HSA, Health FSA, and HRA Eligible Expenses

HSA, Health FSA, and HRA Eligible Expenses 2018-02-27T09:44:36+00:00

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.

HSA, FSA, and HRA Eligible Expenses

ExpenseHSA / HRA / Health FSA EligibilityCategoriesSupplementary Documentation Required
Acne treatmentYes, with prescription.OTC, CosmeticPrescription required
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 medicineYes, with prescription.OTC, Prescription, AllergyPrescription required
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
AnalgesicYes, with prescription.OTCPrescription required
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
AntacidYes, with prescription.OTCPrescription required
Antibiotic ointmentYes, with prescription.OTC
Anti-diarrhea medicineYes, with prescription.OTCPrescription required
Anti-fungal medicineYes, with prescription.OTCPrescription required
AntihistamineYes, with prescription.OTC, AllergyPrescription required
Anti-itch lotion and creamYes, with prescription.OTC, CosmeticPrescription required
AntisepticYes, with prescription.OTCPrescription required
Arch and insole supportYesOTC
Artificial inseminationYesMedical, Baby/Maternity
Artificial limbYesMedical
AspirinYes, with prescription.OTCPrescription required
Asthma preparationYes, with prescription.OTC, PrescriptionPrescription required
Athlete's foot treatmentYes, with prescription.OTCPrescription required
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-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 medicineYes, with prescription.OTCPrescription required
Cold sore remedyYes, with prescription.OTCPrescription required
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 medicationYes, with prescription.OTCPrescription required
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 medicineYes, with prescription.OTCPrescription required
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
DecongestantYes, with prescription.OTCPrescription required
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 creamYes, with prescription.OTC, Baby/Maternity, CosmeticPrescription required
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, PrescriptionPrescription required
Ear drops and medicationYes, with prescription.OTCPrescription required
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 productYes, with prescription.OTCPrescription required
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
EpipenYes, with prescription.Medical, AllergyPrescription required
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
Eye dropsYes, with prescription.OTC, Prescription, VisionPrescription required
Eye examinationYesVision
Eye patchYesOTC, Vision
Eye glass care materialsYes, including materials needed for using the eyeglasses, such as eyeglass cleaners.OTC, Vision
Eye glass repair for Rx glassesYesVision
Eye glasses and materialsYes, including anti-glare or anti-reflective treatment.Vision
Face cream and moisturizerNoCosmetic
Feminine hygiene product (tampons, etc.)NoMedical
Fertility treatmentYes. Examples are IVF (in vitro fertilization—including temporary storage of eggs or sperm), surgery (including an operation to reverse prior surgery preventing someone from having children), shots, treatments, and GIFT (gamete intra-fallopian transfer). Expenses paid to or for an in vitro surrogate do not qualify.Medical, Baby/Maternity
Fiber supplementGenerally, no, unless used to treat a diagnosed medical condition (such as irritable bowel syndrome) until the condition is alleviated.WellnessLetter of Medical Necessity, Doctor's Directive, or Prescription required
Finance chargeNoFees/Financial
First aid creamYes, with prescription.OTCPrescription required
First aid kitYesOTC
Flu shotYesMedical
Fluoride treatment or fluoride pillsYes, with prescription and if used to treat or alleviate a specific medical condition, and not to maintain general health or for other personal reasons.DentalPrescription required
FMLA paperwork feeNoFees/Financial
FitbitGenerally, no, unless it is providing a type of treatment for a medical condition. If so, would require an LMN.OTC, WellnessLetter of Medical Necessity, Doctor's Directive, or Prescription required
Funeral expenseNoFees/Financial
Gender reassignment surgeryMaybe, if recommended by a medical practitioner to treat a specific medical condition, such as gender identity disorder.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Genetic testingMaybe, if the testing is done to diagnose a medical condition or determine possible defects (for example, the possible defects of an unborn child if the mother is over age 35). Testing for non-medical reasons, such as to determine the gender of the fetus, does not qualify.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Glucosamine/chondroitinYes, unless used just to maintain general health. An LMN is usually required.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Guide dog; other service animalYes. The costs of buying, training, and maintaining a guide dog or other service animal to assist a visually impaired or hearing disabled person, or a person with other physical disabilities are eligible.Vision, Medical
Hair loss treatmentGenerally, no, unless treating hair loss due to a specific medical condition.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Hand sanitizerGenerally, no, unless used to treat a specific medical condition or to prevent a specific and imminent illness.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Handicap Parking PassYesFees/Financial
Health insurance and prescription premiums> HSA: Only in limited cases. Generally, an HSA cannot reimburse payments for health insurance. The following post-tax expenses are considered qualified expenses: COBRA; any health or prescription plan maintained while the individual is receiving unemployment compensation under federal or state law; or, for those age 65 or older (whether or not they are entitled to Medicare), any deductible health insurance (e.g., retiree medical coverage) other than a Medicare supplemental policy.

