HSA Eligible Items List (2026): 200+ Expenses Your HSA Can Cover

What is HSA eligible? HSA eligible items are products and services that count as qualified medical expenses under IRS rules: costs paid mainly to diagnose, treat, mitigate, or prevent a disease or medical condition. That covers doctor visits, prescription medications, over the counter medicine, dental expenses, vision and hearing care, first aid supplies, and much more. Dual-purpose items, like fitness equipment or supplements, can also qualify if you have a Letter of Medical Necessity (LMN).

A health savings account (HSA) lets you pay for those costs with pre-tax dollars, so every eligible purchase is a tax-free medical expense. Below is our list of 200+ HSA eligible items and expenses, sorted by category, plus the rules that are specific to health savings accounts: the insurance premiums an HSA can pay, who you can spend it on, and the receipts you should keep.

This list follows the same IRS rules as our FSA eligible items list, since both accounts use the same definition of a medical expense. Your HSA provider can't cover fewer items the way an employer's plan can limit a health FSA, but it may still ask you to show an expense qualifies, so keep your documentation.

Jump to a category:

• Dental, vision, and hearing HSA eligible items
• Prescription medications and over the counter medicine
• Medical care and medical services
• Fitness and nutrition expenses
• Home and sleep items
• Family, pregnancy, and fertility expenses
• Medical equipment and special equipment
• Insurance premiums an HSA can pay

In the lists, "(with LMN)" means the item qualifies for customers who have an LMN from a licensed provider. Items without that note are qualified expenses on their own, though your HSA provider may still require documentation.

What Makes an Item HSA Eligible?

HSA eligibility comes from Section 213(d) of the Internal Revenue Code, which defines medical care as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or to affect a structure or function of the body. IRS Publication 502 lists many of the expenses that meet that definition, and Publication 969 adds the rules that apply only to HSAs.

The key test is the primary purpose of the purchase. An expense that treats or prevents a specific medical condition qualifies; an expense that is merely beneficial to general health, like vitamins or a gym membership you'd use anyway, does not, unless a provider documents that you need it as medical treatment for a diagnosed condition. That is where a Letter of Medical Necessity comes in.

For a deeper look at how the IRS rules work, see our Head of Compliance's guide to HSA and FSA eligibility.

Dental, Vision, and Hearing HSA Eligible Items

Dental care, eye care, and hearing care are some of the most common qualified expenses, and most don't need any extra paperwork. See our guides to using your HSA for dental care, glasses, and hearing aids.

• Contact lenses and contact lens solution
• Crowns and bridges
• Dental cleanings and dental exams
• Dental implants
• Dentures and artificial teeth
• Ear wax removal
• Eye drops
• Eye exams
• Eye surgery, including LASIK surgery, cataract surgery, and PRK
• Fillings
• Fluoride treatments
• Hearing aids, hearing aid batteries, and hearing exams
• Lens cloths and cleaners
• Oral surgery and wisdom teeth removal
• Orthodontics, including braces and clear aligners
• Prescription glasses and sunglasses
• Reading glasses
• Extractions
• Ear plugs (with LMN)
• Prescription toothpaste (with LMN)

Cosmetic dental work, like teeth whitening, isn't a qualified medical expense.

Prescription Medications and Over the Counter Medicine

All prescription medications from a licensed provider qualify. Since the CARES Act of 2020, over the counter medicine and menstrual care products are qualified medical expenses too, with no prescription needed.

• All prescription medications
• Allergy products and antihistamines
• Allergy testing
• Antibiotics
• Asthma inhalers
• Birth control and contraceptives
• Bug bite and sting relief
• Cold and flu medicine
• Cold sore and canker sore treatments
• Cough drops, cough syrup, and sore throat lozenges
• Diabetic supplies: insulin, test strips, and glucose monitors
• Diarrhea medicine and laxatives
• Digestive aids, antacids, and heartburn relief
• Eczema and rash treatments
• First aid supplies: bandages, antiseptics, and first aid kits
• Lice treatment
• Menstrual care products: pads, tampons, cups, and period underwear
• Motion sickness medicine and motion sickness bands
• Nasal sprays, sinus medicine, and nasal strips
• Pain relievers like acetaminophen and ibuprofen, plus topical pain relievers and patches
• Sleep aids
• Smoking cessation products and programs
• Sunscreen (SPF 15+) and lip balm with SPF
• Acne treatments
• Vaccinations and immunizations
• Yeast infection treatments
• Cancer screenings, cholesterol tests, and other preventive care
• Personal protective equipment, such as masks, hand sanitizer, and sanitizing wipes used mainly to prevent the spread of COVID-19 (IRS Announcement 2021-7)
• Hair growth treatments (with LMN)
• Melatonin (with LMN)
• Dietary supplements (with LMN)

