📋 What counts as an HSA-eligible expense?

Anything that diagnoses, treats, or prevents a medical condition — defined by IRS Publication 502. General health and cosmetic spending is excluded.

The governing definition comes from IRC Section 213(d), expanded in IRS Publication 502: expenses for the diagnosis, cure, mitigation, treatment, or prevention of disease, and for treatments affecting any structure or function of the body.

The test is treatment, not health. Gym memberships make you healthier and don't qualify. Crutches don't make you healthier and do.

Commonly eligible and commonly forgotten:

  • Chiropractic care and acupuncture
  • Physical therapy
  • Fertility treatment, including IVF
  • Breast pumps and lactation supplies
  • Hearing aids and batteries
  • Smoking cessation programs
  • Travel mileage to and from medical care (at the IRS medical rate)
  • Guide dogs and service animals
  • Home modifications for a medical condition — ramps, grab bars

Commonly assumed eligible and not:

  • Gym memberships and fitness classes
  • General-purpose vitamins
  • Cosmetic procedures
  • Nonprescription toiletries

Borderline items can often be made eligible with a Letter of Medical Necessity from a provider. Store that letter with the receipt — a decade later, the receipt alone won't explain itself.

Full list: What Actually Counts as an HSA-Eligible Expense?

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