> HRA: Yes. Amounts that an HRA participant pays post-tax for insurance to cover medical, dental, or vision care are reimbursable from an HRA.

> Health FSA: No
Premiums, Fees/Financial
Health screeningYesMedical
Hearing aid and batteriesYesMedical
Heart rate monitorYesMedical
Hemorrhoid treatmentYes, with prescription.OTCPrescription required
Herbal supplementGenerally, no, if they are used to maintain general health. Herbal supplements may qualify if recommended by a medical practitioner for a specific medical condition.WellnessLetter of Medical Necessity, Doctor's Directive, or Prescription required
Home diagnostic kitYes. Testing kits such as blood pressure monitors, cholesterol screening, HIV tests and pregnancy tests will qualify.OTC
Home modification expense (wheelchair ramp, etc.)Maybe. Improvements or special equipment added to a home may qualify if the primary purpose of the expenditure is medical care. How much of the expense would qualify depends on the extent to which the expense permanently increases the property value and whether others besides the person with the medical condition will benefit.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Homeopathic careYes, for care rendered by a licensed healthcare professional providing care for the treatment of a specific illness or disorder.Medical
Homeopathic medicineYes, with prescription.OTCPrescription required
Hormone replacement therapy (HRT)Yes, with prescription.OTC, PrescriptionPrescription required
Hospice careYes. Both inpatient and at-home hospice care is eligible.Medical
Hospital serviceYesMedical
Household helpNo, even if a medical practitioner recommends such help.Professional Services
HumidifierMaybe, if recommended by a medical practitioner to treat a specific medical condition such as a severe allergy.OTCLetter of Medical Necessity, Doctor's Directive, or Prescription required
Hydrogen peroxideYes, with prescription.OTCPrescription required
HypnosisYes, for the treatment of a specific illness or disorder. Requires an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Illegal operation and treatmentNo. If the treatment violates federal law, the expense would not qualify even prescribed by a licensed medical practitioner.Miscellaneous
Immunization and vaccinationsYes. Immunizations to prevent disease (such as tetanus or well-baby shots) will qualify, even if no medical condition has been diagnosed, including those recommended for overseas travel.Medical
Incontinence diapers and supplies (adult)YesOTC
Insect bite cream and ointmentYes, with prescription.OTCPrescription required
InsulinYes, including equipment needed to inject the insulin, such as syringes or insulin pumps.OTC, Prescription
Inversion TableYes, with an LMN.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Laboratory feeYesMedical, Fees/Financial
Lactation consultantYes. If a woman is having lactation problems and cannot breastfeed her child, then the expense of a lactation consultant helping to overcome this dysfunction might qualify.Baby/Maternity, Professional ServicesLetter of Medical Necessity, Doctor's Directive, or Prescription required
Lactose intolerance medicationYes, with prescription.OTCPrescription required
Language trainingYes, if for a child with dyslexia or a disabled child. School fees for regular schooling don't qualify.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Laser vision correction surgery such as Lasik or radial keratotomyYesVision
Late appointment feeNoFees/Financial
LaxativeYes, with prescription.OTCPrescription required
Learning disability, instructional feeGenerally, yes. If prescribed by a physician, tuition fees paid to a special school and tutoring fees paid to a specially-trained teacher for a child who has severe learning disabilities caused by mental or physical impairments qualify.Medical, Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Legal fee, generalGenerally, no. Legal fees that are necessary to authorize treatment for mental illness will qualify.Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Lice treatmentYes, with prescription.OTC
Lifetime care – advance paymentNo. Fees or advance payments made to a retirement home or continued care facility are not eligible expenses. You may include a part of a life-care fee or “founder's fee” paid under an agreement with a retirement home.Fees/FinancialPrescription required
Lodging for medical care not at a hospital or similar institutionYes, up to $50 per night per person if certain conditions are met. Expenses for food and beverages are not eligible.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Lodging of a companionYes, if accompanying a patient for medical reasons and certain conditions are met. If both parents are traveling with a sick child, up to $100 may qualify ($50 for each person). Meals for the companion(s) are not eligible.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Lodging while attending a medical conferenceNoMiscellaneous
Long-term care insurance premiumsNote: Long-term care insurance premium reimbursements that exceed federal tax limits will be treated as taxable and may be subject to an additional excise tax.

> HSA: Yes, amounts paid post-tax up to the limit.

> HRA: Yes, aounts paid post-tax up to the limit.

