HSA/FSA
How to Get a Letter of Medical Necessity for Gym Memberships
Find out when a letter of medical necessity (LMN) qualifies a patient to purchase a gym membership using their HSA/FSA account, and why it’s critical.
November 18, 2025
Teddy Butz
Director of Product & Partner Marketing
Overview
Overview
Overview
Overview
🚀 Fast Facts: Gym Membership Letter of Medical Necessity
Yes, an LMN can make a gym membership eligible to be covered by an HSA/FSA
The gym membership must be for a specific condition and not just general health
With Flex, you can easily and conveniently request an LMN directly at checkout
A gym membership is actually a very common expense. In 2024, 77 million Americans (accounting for nearly 25% of the population over 6) were members of a health club or fitness studio of some kind. While for many of these people, it’s simply part of their regular healthcare routine, others are going to the gym to recover from acute injuries, manage chronic pain, or relieve other illnesses and ailments.
What many people don’t know is that a gym membership can be covered by your HSA/FSA with a Letter of Medical Necessity (LMN) if you meet the right criteria. We’ll explain how by covering:
Does a Letter of Medical Necessity make a gym membership HSA/FSA eligible?
7 popular HSA/FSA eligible gym memberships to get with an LMN
Let’s start by explaining whether an LMN enables you to claim a gym membership using your HSA/FSA.
Does a Letter of Medical Necessity make a gym membership HSA/FSA eligible?
Yes, a Letter of Medical Necessity (LMN) can — but does not automatically — make a gym membership eligible to be covered by your HSA or FSA, if a medical practitioner deems that you have a qualifying medical condition that requires regular exercise as part of the treatment plan.
What qualifies you for a Letter of Medical Necessity for a gym membership?
Remember, for any expense to qualify under an HSA/FSA, it needs to be for a medical expense according to the IRS. Essentially, the Letter of Medical Necessity will need to clearly explain why a gym membership is a crucial component of the patient’s treatment plan.
Typically, this comes down to explaining why routine exercise is a critical part of a patient’s care routine. In some cases, it’s about ensuring the patient has access to the right equipment, like low-impact equipment, weight training equipment, or simply a wide range of equipment.
Acute physical injuries - Many physical injuries require regular exercise or focused physical therapy, which may require access to specialized gym equipment or training programs.
Arthritis - Weight management is critical to reduce the impact on your joints, so regular exercise is essential. Gym access also gives you access to low-impact exercise equipment, which is crucial for your condition.
Chronic back pain - Typically, this involves a personalized home exercise routine involving stretching, core strengthening, and walking. However, depending on the level of exercise and equipment you need, a gym membership may help.
Depression & anxiety - Regular physical activity can alleviate the symptoms of anxiety and depression. Having access to a gym can be justified if it will provide the patient access to the right equipment.
Diabetes & pre-diabetes - Weight management is obviously important for diabetes, but exercise is also critical for managing blood sugar levels. Regular exercise is also important for preventing those that are pre-diabetes from progressing.
Fibromyalgia - Consistent exercise is important for long-term management, but it’s crucial that the patient use low-impact exercise equipment, which a gym membership would typically provide access to.
Heart disease - Maintaining a healthy heart requires regular exercise, ideally between 30 to 60 minutes most days a week. This will help with weight management and overall cardiovascular health.
Obesity - Routine exercise is essential for weight management, helping people get to (and maintain) a healthy weight. Aerobic exercise and strength training are common techniques. A gym membership gives you access to the equipment you need to exercise on a consistent schedule.
Osteoporosis - Strength, balance, and posture training help to strengthen bones and prevent fractures. Regular exercise is crucial to developing this, especially for providing access to weight-lifting equipment.
This is not an exhaustive list, and just because something is listed above, doesn’t mean it will be covered — that depends on the HSA/FSA provider. However, this should help guide you on the types of conditions that could be eligible for coverage with an LMN. This way, you’ll know to ask your medical practitioner to write you an LMN when it applies.
Most importantly, to make any expense eligible under your HSA/FSA, your LMN must clearly connect your diagnosis with the benefits of a gym membership.