Medical Care and Medical Services

These are the services you pay a provider for, from routine primary care to hospital stays and therapy. Your health plan's copays, deductibles, and coinsurance for these medical services count too.

• Copays, deductibles, and coinsurance
• Primary care and specialist visits
• Telehealth visits with a licensed provider
• Urgent care, emergency room visits, and ambulance fees
• Hospital stays and services
• Anesthesia and surgery (non-cosmetic)
• Laboratory fees and blood work for physician-ordered tests
• Diagnostic services: X-rays, MRI, CT scans, and ultrasounds
• Physical therapy
• Occupational therapy
• Speech therapy
• Chiropractic care
• Acupuncture
• Mental health counseling and therapy
• Psychiatric care and psychologist visits
• Inpatient mental health and substance use disorder treatment
• Nursing services, including in-home nursing
• Nursing home care, when the main reason for being in the nursing home is medical care
• Long-term care services for a chronically ill person
• Direct primary care fees for a qualifying arrangement (starting in 2026)
• Weight loss programs to treat a specific disease diagnosed by a provider, such as obesity or hypertension (weight loss for general health doesn't count)
• Lodging away from home for medical care at a hospital or similar facility, up to $50 per night per person
• Transportation primarily for medical care
• Massage therapy (with LMN)
• Nutrition counseling and dietitian services (with LMN)
• Botox for medical conditions like chronic migraines (with LMN)
• Hydrotherapy (with LMN)

Cosmetic surgery isn't HSA eligible unless it corrects a deformity from a congenital abnormality, an injury from an accident or trauma, or a disfiguring disease.

Fitness and Nutrition Expenses

Fitness and nutrition products have both medical and everyday uses, so most are eligible only for qualifying customers with an LMN that ties them to a specific medical condition. Read more about using HSA funds for a gym membership.

• Gym memberships (with LMN)
• Fitness studio memberships and fitness programs, like pilates, spin, or yoga (with LMN)
• Personal training (with LMN)
• Fitness equipment: treadmills, rowing machines, stationary bikes, and weights (with LMN)
• Health and activity trackers like Whoop or Oura Ring (with LMN)
• Health and fitness apps (with LMN)
• Recovery tools: foam rollers and percussion massagers (with LMN)
• Compression clothing (with LMN)
• Running or cross-training shoes (with LMN)
• Vitamins and mineral supplements (with LMN)
• Protein powder (with LMN)
• Probiotics and digestive enzymes (with LMN)
• Omega-3s (with LMN)
• Electrolytes and hydration mixes (with LMN)

Home and Sleep Items

Some home and sleep products qualify when they treat a diagnosed condition, such as allergies, sleep apnea, or chronic pain.

• CPAP machines and sleep apnea supplies
• Thermometers
• Air purifiers and air filters (with LMN)
• Humidifiers (with LMN)
• Blackout curtains (with LMN)
• Light therapy lamps (with LMN)
• Red light therapy devices (with LMN)
• Sauna (with LMN)
• Cold plunge (with LMN)
• Specialty mattresses, beds, and pillows (with LMN)
• Sleep masks and sleeping earbuds (with LMN)
• White noise machines (with LMN)
• Water filtration devices (with LMN)
• Smart scales (with LMN)

Family, Pregnancy, and Fertility Expenses

You can use your HSA for your own costs and for the care of your spouse and eligible dependents, which makes it useful for pregnancy, fertility treatments, and new-parent expenses. See our guides to HSA and FSA eligible baby items and fertility treatments.