> Health FSA: No.
Premiums, Fees/Financial
Magnetic therapy wrapYesOTC
Magnifying glassesYesOTC, Vision
MakeupNoCosmetic
MarijuanaNo. See Controlled substances in violation of federal law.Miscellaneous
Marriage and family counselingNoProfessional Services
Massage therapyGenerally, no. If the massage therapy was recommended by a physician to treat a specific injury or trauma, then it would qualify.Professional ServicesLetter of Medical Necessity, Doctor's Directive, or Prescription required
Mastectomy-related special braYesMedical
Maternity clothesNoBaby/Maternity
Matriculation FeeNoFees/Financial
MattressYes, with an LMN.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
Medical alert bracelet or necklaceYesMedical
Medical credit card paymentsYes, if the underlying service/item qualifies. Interest for the credit card would not be an eligible expense.Fees/Financial
Medical conference admission and transportationYes. Expenses for admission and transportation to a medical conference qualify, if the conference relates to a chronic disease suffered by a covered person and if the conference is primarily for and essential to the person in need of medical care. Most of the time at the conference must be spent attending sessions on medical information. The expenses of meals and lodging while attending the conference don't qualify.Medical, Fees/FinancialLetter of Medical Necessity, Doctor's Directive, or Prescription required
Medical monitoring and testing deviceYesMedical
Medical newsletterNo. Although a newsletter may discuss current information about treatments for a specific medical condition, the newsletter itself does not directly treat the condition.Miscellaneous
Medical records chargeYes, including the fee associated with copying or transferring medical records to a new medical practitioner or for storing and maintaining medical records electronically.Medical, Fees/Financial
Medicated lip balmYes, with prescription.OTCPrescription required
Menstrual pain relieverYes, with prescription.OTCPrescription required
Mentally handicapped, special home forMaybe. A psychiatrist may recommend a special home (not a relative's home) to help a person with intellectual and/or developmental disabilities.MiscellaneousLetter of Medical Necessity, Doctor's Directive, or Prescription required
MidwifeYesMedical, Baby/Maternity
Mileage for Medical VisitsYes, up to the IRS designated medical mileage rate (2017 rate: 17 cents per mile).

Required Documentation for Claims for Mileage for Medical Visits:

> Itemized receipt from medical visit
> A copy of Google Map travel summary showing the mileage for the trip OR receipt for taxi or Uber
Medical
Missed appointment feeNoFees/Financial
Motion sickness band and suppliesYesOTC
Motion sickness medicineYes, with prescription.OTCPrescription required
Mouthwash and toothpasteGenerally, no. Mouthwashes and toothpastes available by prescription only would qualify.OTC, Prescription, DentalPrescription required
Nasal allergy sprayYes, with prescription.OTC, AllergyPrescription required
Nasal moistening spray and stripsYes, if used to treat sinus problems and primarily for medical care (e.g., used to prevent sleep apnea).OTC
Naturopathic healer, dietary substitute and drugs and medicineMaybe. Non-traditional healing treatments provided by a licensed professional may be eligible if provided to treat a specific medical condition. The treatments must be legal, and the expenses do not qualify if the remedy is a food or substitute for food.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Nicotine gum or patchYes, with prescription.OTC
Nursing servicesYes, wages, employment taxes, and other amounts paid for nursing will qualify, whether provided in the participant's home or another facility.Medical
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
NutritionistMaybe, if the treatment relates to a specifically diagnosed medical condition. Not if the expense is for general health.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
Obstetrical expenseYesMedical
Occlusal guard to prevent teeth grindingYesDental
Occupational therapyYes, if treating or alleviating a medical condition.MedicalLetter of Medical Necessity, Doctor's Directive, or Prescription required
OptometristYesVision
Oral pain relief medicineYes, with prescription.OTCPrescription required
Orthodontia, including bracesGenerally, yes. When an orthodontic treatment plan is pre-paid upfront at the time of the first visit, some health FSAs will apportion the reimbursements as services are provided during the treatment plan.Dental
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 relieverYes, with prescription.OTC, PrescriptionPrescription required
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 PillYes, with prescription.OTCPrescription required
Porcelain veneersNoDental
Pregnancy test kitYesOTC
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
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 medicationYes, with prescription.OTCPrescription required
Skin moisturizerNoCosmetic
Sleeping aidYes, with prescription.OTCPrescription required
Smoking cessation medicineYes, with prescription.OTCPrescription required
Smoking cessation programYesOTC
Sore throat pain reliefYes, with prescription.OTCPrescription required
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 ointmentYes, with prescription.OTCPrescription required
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 medicationYes, with prescription.OTC, Baby/MaternityPrescription required
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 relieverYes, with prescription.OTC, DentalPrescription required
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 treatmentYes, with prescription.OTCPrescription required
Water PikNoMiscellaneous
Weight loss medicationYes, with prescription.OTC, PrescriptionPrescription required
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 HazelYes, with prescription.OTCPrescription required
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).

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.

  • Printer-friendly eligible expense example lists:

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