Waiting for a Letter of Medical Necessity from your doctor can take longer than you want to wait to sign up for the gym. For an easier approval process, check out these gyms with a Flex-powered checkout, which makes the entire process seamless. Get your Letter of Medical Necessity sent to your email within 24 hours, while signing up for some of the biggest gyms, including 24 Hour Fitness, Anytime Fitness, and Crunch Fitness.
5 key components to include in a gym membership Letter of Medical Necessity
Ultimately, a Letter of Medical Necessity needs to not only state the customer’s diagnosis, but actually justify why a gym membership is crucial to the patient’s care. Below, we explore some of the core components any LMN should have if you want to make a gym membership eligible under an HSA/FSA.
Just as a reminder, you can’t write a Letter of Medical Necessity yourself. It will need to come from a medical professional. This template is not meant to be used to create your own, but simply to identify what a letter should have included so your claim has a better chance of being approved by your provider.
1. Patient Details
The letter needs to indicate who the patient is, as an LMN only pertains to a specific individual for a particular medical condition. It should include the patient’s name and date of birth, and in some cases, may include other personal information such as their address and policy number.
2. Medical Diagnosis
The LMN should clearly state the precise medical diagnosis. This is also a good place to include additional details about the patient’s medical history and any other details that pertain to this medical condition, including when it was first diagnosed, how it has changed and progressed, and what treatment plans have been used in the past.
3. Treatment Plan
This should outline the specific treatment plan for the patient, defining the exact recovery and care routine for the patient. The more specific this section can be, the better when it comes to allowing a gym membership to be eligible for payment with an HSA/FSA. Identify the exact service, product, therapy, or device that should be used in the patient’s care plan, and indicate any details about the frequency, duration, and method of care.
4. Justification for Medical Necessity
The LMN should state clearly why a gym membership is an essential component of the patient’s treatment plan. This is one of the most crucial components of the LMN, as it’s what often determines whether the gym membership will qualify to be covered under an HSA/FSA. Essentially, this is what providers will use to determine whether a gym membership is a necessary medical expense versus a general health expense, so they can determine if it qualifies for HSA/FSA coverage.
5. Signature and Credentials
The LMN should have an official signature from the medical practitioner, along with pertinent credentials.
And when you put them all together, this is what an example would look like:
4 methods to get a Letter of Medical Necessity for a gym membership
There are four main methods to get a Letter of Medical Necessity for a gym membership, ranging in simplicity and convenience. While you can visit your doctor in person, you can often get an LMN online via an online consultation, which is much faster and more efficient.
Below, we cover the four main ways to get an LMN for a gym membership.
Method 1: Request one instantly and pay with your HSA/FSA card
Timeline: 5-15 minutes
The easiest and most efficient way to get an LMN for a gym membership is to request one directly at checkout when you’re signing up. With Flex, you can complete a quick, digital consultation in just a couple minutes. If you’re eligible, you can purchase your gym membership using your HSA/FSA card
By completing the consultation at checkout, you ensure that the LMN is specific to the exact product you’re looking to buy. You don’t have to double check whether the LMN you have works for your situation, as it’s been issued based on the information you provided for this exact product.
Alo Wellness Club and Ladder Health are both digital fitness clubs that have partnered with Flex to make it easier for their customers to purchase a gym membership using their HSA/FSA.
Method 2: Request one instantly and submit your gym membership receipt for reimbursement
Timeline: Hours
For select gyms, you can request an LMN through Flex, pay with your normal card, and submit the LMN and receipt to your health benefits administrator. You’ll outline your situation through a brief consultation, and the provider will assess your circumstances and — if eligible — write you an LMN. You can then submit the LMN along with your itemized reciept to your HSA/FSA provider for reimbursement.
Method 3: Make an appointment to see your doctor in person
Timeline: Days to weeks
Patients can often get a Letter of Medical Necessity directly from their family doctor or regular medical practitioner. Simply schedule a consultation with your doctor, and make sure you request an LMN based on the treatment plan they’ve recommended.
The main shortcoming is that this will take a long time, as you’ll need to schedule, wait for, and attend a doctor’s appointment in-person. You’ll need to pay for this appointment, which is often more costly — and time-consuming — than the online consultation fee you’d pay through Flex to get an LMN.
