Eligible expenses — what counts and what doesn't

The IRS publishes the official rules in Publication 502, but the short version is: a qualified medical expense is one that diagnoses, treats, or prevents a medical or dental condition.

Definitely eligible

• Doctor visits, specialist co-pays, hospital bills
• Prescriptions and most over-the-counter medications (since 2020)
• Dental work — cleanings, fillings, crowns, orthodontics, even some cosmetic dentistry
• Vision — eye exams, glasses, contacts, LASIK
• Mental health — therapy, psychiatry, counseling
• Physical therapy, chiropractic, acupuncture
• Medical equipment — CPAP, glucose monitors, blood pressure cuffs
• Lab work, imaging (X-rays, MRIs)
• COBRA premiums and Medicare premiums (most parts)
• Long-term care insurance premiums (within IRS limits)

Sometimes eligible

These need a doctor's note ("Letter of Medical Necessity") to qualify:

• Gym memberships (for a specific medical condition)
• Weight-loss programs (only for treating obesity, hypertension, etc.)
• Special diets
• Massage therapy
• Vitamins and supplements (rarely qualify)

Not eligible

• General health and wellness — vitamins, supplements, gym memberships without a medical necessity letter
• Cosmetic procedures (Botox for wrinkles, teeth whitening, elective plastic surgery)
• Insurance premiums (with the exceptions above — COBRA, Medicare, long-term care, and unemployment-period premiums)
• Funeral expenses
• Most non-prescription items that aren't OTC medications

Browse the full directory

We maintain a searchable directory of 890+ HSA-eligible items based on IRS Publication 502 — head to the HSA-Eligible Items section on the marketing site. Search "is X eligible?" for instant answers.

When in doubt

• Check the directory first.
• If you're unsure, ask your tax professional.
• Save the receipt anyway — you can decide later whether to claim it.

We don't pre-filter your expenses

When you log an expense, we don't block you from entering anything. The eligibility flag is yours to set. If you mistakenly log something ineligible, just delete or edit it — nothing is locked in until you reimburse yourself and file your taxes.

Updated on: 05/06/2026