🚀 Fast Facts: Can you use an HSA or FSA for a chiropractor?
- Yes, chiropractic care for a medical condition is a qualified medical expense under IRS Publication 502
- Adjustments, exams, X-rays, and copays are eligible without a Letter of Medical Necessity
- Dual-purpose items your chiropractor recommends, like back braces or ergonomic chairs, typically need an LMN
- Limited purpose FSAs only cover dental and vision, so use your HSA for chiropractic care if you have both
Yes. Chiropractic care is a qualified medical expense, so you can use your health savings account (HSA) or flexible spending account (FSA) to pay a chiropractor. IRS Publication 502 says it plainly: "You can include in medical expenses fees you pay to a chiropractor for medical care." That means you can use HSA funds or FSA money for chiropractic adjustments, exams, and related treatment without needing a Letter of Medical Necessity for the visit itself.
Here's what's covered, what may need extra documentation, and how to use your HSA for chiropractor visits.
Is chiropractic care a qualified medical expense?
Yes. Under IRS guidelines, qualified medical expenses are amounts paid primarily to alleviate or prevent a physical or mental disability or illness. IRS Publication 502 lists chiropractors by name, so chiropractic treatment for a medical condition is generally considered an eligible medical expense for:
- Health savings accounts (HSAs)
- Health care flexible spending accounts (FSAs)
- Health reimbursement arrangements (HRAs), if your employer's plan covers it
Your plan documents still matter. An employer's flexible spending account or HRA can choose to cover fewer expenses than the IRS allows, so check your plan if you're unsure.
What conditions can chiropractic care treat?
Chiropractic care focuses on the spine, joints, and muscles, and how they support the rest of your body. A licensed chiropractor uses spinal manipulation, also called chiropractic adjustments, along with other hands-on techniques to relieve pain and discomfort and improve mobility. Many patients see a chiropractor for neck pain, back pain, and other conditions, including:
- Low back pain and neck pain
- Chronic pain in the joints or muscles
- Headaches related to neck or spine problems
- Sports injuries and repetitive stress injuries
- Stiffness or limited range of motion in the body
When chiropractic treatment addresses a medical condition like these, it's an eligible use of your HSA funds, and many patients schedule regular visits as part of a treatment plan. Chiropractic care for general relaxation or wellness, without a medical condition, may not qualify in most cases.
What chiropractic services can your HSA or FSA cover?
When a licensed chiropractor provides care to treat a medical condition, these chiropractic services are generally eligible:
- Initial exams and consultations
- Chiropractic adjustments and spinal manipulation
- X-rays taken for medical reasons
- Follow-up visits that are part of your treatment plan
- Therapies your chiropractor provides as part of treatment, like stretching or soft-tissue work
- Copays, deductibles, and coinsurance for chiropractic visits your insurance plan covers
Physical therapy is also a qualified medical expense, so if your chiropractor refers you to a physical therapist, you can use the same account to pay for it.
When might you need a Letter of Medical Necessity?
You don't need a Letter of Medical Necessity (LMN) for chiropractic visits themselves. You may need one for products or services your chiropractor recommends that also have everyday uses, such as:
- Back braces and support devices
- Ergonomic chairs or specialty pillows
- Massage therapy or massage devices
- Exercise equipment for a home rehab program
These are dual-purpose items, so they're eligible only for qualifying customers whose provider documents why the item treats a specific medical condition. Some plans may also ask for documentation if your visits look like general wellness care rather than medically necessary treatment, so keep your chiropractor's notes or treatment plan with your records.
Health savings account (HSA) benefits for chiropractic care
Using a health savings account for chiropractic care comes with tax advantages:
- Pre-tax contributions. HSA contributions are made with pre-tax dollars or are tax-deductible, which lowers your taxable income.
- Tax-free growth and withdrawals. HSA funds can grow tax-free, and withdrawals for qualified medical expenses aren't taxed.
- Money that rolls over. Unused HSA money stays in your account year to year, so you can save for ongoing chiropractic treatment.
Taking advantage of these HSA benefits, and planning ahead for ongoing visits, can help you save money on regular care and maximize your health savings account (HSA). How much you save depends on your tax bracket and eligibility.
Does insurance cover chiropractic care?
Many health insurance plans cover some chiropractic care, but your insurance policy may limit the number of visits, require prior authorization, or leave you with high out-of-pocket costs until you meet your deductible. Check with your insurance provider, then use your HSA or FSA to fill the gaps:
- Visits before you meet your deductible
- Copays and coinsurance
- Visits beyond your plan's annual limit
- Out-of-network chiropractors, if your insurance provider won't cover them
HSA vs. FSA for chiropractic care
Both accounts cover chiropractic care, but there are a few differences:
- HSA money rolls over. Your HSA funds stay with you year to year and if you change jobs.
- FSA money expires. A flexible spending account follows the "use it or lose it" rule, so scheduling chiropractic visits before your plan year ends is a good way to avoid losing a remaining balance.
- Limited purpose FSAs don't cover it. If you have a limited purpose FSA alongside an HSA, it only covers dental and vision care, so pay for chiropractic care with HSA funds instead.
- Family members are covered. You can use your HSA or FSA to pay for chiropractic care for your spouse and dependents, too.
How to use your HSA for chiropractor visits
- Pay with your card. When you schedule your first visit, ask whether the office accepts HSA and FSA debit cards. Most chiropractic offices accept them as a form of payment at checkout, so your HSA funds pay for the visit directly.
- Or pay out of pocket and get reimbursed. If you pay cash or use another card, submit a claim for reimbursement with an itemized receipt showing the provider, date of service, the service you received, and the cost. With an HSA, you can reimburse yourself later for any qualified expense incurred after you opened the account. Here's how HSA and FSA reimbursement works.
- Keep your records. Save receipts, explanations of benefits, and any LMNs. If you're ever asked to show an expense was qualified, you'll have what you need.
Using HSA money for something that isn't a qualified medical expense means paying income tax on it, plus a 20% penalty if you're under 65, so documentation is worth the effort.
Physical therapy and other treatments you can pay for with HSA funds
If you're managing pain or working to improve mobility, you may also be able to use your HSA funds or flexible spending account for:
- Acupuncture
- Massage therapy (with an LMN)
- Orthopedic shoes and inserts (with an LMN)
- Physical therapy and occupational therapy
For a bigger picture, see our list of 200+ FSA eligible items, or shop products for pain relief and recovery in the Flex Marketplace, where qualifying customers can get an LMN at checkout.