Method 4: Ask at the gym
Timeline: Hours to days
In rare cases, the gym may have a medical practitioner on staff that can issue an LMN. Remember, this doesn’t automatically mean that your HSA/FSA provider will approve this as a qualified expense. You’ll still need to bring this to your provider and check that this will be eligible for coverage, and ensure that the person offering LMNs at the gym is qualified to do so.
4 important considerations for your gym membership Letter of Medical Necessity
We want to make sure that you aren’t the one stuck with the bill. Here are a few things to keep in mind to make sure you’ll be able to cover the expense of your gym membership using your HSA/FSA.
1. Claims require a specific diagnosis
A gym membership is not automatically guaranteed to be covered by an HSA/FSA — even with an LMN. In all cases, the HSA/FSA provider will review the claim and determine if it qualifies for coverage. Importantly, the membership can’t just be for a patient’s general health, it needs to be for a specific diagnosis. To qualify, the LMN should clearly outline exactly why a gym membership is an integral part of the treatment plan for this particular diagnosis.
2. Be specific about the treatment plan
The treatment plan should be specific about the exact exercises the patient will need to do and — if possible — the equipment they should use. Remember, to qualify, a medical expense needs to actually be related to a particular diagnosis the patient has. By clearly connecting the benefits of a gym membership to a patient’s care plan, it makes a much stronger case for the need for the membership, increasing the chances that it will be covered under an HSA/FSA.
3. You need to possess the LMN before you can make any purchases
Critically, you can’t claim expenses on purchases you’ve made before you receive a Letter of Medical Necessity. That means you can’t use an LMN to retroactively cover purchases you’ve already made, whether you made it 2 days ago or 2 years ago. Sadly, you won’t be able to go back and get previous years or months of your gym membership covered.
You need the LMN in-hand before you’d be eligible to be covered.
4. Keep your medical records
Make sure to keep all medical records so you can support the claim you make with the provider. They may want further proof of your condition or medical history, or may want further details to review the case. Typically, the more you can provide, the more likely a claim is to be approved.
7 popular HSA/FSA eligible gym memberships to get with a Letter of Medical Necessity
Take the guesswork out of the process. Flex powers instant LMN consultations with the following gyms, making it easy for eligible patients to pay for their gym membership using their HSA/FSA.
Gym & Locations | Services Overview |
Ladder Health | A digital workout platform with daily and customizable workout plans, you can cut the planning time out and just get to the workout. |
At-home fitness app | full at-home studio experience with thousands of the best online yoga, fitness, meditation, HIIT, barre, and Pilates classes. |
5,500+ locations in over 30 countries | Access personal and group training 24 hours a day. With more than 5500 across North America, they have a wide reach. They also offer free access to Apple Fitness+ as part of their membership. |
Over 600 locations worldwide | With a focus on serious strength training, they offer a range of personal training options, group classes, and weight training equipment so you can achieve your fitness goals. |
Over 500 Clubs in North America, Europe, and Australia | Crunch’s no judgement policy fosters an environment built on positivity, inclusivity, and fun. With access to group classes, personal training, and more, you get access to everything you’d need. |
Over 240 Clubs in 9 US states | Get 24 hour access to a gym membership with additional amenities like basketball and lap pools. Their free mobile app gives you access to over 2000 workouts so you can exercise anytime, anywhere. |
More than 60 Clubs in 7 states | VASA Fitness has premium amenities that support every stage of your fitness journey, including HIIT classes, infrared yoga, and more. |
Haverhill, MA | Cedardale Health & Fitness is a part of the community, offering group exercise classes, aquatics, and a lot more. |
Tucson, Arizona | Serving the Tucson community, this World Gym location has dedicated abs and stretching areas, strength machines, and a large indoor turf area for a range of exercise routines. |
We want to make sure patients get the care they need, and that eligible patients can easily pay for that care using their HSA/FSA. We email the LMN within two hours to make sure you’re not waiting around or forced to pay before you’re eligible. You get an LMN quickly so you can complete your purchase confidently, knowing you’ll be reimbursed.
Get in touch with our team to find out how you can get an LMN for a gym membership quickly and easily during checkout. We know what providers are looking for, so we ensure any LMN will have all the information to get the claim approved.
