HSA/FSA

What Can You Use Your HSA and FSA For? A Comprehensive Guide

How to guide: Learn to use your HSA and FSA for better health! Discover smart ways to spend your health savings account on medical and wellness products.

December 6, 2023

Sam O'Keefe

Co-founder & CEO of Flex

flex What Can You Use Your HSA and FSA For?

Overview

What We’ll Cover About HSA and FSA Eligible Items

What is HSA and FSA?

What Are HSA and FSA-Eligible Expenses?

List of Common HSA and FSA-Eligible Expenses

HSA and FSA-Eligible Expenses With a Letter of Medical Necessity

What Purchases Qualify With a Letter of Medical Necessity?

What Stores Accept HSA/FSA Cards?

Why It’s Easier to to Pay For Qualified Medical Expenses With Flex

Did you know that you can use your HSA and FSA to pay for much more than prescription medications and copays? Beyond common out of pocket healthcare expenses, you can use your Health Savings Account and Flexible Savings Account for things like vision and dental, fitness and sleep trackers, genetic tests, and a whole host of other items.

Every year, the Internal Revenue Service (IRS) sets guidelines for what is covered. The general rule is that “[qualified] medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness,” according to the IRS. This includes costs associated with diagnosis, cure, mitigation, treatment, or prevention.

But there is wiggle room for individualized treatments, which means much more flexibility for how you can spend your HSA or FSA. We’ll go into this and more below.

What We’ll Cover About HSA and FSA Eligible Items

In this article, we’re going to answer a variety of questions about what you can spend your HSA and FSA funds for, including:

What are HSAs and FSAs?
What are HSA and FSA-eligible expenses?
Common HSA and FSA-eligible items
How you can pay for non-standard HSA-eligible expenses with a Letter of Medical Necessity
Surprising things you can buy with an HSA or FSA
Stores that accept HSA/FSA cards
And a list of commonly asked questions

We mentioned this would be a comprehensive guide, right?

What is HSA and FSA?

Briefly, your HSA (or employer-provided FSA) is like a bank account for out of pocket health care expenses. These specialty savings accounts are tax-advantaged which means that you don’t pay taxes for money you put in or take out. The net-net is that on average, consumers save 30 to 40% percent on purchases they make with their HSA/FSA.

There are some differences between HSAs and FSAs to be mindful of, which you can read about in our article, What Are HSAs & FSAs?

What Are HSA and FSA-Eligible Expenses?

HSA and FSA-eligible expenses include a wide range of medical, dental, and vision-related costs. Some common examples include doctor visits, lab fees, and prescription medications. The CARES Act expanded what was covered to include menstrual products (tampons, pads, liners, cups, sponges, etc.), telehealth expenses, and other at-home services.

In some instances, you may need a Letter of Medical Necessity, or LOMN, to cover an expense. We’ll review this later on.

There’s a lot that is eligible, so you can find a list of approved medical expenses from the IRS here.

How to use HSA money

When you open an HSA or FSA, you’ll likely receive a debit card which allows you to purchase items directly.

If you've paid for qualified medical expenses out of pocket, you can submit a reimbursement request to your HSA provider (be sure to keep your receipt!). This might involve completing a reimbursement form and providing documentation of the expenses.

What is an HSA or FSA card?

For most HSAs and FSAs, you’ll receive a debit card that allows you to use your funds at point-of-sale. Like a standard debit card, transactions are limited to your current balance.

What can HSA or FSA not be used for?

Generally, items or services that are not considered medically necessary, or which don’t prevent or treat illness and disease, are not covered. This includes things like vitamins and nutritional supplements, cosmetic procedures and products, personal hygiene items such as toothpaste and deodorant, and weight loss programs not prescribed by a physician. However, there are exceptions to these rules, which we dive into in the next section.

Note that if you do use HSA funds for non-qualified expenses you may be subjected to taxes and penalties. If you are uncertain whether something qualifies, it’s recommended you seek tax or legal advice or speak with your doctor.