• Childbirth expenses and prenatal care
• Childbirth classes, like Lamaze classes
• Breast pumps and lactation supplies
• Lactation consultants
• Pregnancy tests and ovulation kits
• Gynecologist visits
• Infertility treatment, including in vitro fertilization (IVF)
• Sterilization procedures, like vasectomy and tubal ligation
• Erectile dysfunction treatments
• Prenatal vitamins (with LMN)
• Doulas (with LMN)
• Sperm and egg storage (with LMN)
• Pelvic floor devices and treatments (with LMN)
• Baby monitors (with LMN)

Dependent care expenses, like child care or day care, aren't covered. Those belong in a dependent care FSA, one of the flexible spending accounts some employers offer, not a health savings account.

Medical Equipment and Special Equipment

Medical equipment and supplies qualify, and so does special equipment installed in your home for medical reasons, like ramps, grab bars, or a stair lift. For special equipment installed in your home, the amount that counts is generally the cost minus any increase in your home's value.

• Blood pressure monitors
• Glucose meters and test strips
• Crutches, walkers, canes, and wheelchairs
• Braces and supports, like back or knee braces (with LMN)
• Nebulizers
• Catheters and bed pans
• Prosthetics
• Oxygen and oxygen equipment
• Medical alert devices (with LMN)
• Orthotics and arch supports
• Hearing and vision aids for the disabled, like Braille books
• A guide dog or other service animal, including the guide dog's food and vet care
• Home modifications for a medical condition, like ramps, grab bars, and widened doorways
• Wigs after hair loss from a disease (with LMN)
• At-home tests and diagnostic devices (with LMN)

Insurance Premiums an HSA Can Pay

Unlike a health FSA, an HSA can pay a few insurance premiums tax-free. According to IRS Publication 969, those are:

• Long-term care insurance premiums (up to age-based IRS limits)
• COBRA and other health care continuation coverage
• Health insurance while you're receiving unemployment compensation
• Medicare premiums and other health coverage once you're 65 or older

Medicare supplemental policies, like Medigap, aren't qualified medical expenses. Other health insurance premiums aren't either.

What Isn't HSA Eligible?

Anything that's mainly for general health, comfort, or appearance doesn't qualify. Common examples:

• Groceries and everyday food
• Toilet paper, toothpaste, shampoo, and other toiletries
• Cosmetic procedures, like teeth whitening or most cosmetic surgery
• Gym memberships and supplements without an LMN
• Child care and other dependent care expenses
• Medigap premiums and most health insurance premiums
• Expenses incurred before you opened your HSA

If you use HSA money for something that isn't a qualified medical expense before age 65, you'll pay income tax on it plus a 20% penalty. After 65, there's no penalty, but non-medical withdrawals are taxed as income.

HSA Rules to Know Before You Spend

A few rules apply to every purchase, no matter what you buy.

Who you can spend it on. Your HSA can pay for qualified medical expenses for you, your spouse, and eligible dependents you claim on your tax return, even if they aren't covered by your health plan.

When the expense happened. Only expenses incurred after you open your HSA count. Once you have the account, you can pay out of pocket and reimburse yourself later, even years later, as long as you kept records. HSA money never expires and rolls over every year.

What records to keep. The IRS expects you to show that each withdrawal paid for a qualified medical expense that wasn't reimbursed anywhere else. Keep itemized receipts that show what you bought, the date, and the amount. Bankcard statements alone usually aren't enough, since they don't show the item. Keep any LMN with your receipts, and get it before you buy.

State taxes. HSA contributions are free from federal income tax, but a couple of states, including California and New Jersey, tax them. Check your state's rules.

How to Tell if an Item Is HSA Eligible

1. Check whether it treats or prevents a condition. If it's in IRS Publication 502 or on this list without an LMN note, it's generally a qualified medical expense.
2. For dual-purpose items, get an LMN from a licensed provider before you buy.
3. Look for HSA checkout options. Many retailers mark eligible items, and Flex partners let you pay with your HSA card at checkout. If an item needs an LMN, qualifying customers can complete a short telehealth consultation right at checkout.
4. Save your itemized receipts and any LMN in case your HSA provider or the IRS asks.

Ready to use your HSA? The Flex Marketplace brings together eligible products from partner brands, from fitness and sleep to nutrition, with HSA card payment at checkout.