🚀 Fast Facts: Gym Membership Letter of Medical Necessity
Yes, an LMN can make a gym membership eligible to be covered by an HSA/FSA
The gym membership must be for a specific condition and not just general health
With Flex, you can easily and conveniently request an LMN directly at checkout
A gym membership is actually a very common expense. In 2024, 77 million Americans (accounting for nearly 25% of the population over 6) were members of a health club or fitness studio of some kind. While for many of these people, it’s simply part of their regular healthcare routine, others are going to the gym to recover from acute injuries, manage chronic pain, or relieve other illnesses and ailments.
What many people don’t know is that a gym membership can be covered by your HSA/FSA with a Letter of Medical Necessity (LMN) if you meet the right criteria. We’ll explain how by covering:
Does a Letter of Medical Necessity make a gym membership HSA/FSA eligible?
7 popular HSA/FSA eligible gym memberships to get with an LMN
Let’s start by explaining whether an LMN enables you to claim a gym membership using your HSA/FSA.
Does a Letter of Medical Necessity make a gym membership HSA/FSA eligible?
Yes, a Letter of Medical Necessity (LMN) can — but does not automatically — make a gym membership eligible to be covered by your HSA or FSA, if a medical practitioner deems that you have a qualifying medical condition that requires regular exercise as part of the treatment plan.
What qualifies you for a Letter of Medical Necessity for a gym membership?
Remember, for any expense to qualify under an HSA/FSA, it needs to be for a medical expense according to the IRS. Essentially, the Letter of Medical Necessity will need to clearly explain why a gym membership is a crucial component of the patient’s treatment plan.
Typically, this comes down to explaining why routine exercise is a critical part of a patient’s care routine. In some cases, it’s about ensuring the patient has access to the right equipment, like low-impact equipment, weight training equipment, or simply a wide range of equipment.
Acute physical injuries - Many physical injuries require regular exercise or focused physical therapy, which may require access to specialized gym equipment or training programs.
Arthritis - Weight management is critical to reduce the impact on your joints, so regular exercise is essential. Gym access also gives you access to low-impact exercise equipment, which is crucial for your condition.
Chronic back pain - Typically, this involves a personalized home exercise routine involving stretching, core strengthening, and walking. However, depending on the level of exercise and equipment you need, a gym membership may help.
Depression & anxiety - Regular physical activity can alleviate the symptoms of anxiety and depression. Having access to a gym can be justified if it will provide the patient access to the right equipment.
Diabetes & pre-diabetes - Weight management is obviously important for diabetes, but exercise is also critical for managing blood sugar levels. Regular exercise is also important for preventing those that are pre-diabetes from progressing.
Fibromyalgia - Consistent exercise is important for long-term management, but it’s crucial that the patient use low-impact exercise equipment, which a gym membership would typically provide access to.
Heart disease - Maintaining a healthy heart requires regular exercise, ideally between 30 to 60 minutes most days a week. This will help with weight management and overall cardiovascular health.
Obesity - Routine exercise is essential for weight management, helping people get to (and maintain) a healthy weight. Aerobic exercise and strength training are common techniques. A gym membership gives you access to the equipment you need to exercise on a consistent schedule.
Osteoporosis - Strength, balance, and posture training help to strengthen bones and prevent fractures. Regular exercise is crucial to developing this, especially for providing access to weight-lifting equipment.
This is not an exhaustive list, and just because something is listed above, doesn’t mean it will be covered — that depends on the HSA/FSA provider. However, this should help guide you on the types of conditions that could be eligible for coverage with an LMN. This way, you’ll know to ask your medical practitioner to write you an LMN when it applies.
Most importantly, to make any expense eligible under your HSA/FSA, your LMN must clearly connect your diagnosis with the benefits of a gym membership.
Waiting for a Letter of Medical Necessity from your doctor can take longer than you want to wait to sign up for the gym. For an easier approval process, check out these gyms with a Flex-powered checkout, which makes the entire process seamless. Get your Letter of Medical Necessity sent to your email within 24 hours, while signing up for some of the biggest gyms, including 24 Hour Fitness, Anytime Fitness, and Crunch Fitness.