List of Common HSA and FSA-Eligible Expenses

For items and services not covered by your health insurance, you can use your HSA and FSA funds to pay for common qualified medical expenses, like:

Allergy medications
Ambulance services
Annual exams
Band-Aids and bandages
Birth control pills, condoms, and other contraceptives
Braces
Breast pump
Contacts
Copays for prescriptions and office visits
COVID-19 tests
Crutches
Dental care, such as cleanings, root canals, fillings, and dentures
Diaper-rash cream
Emergency room visits
Eyeglasses
Flu shots
Hearing aids
Heartburn medications
Infertility treatments
MRIs
Orthodontist visits
Over-the-counter (OTC) medications
Pedialyte
Pregnancy tests
Prescription medications
Ultrasounds
Urgent care services
Vision care, such as eye exams, prescription glasses, and contact lenses
Wheelchairs
X-rays

To see if something is HSA-eligible or not, HSA Store has a fairly comprehensive list.

HSA and FSA-Eligible Expenses With a Letter of Medical Necessity

Some items and services can be paid for with your HSA/FSA even if they do not fall under the standard IRS guidelines. This is because the IRS allows doctors and medical professionals to recommend individualized interventions as long as they meet the criteria of treatment, prevention, or mitigation of a specific medical condition.

To do so, you’ll need to get a Letter of Medical Necessity which is essentially a doctor's note that outlines your condition and why they deem a product or service medically necessary.

How do you get a Letter of Medical Necessity and how do you get reimbursed?

If you want to get a LOMN you need to schedule time with your provider to discuss the issue ahead of purchase. This has been made a bit easier in recent years due to telemedicine and virtual visits but often patients need to wait weeks for an appointment.

While you may leave with a letter in hand, that’s only step one. From there, you need to purchase the product or service with your regular credit or debit card, and then submit both an itemized receipt and the LOMN to your HSA or FSA provider to substantiate the purchase. Then wait for reimbursement, of course.

To learn more, check out our article about What are Letters of Medical Necessity?

What Purchases Qualify With a Letter of Medical Necessity?

There are a variety of expenses that may qualify for an exception. As always, consult with your HSA administrator or tax specialist to make sure the item or service is eligible with a LOMN.

List of possible HSA and FSA-eligible expenses with a Letter of Medical Necessity:

Air purifier
At-home test kit for biomarkers
Baby monitoring devices
Birthing classes
DNA test kits for health purposes (not ancestry)
Exercise equipment
Fitness program
Fitness tracker
Fluoride toothpastes and rinses
Health clubs
Homeopathic medicines
Meal delivery programs
Medical devices and supplies
Nutrition counseling
Specialty footwear such as orthopedic shoes, insoles, and orthotics
Sunglasses
Theragun and other massage guns
Travel for medical care and other transportation
Vitamins (i.e., iron or calcium supplementation)
Weight-loss programs
Yoga

What Stores Accept HSA/FSA Cards?

As we mentioned above, your HSA or FSA card operates much like a debit card. However, you can’t use your card in just any store.

To start, the location must sell qualified medical products (such as a pharmacy) or the non-healthcare merchant (i.e., a grocery store) must have the ability to verify whether a product is HSA-eligible or not. This is done on the backend as part of their inventory management system. Of course, you can also use it at places like your doctor’s office or dentist too.

Many big box retailers also accept HSA and FSA cards. Be mindful that for certain purchases you will need a LOMN.

Increasingly, you can buy directly from merchants online that are partnered with Flex.

Why It’s Easier to to Pay For Qualified Medical Expenses With Flex

Flex partners with merchants to make the process super simple for consumers. Here’s how it works:

For pre-approved medical expenses: Pay for the product or service with your HSA or FSA card. Flex substantiates the purchase automatically, meaning you don't need to submit for reimbursement.

