What makes an expense eligible?
An expense is HSA or FSA eligible if it's primarily for the "diagnosis, cure, mitigation, treatment, or prevention of disease" as defined in IRS Publication 502. Cosmetic procedures that don't treat a medical condition are generally not eligible. General health and wellness without a specific medical purpose usually isn't either — with some notable exceptions.
2026 update: The CARES Act permanently expanded eligibility to include over-the-counter medications without a prescription, menstrual care products, and certain telehealth services. These are now fully eligible without any extra documentation.
The big categories
✅ Medical care (always eligible)
- Doctor visits, specialist appointments, urgent care
- Hospital stays, surgery, anesthesia
- Prescription medications
- Lab tests, X-rays, MRIs, blood work
- Dental care: cleanings, fillings, crowns, braces, oral surgery
- Vision: eye exams, prescription glasses, contact lenses, LASIK
- Mental health: therapy, psychiatry, counseling
- Physical therapy, occupational therapy, speech therapy
- Chiropractic care
- Acupuncture
✅ Over-the-counter medications (no prescription needed since 2020)
- Pain relievers: Advil, Tylenol, aspirin
- Allergy medications: Claritin, Zyrtec, Benadryl
- Cold and flu medicine
- Antacids, heartburn medication
- First aid supplies: bandages, antiseptic, gauze
- Sleep aids (for medical insomnia)
- Menstrual care products: tampons, pads, cups
✅ Preventive care and wellness (mostly eligible)
- Sunscreen SPF 15+ (eligible since 2020)
- Breast pumps and lactation supplies
- Fertility treatments: IVF, egg freezing, sperm analysis
- Pregnancy tests
- Hearing aids and batteries
- Blood pressure monitors
- Glucose monitors and test strips
- Wheelchairs, walkers, crutches
Not sure if something qualifies?
Type any expense into BenefAgent and get an instant answer with the IRS citation — in seconds.
Check an expense free →The expenses most people don't know are eligible
| Expense | Eligible? | Notes |
|---|---|---|
| Therapy / mental health counseling | ✓ Yes | Any licensed mental health provider |
| Sunscreen (SPF 15+) | ✓ Yes | Permanently eligible since CARES Act |
| Acupuncture | ✓ Yes | Must be for a medical condition |
| Fertility treatments / IVF | ✓ Yes | Including egg freezing |
| Wegovy / Ozempic (weight loss) | ✓ Yes | As a prescription medication |
| Gym membership | ⚠ Partial | Only with Letter of Medical Necessity (LMN) |
| Vitamins and supplements | ⚠ Partial | Only if prescribed for a specific condition |
| Teeth whitening | ✗ No | Cosmetic — not medically necessary |
| Cosmetic surgery | ✗ No | Unless treating a medical condition |
| Hair loss treatment | ⚠ Partial | Rogaine yes, hair transplants no |
| Standing desk | ⚠ Partial | Only with LMN for a back condition |
| CPAP machine | ✓ Yes | Sleep apnea treatment |
| Air purifier | ⚠ Partial | Only with LMN for allergies/asthma |
| Service animals | ✓ Yes | Including food, training, vet care |
HSA vs FSA: same expenses, different rules
Both HSA and FSA cover the same expense categories under IRS Publication 502. The difference is in how the accounts work — not what you can spend money on. HSAs roll over forever. FSAs are use-it-or-lose-it by December 31st (or your plan's grace period). If you're not sure which you have, check your benefits document or pay stub deduction description.
How to document eligible expenses
For any eligible expense, keep:
- The receipt — itemized, showing what was purchased
- Proof of payment — credit card statement or EOB from insurance
- Date of service — must be after your account was opened
You don't need to submit documentation to your HSA custodian upfront — but if you're ever audited by the IRS, you'll need to prove every withdrawal was for a qualified medical expense. Keep records for at least 7 years.
Common mistake: Many people use their HSA debit card for a purchase and never keep the receipt. If the IRS questions a withdrawal years later, you'll need that documentation. Scan and save every receipt digitally.
What happens if you use HSA money on an ineligible expense?
If you're under 65 and use HSA funds for a non-qualified expense, you'll owe income tax on the amount plus a 20% penalty. After age 65, the penalty disappears — you just owe regular income tax, making the HSA function like a traditional IRA.
The fastest way to check any expense
The IRS list is thousands of items long and changes regularly. Rather than trying to memorize it, the practical approach is to check expenses one at a time before you pay — or right after. BenefAgent does this instantly, with IRS citations, for any expense you type in.
Check any expense instantly
Type "sunscreen", "therapy", "gym membership" — get an immediate answer with the exact IRS rule that applies.
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