A health savings account (HSA) covers a wide range of medical, dental, vision, and mental health expenses, plus over-the-counter medications and many products you might not expect. The IRS defines eligible spending broadly: anything that diagnoses, treats, prevents, or mitigates disease, or affects a structure or function of the body. That language is intentionally wide, which means your HSA stretches further than most people realize.
Medical, Dental, and Vision Expenses
The core use of an HSA is paying for medical care. Doctor visits, specialist appointments, hospital stays, lab work, imaging, surgeries, and prescription medications all qualify. So do medical devices like crutches, hearing aids, and blood sugar monitors.
Dental coverage is equally broad. Cleanings, X-rays, fillings, extractions, braces, sealants, fluoride treatments, and dentures are all eligible. Cosmetic dental work like veneers only qualifies when it’s medically necessary, not purely aesthetic.
For vision, you can use your HSA for eye exams, prescription eyeglasses, contact lenses, contact lens solution, and corrective eye surgery like LASIK.
Over-the-Counter Medications and Products
Since the CARES Act took effect in 2020, all over-the-counter medications are HSA-eligible without a prescription. That includes pain relievers, allergy medicine, cold and flu remedies, antacids, acne treatments, and anti-itch creams. Before 2020, you needed a doctor’s prescription for most OTC drugs to qualify. That requirement is gone.
Non-drug OTC products that treat or prevent a medical condition also qualify. Think sunscreen, bandages, first-aid supplies, reading glasses, and thermometers. Menstrual care products, including pads, tampons, and cups, became eligible under the same law. The key distinction: if an item is purchased for general health or cosmetic purposes rather than to address a medical condition, it doesn’t qualify.
Mental Health and Therapy
Psychiatric care, psychologist visits, psychoanalysis, and therapy sessions are all qualified expenses. If you’re paying out of pocket for a therapist because your insurance doesn’t cover enough sessions or you haven’t met your deductible, your HSA can cover those costs directly.
Acupuncture is also eligible without any special documentation. Massage therapy is a bit different: it typically requires a letter of medical necessity from your provider, tying the treatment to a specific diagnosis like chronic back pain rather than general relaxation.
What Your HSA Cannot Cover
The IRS draws a clear line at cosmetic procedures and general wellness products. Teeth whitening, elective cosmetic surgery, and veneers done purely for appearance don’t qualify. Vitamins and supplements purchased for general health (rather than to treat a diagnosed deficiency) are ineligible. Gym memberships, even if your doctor recommends exercise, generally don’t make the cut either.
Other common items that fall outside HSA eligibility:
- Clothing: Even if prescribed, clothing that substitutes for regular clothing isn’t covered.
- Childcare expenses: Charges primarily for child care, including after delivery, aren’t reimbursable through an HSA.
- Diapers: Standard diaper expenses don’t qualify unless they’re needed to manage the effects of a specific disease.
- Toiletries and hygiene products: Toothpaste, shampoo, and similar items used for everyday hygiene aren’t eligible.
Insurance Premiums: Limited but Possible
In general, you cannot use your HSA to pay regular health insurance premiums. But there are four specific exceptions. You can use HSA funds for COBRA continuation coverage, long-term care insurance premiums, health insurance premiums while you’re receiving unemployment compensation, and Medicare premiums (including Parts B and D) once you’re 65 or older. These carve-outs make the HSA particularly valuable during job transitions and in retirement.
Using Your HSA After Age 65
Before you turn 65, withdrawing HSA money for non-medical expenses triggers income tax plus a steep 20% penalty. After 65, that penalty disappears entirely. You’ll still owe ordinary income tax on non-medical withdrawals, making it function similarly to a traditional retirement account. For qualified medical expenses, withdrawals remain completely tax-free at any age.
This is why many people treat their HSA as a long-term savings vehicle rather than spending it down each year. Unlike a flexible spending account (FSA), HSA funds never expire. They roll over indefinitely.
The Reimbursement Strategy Worth Knowing
There is no deadline for reimbursing yourself from your HSA. You can pay for a qualified medical expense out of pocket today and withdraw the equivalent amount from your HSA days, years, or even decades later. The only requirements are that the HSA was already open when you incurred the expense, you weren’t reimbursed another way, and you didn’t claim the expense as a tax deduction.
This creates a powerful option sometimes called “shoeboxing.” You pay medical bills out of pocket now, save your receipts, and let your HSA balance grow through investments. Later, potentially in retirement, you reimburse yourself for years’ worth of accumulated medical expenses, all tax-free. The key is keeping thorough records. Your HSA provider may not require receipts for reimbursement, but you’ll want them if you’re ever audited.
HSA Contribution Limits for 2025
To contribute to an HSA, you need a high-deductible health plan (HDHP). For 2025, that means your plan must have a minimum annual deductible of $1,650 for individual coverage or $3,300 for family coverage. Out-of-pocket maximums can’t exceed $8,300 for individuals or $16,600 for families.
If your plan qualifies, you can contribute up to $4,300 for individual coverage or $8,550 for family coverage in 2025. If you’re 55 or older, you can add an extra $1,000 as a catch-up contribution. These limits apply to total contributions from all sources, including anything your employer puts in.