If the item falls outside of standard IRS guidelines: Flex will check your eligibility for a Letter of Medical Necessity. When you go to checkout, a doctor’s appointment takes place:

Fill out a short eligibility form, sharing relevant information with Flex’s medical team.
If you qualify, Flex sends the LOMN to you via email.
Then, simply enter your HSA or FSA card details and complete the purchase. Again, no more need for reimbursements!

But there is wiggle room for individualized treatments, which means much more flexibility for how you can spend your HSA or FSA. We’ll go into this and more below.

What We’ll Cover About HSA and FSA Eligible Items

In this article, we’re going to answer a variety of questions about what you can spend your HSA and FSA funds for, including:

What are HSAs and FSAs?
What are HSA and FSA-eligible expenses?
Common HSA and FSA-eligible items
How you can pay for non-standard HSA-eligible expenses with a Letter of Medical Necessity
Surprising things you can buy with an HSA or FSA
Stores that accept HSA/FSA cards
And a list of commonly asked questions

We mentioned this would be a comprehensive guide, right?

What is HSA and FSA?

There are some differences between HSAs and FSAs to be mindful of, which you can read about in our article, What Are HSAs & FSAs?

What Are HSA and FSA-Eligible Expenses?

In some instances, you may need a Letter of Medical Necessity, or LOMN, to cover an expense. We’ll review this later on.

There’s a lot that is eligible, so you can find a list of approved medical expenses from the IRS here.

How to use HSA money

When you open an HSA or FSA, you’ll likely receive a debit card which allows you to purchase items directly.

What is an HSA or FSA card?

For most HSAs and FSAs, you’ll receive a debit card that allows you to use your funds at point-of-sale. Like a standard debit card, transactions are limited to your current balance.

What can HSA or FSA not be used for?

List of Common HSA and FSA-Eligible Expenses

For items and services not covered by your health insurance, you can use your HSA and FSA funds to pay for common qualified medical expenses, like:

Allergy medications
Ambulance services
Annual exams
Band-Aids and bandages
Birth control pills, condoms, and other contraceptives
Braces
Breast pump
Contacts
Copays for prescriptions and office visits
COVID-19 tests
Crutches
Dental care, such as cleanings, root canals, fillings, and dentures
Diaper-rash cream
Emergency room visits
Eyeglasses
Flu shots
Hearing aids
Heartburn medications
Infertility treatments
MRIs
Orthodontist visits
Over-the-counter (OTC) medications
Pedialyte
Pregnancy tests
Prescription medications
Ultrasounds
Urgent care services
Vision care, such as eye exams, prescription glasses, and contact lenses
Wheelchairs
X-rays

To see if something is HSA-eligible or not, HSA Store has a fairly comprehensive list.

HSA and FSA-Eligible Expenses With a Letter of Medical Necessity

To do so, you’ll need to get a Letter of Medical Necessity which is essentially a doctor's note that outlines your condition and why they deem a product or service medically necessary.

How do you get a Letter of Medical Necessity and how do you get reimbursed?

To learn more, check out our article about What are Letters of Medical Necessity?

What Purchases Qualify With a Letter of Medical Necessity?

There are a variety of expenses that may qualify for an exception. As always, consult with your HSA administrator or tax specialist to make sure the item or service is eligible with a LOMN.

List of possible HSA and FSA-eligible expenses with a Letter of Medical Necessity:

Air purifier
At-home test kit for biomarkers
Baby monitoring devices
Birthing classes
DNA test kits for health purposes (not ancestry)
Exercise equipment
Fitness program
Fitness tracker
Fluoride toothpastes and rinses
Health clubs
Homeopathic medicines
Meal delivery programs
Medical devices and supplies
Nutrition counseling
Specialty footwear such as orthopedic shoes, insoles, and orthotics
Sunglasses
Theragun and other massage guns
Travel for medical care and other transportation
Vitamins (i.e., iron or calcium supplementation)
Weight-loss programs
Yoga

What Stores Accept HSA/FSA Cards?

