed material)
  • Chiropractic care
  • Christian Science practitioner
  • COBRA premiums (post tax, HSA & HRA only)
  • Contact lenses & related materials
  • Crutches
  • Dental treatment
  • Dentures
  • Diagnostic services
  • Drug addiction treatment
  • Eye examination
  • Eye glasses & related materials
  • Fertility treatment
  • Flu shot
  • Guide dog or other animal aide
  • Hearing aids
  • Hospital services
  • Immunization
  • Insulin
  • Insurance premiums (post tax, HRA only)
  • Laboratory fees
  • Laser eye surgery
  • Long-term care premiums or expenses (post tax, HSA & HRA only)
  • Medical testing device
  • Nursing services
  • Obstetrical expenses
  • Organ transplant
  • Orthodontia (not for cosmetic reasons)
  • Over-the-counter (OTC) health items*
  • Oxygen
  • Physical exam
  • Physical therapy
  • Prescription drugs
  • Psychiatric care
  • Retiree medical insurance premiums (HSA only)
  • Smoking cessation program
  • Surgery
  • Transportation for medical care
  • Weight loss program necessary to treat obesity
  • Wheelchair

*OTC items that contain a drug or medication require a prescription. Insulin, medical monitoring and testing devices, and other non-medical health items are eligible without a prescription.

For more, see the PDF eligible expenses lists below or the desktop version of this page for a searchable list (coming to mobile displays soon).

View & Download Eligible Expense Lists:

Please keep in mind that your employer might have additional limitations on what can be purchased with your account funds.
See IRS Publication 502 and your plan documents for more information.

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