A Health Savings Account (HSA) covers a wide range of medical, dental, vision, and mental health expenses, plus over-the-counter medications and menstrual care products. The IRS defines qualified expenses broadly: anything that diagnoses, cures, treats, or prevents disease, or that affects a structure or function of the body. That broad definition means HSAs cover far more than most people realize.
Doctor Visits and Medical Services
The core of HSA-eligible spending is professional medical care. You can use HSA funds for visits to physicians, surgeons, dentists, optometrists, chiropractors, psychologists, psychiatrists, and osteopaths. Annual physicals, diagnostic tests, and lab work all qualify. So do operations, ambulance services, X-rays, and hospital stays. Acupuncture is explicitly included on the IRS list without requiring additional documentation.
Fertility treatments qualify too, including in vitro fertilization and surgeries to reverse a prior sterilization. Prenatal care, well-child visits, and routine immunizations for children and adults are all covered. Stop-smoking programs and medically supervised weight-loss programs (when prescribed for a specific diagnosis like obesity, heart disease, or hypertension) also count.
Dental and Vision Expenses
HSAs cover dental treatment aimed at preventing or treating dental disease, which includes cleanings, fillings, crowns, root canals, extractions, and orthodontics like braces. Cosmetic dental procedures that are purely aesthetic do not qualify.
For vision, you can pay for eye exams, prescription eyeglasses, contact lenses, and the solutions and supplies that go with them. Laser vision correction procedures, including LASIK, SMILE, and PRK, are all eligible expenses. If you’ve been considering LASIK, HSA funds are one of the most tax-efficient ways to pay for it since the procedure typically costs several thousand dollars.
Over-the-Counter Products and Menstrual Care
Since the CARES Act took effect in 2020, over-the-counter medications no longer require a prescription to be HSA-eligible. That means you can use your HSA for pain relievers, allergy medicine, cold and flu remedies, antacids, and similar products bought off the shelf. Sunscreen, first aid supplies, and bandages qualify as well.
Menstrual care products are also covered. Tampons, pads, liners, menstrual cups, and sponges all count as qualified medical expenses.
Mental Health and Therapy
Therapy and psychiatric care are qualified HSA expenses when they treat a diagnosed mental health condition. That includes sessions with a psychologist, psychoanalyst, or licensed therapist, along with psychiatric consultations, assessments, and ongoing treatment. Inpatient treatment for alcohol or drug addiction also qualifies.
There’s an important boundary here: counseling that isn’t tied to a medical or mental health diagnosis, such as general marriage counseling or life coaching, typically does not qualify. If a treatment falls in a gray area, your provider can supply a letter of medical necessity, a formal document explaining why a specific service is essential for your health. That letter can make the difference between an eligible and ineligible expense.
Equipment, Supplies, and Home Modifications
Medical equipment and supplies are covered when they serve a medical purpose. The list includes hearing aids and their batteries, wheelchairs, crutches, artificial limbs, prostheses, blood sugar test kits, oxygen equipment, breast pumps, and pregnancy test kits. Guide dogs and other service animals qualify too, including costs for buying, training, and maintaining the animal.
If a medical condition requires changes to your home, those capital expenses can also be eligible. Examples include installing entrance ramps, widening doorways, adding grab bars or support rails in bathrooms, and putting in stairway lifts. The eligible amount is generally the cost of the modification minus any increase in your home’s value.
Transportation for Medical Care
Getting to and from medical care counts as a qualified expense. You can use HSA funds for bus, taxi, train, or plane fares when the trip is primarily for medical care. If you drive, you can deduct mileage, parking fees, and tolls. Ambulance costs are included as well.
What an HSA Does Not Cover
The IRS draws a clear line at cosmetic procedures. Surgery or treatments that don’t address a medical condition or disease, like teeth whitening, elective cosmetic surgery, or hair transplants done purely for appearance, are not eligible. General health items like gym memberships and nutritional supplements typically don’t qualify either, unless prescribed for a specific diagnosed condition with supporting documentation.
Insurance premiums generally cannot be paid with HSA funds, with a few exceptions: Medicare Part A, B, and D premiums, COBRA continuation coverage, and qualified long-term care insurance premiums are all eligible.
Spending on Spouse and Dependents
Your HSA isn’t limited to your own expenses. You can use it to pay qualified medical costs for your spouse and your tax dependents, even if they aren’t covered by your high-deductible health plan. This makes the HSA especially flexible for families where one spouse has different insurance coverage or where children are on a separate plan.
Preventive Care Your Plan Covers Before the Deductible
One feature that confuses many HSA holders: high-deductible health plans are required to cover certain preventive services at no cost, before you meet your deductible. This doesn’t come out of your HSA at all. These services include annual physicals, routine prenatal care, immunizations, tobacco cessation programs, and a wide range of screenings for cancer (mammograms, colonoscopies, PSA tests, skin cancer checks), heart disease, diabetes, depression, HIV, hepatitis, osteoporosis, and more.
The distinction matters because preventive care aims to catch problems early in people without symptoms. Once a service is treating an existing condition, it falls under your deductible, and that’s where your HSA funds come into play.
Contribution Limits and Withdrawal Rules
To contribute to an HSA, you need a high-deductible health plan. For 2025, that means a plan with a minimum annual deductible of $1,650 for individual coverage or $3,300 for family coverage, with out-of-pocket maximums no higher than $8,300 (individual) or $16,600 (family). For 2026, contribution limits rise to $4,400 for individuals and $8,750 for families. If you’re 55 or older, you can contribute an additional $1,000 per year as a catch-up contribution.
Money you withdraw for qualified medical expenses is completely tax-free. If you take money out for something that isn’t a qualified medical expense before age 65, you’ll owe income tax plus a steep 20% penalty. After 65, that penalty disappears. You’ll still owe ordinary income tax on non-medical withdrawals, but the account essentially functions like a traditional retirement account at that point, making it a useful long-term savings tool even beyond healthcare.