5 key components to include in a gym membership Letter of Medical Necessity
Ultimately, a Letter of Medical Necessity needs to not only state the customer’s diagnosis, but actually justify why a gym membership is crucial to the patient’s care. Below, we explore some of the core components any LMN should have if you want to make a gym membership eligible under an HSA/FSA.
Just as a reminder, you can’t write a Letter of Medical Necessity yourself. It will need to come from a medical professional. This template is not meant to be used to create your own, but simply to identify what a letter should have included so your claim has a better chance of being approved by your provider.
1. Patient Details
The letter needs to indicate who the patient is, as an LMN only pertains to a specific individual for a particular medical condition. It should include the patient’s name and date of birth, and in some cases, may include other personal information such as their address and policy number.
2. Medical Diagnosis
The LMN should clearly state the precise medical diagnosis. This is also a good place to include additional details about the patient’s medical history and any other details that pertain to this medical condition, including when it was first diagnosed, how it has changed and progressed, and what treatment plans have been used in the past.
3. Treatment Plan
This should outline the specific treatment plan for the patient, defining the exact recovery and care routine for the patient. The more specific this section can be, the better when it comes to allowing a gym membership to be eligible for payment with an HSA/FSA. Identify the exact service, product, therapy, or device that should be used in the patient’s care plan, and indicate any details about the frequency, duration, and method of care.
4. Justification for Medical Necessity
The LMN should state clearly why a gym membership is an essential component of the patient’s treatment plan. This is one of the most crucial components of the LMN, as it’s what often determines whether the gym membership will qualify to be covered under an HSA/FSA. Essentially, this is what providers will use to determine whether a gym membership is a necessary medical expense versus a general health expense, so they can determine if it qualifies for HSA/FSA coverage.
5. Signature and Credentials
The LMN should have an official signature from the medical practitioner, along with pertinent credentials.
And when you put them all together, this is what an example would look like:
4 methods to get a Letter of Medical Necessity for a gym membership
There are four main methods to get a Letter of Medical Necessity for a gym membership, ranging in simplicity and convenience. While you can visit your doctor in person, you can often get an LMN online via an online consultation, which is much faster and more efficient.
Below, we cover the four main ways to get an LMN for a gym membership.
Method 1: Request one instantly and pay with your HSA/FSA card
Timeline: 5-15 minutes
The easiest and most efficient way to get an LMN for a gym membership is to request one directly at checkout when you’re signing up. With Flex, you can complete a quick, digital consultation in just a couple minutes. If you’re eligible, you can purchase your gym membership using your HSA/FSA card
By completing the consultation at checkout, you ensure that the LMN is specific to the exact product you’re looking to buy. You don’t have to double check whether the LMN you have works for your situation, as it’s been issued based on the information you provided for this exact product.
Alo Wellness Club and Ladder Health are both digital fitness clubs that have partnered with Flex to make it easier for their customers to purchase a gym membership using their HSA/FSA.
Method 2: Request one instantly and submit your gym membership receipt for reimbursement
Timeline: Hours
For select gyms, you can request an LMN through Flex, pay with your normal card, and submit the LMN and receipt to your health benefits administrator. You’ll outline your situation through a brief consultation, and the provider will assess your circumstances and — if eligible — write you an LMN. You can then submit the LMN along with your itemized reciept to your HSA/FSA provider for reimbursement.
Method 3: Make an appointment to see your doctor in person
Timeline: Days to weeks
Patients can often get a Letter of Medical Necessity directly from their family doctor or regular medical practitioner. Simply schedule a consultation with your doctor, and make sure you request an LMN based on the treatment plan they’ve recommended.
The main shortcoming is that this will take a long time, as you’ll need to schedule, wait for, and attend a doctor’s appointment in-person. You’ll need to pay for this appointment, which is often more costly — and time-consuming — than the online consultation fee you’d pay through Flex to get an LMN.
Method 4: Ask at the gym
Timeline: Hours to days
In rare cases, the gym may have a medical practitioner on staff that can issue an LMN. Remember, this doesn’t automatically mean that your HSA/FSA provider will approve this as a qualified expense. You’ll still need to bring this to your provider and check that this will be eligible for coverage, and ensure that the person offering LMNs at the gym is qualified to do so.