As we mentioned above, your HSA or FSA card operates much like a debit card. However, you can’t use your card in just any store.

Many big box retailers also accept HSA and FSA cards. Be mindful that for certain purchases you will need a LOMN.

Increasingly, you can buy directly from merchants online that are partnered with Flex.

Why It’s Easier to to Pay For Qualified Medical Expenses With Flex

Flex partners with merchants to make the process super simple for consumers. Here’s how it works:

For pre-approved medical expenses: Pay for the product or service with your HSA or FSA card. Flex substantiates the purchase automatically, meaning you don't need to submit for reimbursement.

If the item falls outside of standard IRS guidelines: Flex will check your eligibility for a Letter of Medical Necessity. When you go to checkout, a doctor’s appointment takes place:

Fill out a short eligibility form, sharing relevant information with Flex’s medical team.
If you qualify, Flex sends the LOMN to you via email.
Then, simply enter your HSA or FSA card details and complete the purchase. Again, no more need for reimbursements!

Common Questions About What You Can Use Your HSA and FSA For:

Can I use my HSA card for groceries?

No, groceries and food are not eligible for reimbursement with an HSA or FSA. These are not eligible medical expenses and may subject you to penalties from the IRS.

Can I use HSA for dental?

Yes. Your dental insurance will pay for many things, however sometimes you need to cover out of pocket expenses. Examples of medically necessary dental costs include root canals, crowns and fillings, x-rays, sealants, braces, dentures and dental implants. Cosmetic costs, such as teeth whitening, are not covered. Along those lines, is toothpaste HSA eligible? No, this is considered a general health item, along with brushes, floss, mouthwash, etc.

Can I use my HSA for vision?

Yes, items and services that are deemed medically necessary, such as prescription glasses and sunglasses, contact lenses, eye allergy itch relief, eye exams, LASIK and other vision correction surgeries, reading glasses, sports masks and goggles with prescription lenses, are covered.

Are vitamins and supplements HSA or FSA eligible?

In general, over-the-counter vitamins and nutritional supplements are not covered by an HSA or FSA. However, some supplements do qualify because they treat medical conditions, such as prenatal vitamins (which help support fetal development) and glucosamine/chondroitin supplements (which can treat joint conditions, such as arthritis). In other cases, doctors may prescribe a specific dietary supplement to treat a medical condition, such as iron supplementation for iron deficiency anemia.

Is sunscreen HSA eligible?

Yes, sunscreens with a Sun Protection Factor (SPF) of 15+ and which offer “broad spectrum” protection (UAB and UAV rays), are eligible. This is because sunscreen can help reduce the risk of skin cancer, which roughly one in five Americans will develop in their lifetime.

Are probiotics HSA eligible?

Yes and no. If you are taking probiotics for general gut health, they are not HSA qualified. However, if your doctor or gastroenterologist recommends probiotic supplementation to treat a medical condition, they may be eligible with a LOMN.

Are diapers HSA eligible?

It depends. Unfortunately, diapers for infants are not considered HSA and FSA-eligible baby products (which include items like breast pumps, baby monitors, and diaper rash cream). However, incontinence supplies, such as adult diapers, generally are covered.

Are humidifiers HSA eligible?

Yes, humidifiers that are prescribed to treat or mitigate a medical condition (which means you need a LOMN) are HSA eligible.

Are tampons HSA eligible?

Yes, menstrual products, such as tampons, are eligible thanks to the CARES Act. Other items include pads, panty liners, menstrual cups, and sanitary wipes.

Are condoms HSA eligible?

Yes, condoms and other contraceptives are considered “family planning” and are covered by your HSA or FSA. Items under this bucket are meant to help you plan for or prevent pregnancy, such as birth control, day-after pills, pregnancy tests, and fertility treatments.

Flex is a modern marketplace for consumers to discover and purchase HSA/FSA eligible 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.

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