4 important considerations for your gym membership Letter of Medical Necessity
We want to make sure that you aren’t the one stuck with the bill. Here are a few things to keep in mind to make sure you’ll be able to cover the expense of your gym membership using your HSA/FSA.
1. Claims require a specific diagnosis
A gym membership is not automatically guaranteed to be covered by an HSA/FSA — even with an LMN. In all cases, the HSA/FSA provider will review the claim and determine if it qualifies for coverage. Importantly, the membership can’t just be for a patient’s general health, it needs to be for a specific diagnosis. To qualify, the LMN should clearly outline exactly why a gym membership is an integral part of the treatment plan for this particular diagnosis.
2. Be specific about the treatment plan
The treatment plan should be specific about the exact exercises the patient will need to do and — if possible — the equipment they should use. Remember, to qualify, a medical expense needs to actually be related to a particular diagnosis the patient has. By clearly connecting the benefits of a gym membership to a patient’s care plan, it makes a much stronger case for the need for the membership, increasing the chances that it will be covered under an HSA/FSA.
3. You need to possess the LMN before you can make any purchases
Critically, you can’t claim expenses on purchases you’ve made before you receive a Letter of Medical Necessity. That means you can’t use an LMN to retroactively cover purchases you’ve already made, whether you made it 2 days ago or 2 years ago. Sadly, you won’t be able to go back and get previous years or months of your gym membership covered.
You need the LMN in-hand before you’d be eligible to be covered.
4. Keep your medical records
Make sure to keep all medical records so you can support the claim you make with the provider. They may want further proof of your condition or medical history, or may want further details to review the case. Typically, the more you can provide, the more likely a claim is to be approved.
7 popular HSA/FSA eligible gym memberships to get with a Letter of Medical Necessity
Take the guesswork out of the process. Flex powers instant LMN consultations with the following gyms, making it easy for eligible patients to pay for their gym membership using their HSA/FSA.
Gym & Locations | Services Overview |
Ladder Health | A digital workout platform with daily and customizable workout plans, you can cut the planning time out and just get to the workout. |
At-home fitness app | full at-home studio experience with thousands of the best online yoga, fitness, meditation, HIIT, barre, and Pilates classes. |
5,500+ locations in over 30 countries | Access personal and group training 24 hours a day. With more than 5500 across North America, they have a wide reach. They also offer free access to Apple Fitness+ as part of their membership. |
Over 600 locations worldwide | With a focus on serious strength training, they offer a range of personal training options, group classes, and weight training equipment so you can achieve your fitness goals. |
Over 500 Clubs in North America, Europe, and Australia | Crunch’s no judgement policy fosters an environment built on positivity, inclusivity, and fun. With access to group classes, personal training, and more, you get access to everything you’d need. |
Over 240 Clubs in 9 US states | Get 24 hour access to a gym membership with additional amenities like basketball and lap pools. Their free mobile app gives you access to over 2000 workouts so you can exercise anytime, anywhere. |
More than 60 Clubs in 7 states | VASA Fitness has premium amenities that support every stage of your fitness journey, including HIIT classes, infrared yoga, and more. |
Haverhill, MA | Cedardale Health & Fitness is a part of the community, offering group exercise classes, aquatics, and a lot more. |
Tucson, Arizona | Serving the Tucson community, this World Gym location has dedicated abs and stretching areas, strength machines, and a large indoor turf area for a range of exercise routines. |
We want to make sure patients get the care they need, and that eligible patients can easily pay for that care using their HSA/FSA. We email the LMN within two hours to make sure you’re not waiting around or forced to pay before you’re eligible. You get an LMN quickly so you can complete your purchase confidently, knowing you’ll be reimbursed.
Get in touch with our team to find out how you can get an LMN for a gym membership quickly and easily during checkout. We know what providers are looking for, so we ensure any LMN will have all the information to get the claim approved.
Flex is the easiest way for direct to consumer brands and retailers to accept HSA/FSA for their products. From fitness and nutrition, to sleep and mental health, Flex takes a holistic view of healthcare and enables consumers to use their pre-tax money to do the same.