What counts as a qualified HSA medical expense?
Your HSA is only tax-free on the way out if the money pays for a qualified medical expense. Most healthcare costs qualify, but a few common ones do not, and whether an expense qualifies can depend on why it was purchased and your specific circumstances. Here is how to tell the difference.
The IRS definition
The IRS defines medical expenses as the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for treatments affecting any part or function of the body. Health Savings Accounts use this same definition. IRS Publication 502 explains which expenses generally qualify under Internal Revenue Code Section 213(d), with HSA-specific notes in Publication 969. That list is not exhaustive, so when an item is unclear, check Publication 502 or ask your HSA administrator.
What usually qualifies, and what usually doesn't
✓ Usually qualifies
- Doctor, dentist, and specialist visits
- Prescription medications
- Over-the-counter medicines (no prescription needed)
- Dental care: cleanings, fillings, braces
- Vision care: exams, glasses, contacts, LASIK
- Mental health and therapy
- Physical therapy and chiropractic care
- Medical equipment: crutches, blood-pressure monitors, CPAP
- Lab tests and diagnostics
- Menstrual care products
- Hearing aids and batteries
- Breast pumps and lactation supplies
✗ Usually doesn't
- Vitamins and supplements for general health
- Cosmetic procedures (unless medically necessary)
- Gym memberships and general fitness
- Toiletries: toothpaste, toothbrushes, deodorant
- Most health insurance premiums (see exceptions below)
- Anything already reimbursed by insurance
Common HSA expenses people ask about
Vitamins and supplements. These qualify only when a provider recommends a specific supplement to treat a diagnosed condition. Keep a letter of medical necessity if you plan to reimburse yourself for one.
Sunscreen. Broad-spectrum sunscreen with SPF 15 or higher is generally treated as qualified because it helps prevent a medical condition. Everyday cosmetics with SPF are a grayer area.
Insurance premiums. Premiums are generally not HSA-qualified, but there are exceptions: COBRA continuation coverage, coverage while you are receiving unemployment, and, after age 65, most Medicare premiums (not Medigap), plus qualified long-term care insurance up to age-based limits.
Dual-purpose items. Things that serve both a medical and a general purpose, such as special foods or some equipment, may qualify with a letter of medical necessity from your provider.
How to check a specific expense
- Look it up in IRS Publication 502.
- Check your HSA administrator's eligibility list. Many publish one.
- For a dual-purpose item, get a letter of medical necessity from your provider before you reimburse yourself.
Why it matters when you reimburse yourself
Knowing an expense qualifies is only half the job. If the IRS ever asks, you have to be able to show that each distribution paid a qualified expense, which means keeping the itemized receipt or bill. That burden is on you, and because there is no deadline to reimburse yourself, you may need to keep the proof for years. See do you need to keep HSA receipts? for the recordkeeping rules.
Why Receipt Locker is different
Most receipt apps simply store files. Receipt Locker keeps each medical receipt categorized, preserved, and exportable as an independently verifiable record, so when you reimburse yourself years later you can show both what you spent and that the stored record's integrity can be independently verified.
Keep your HSA receipts ready to prove
Capture each qualified expense once, tagged and preserved for the day you reimburse yourself. Free to start, no credit card required.
Frequently asked questions
Are vitamins HSA eligible?
Usually not. Vitamins and supplements taken for general health are not qualified. They can qualify if a provider recommends a specific vitamin to treat a diagnosed condition, with a letter of medical necessity.
Is sunscreen HSA eligible?
Broad-spectrum sunscreen with SPF 15 or higher is generally treated as qualified. Everyday cosmetics with SPF are a grayer area, so check your plan's list or IRS Publication 502.
Are over-the-counter medicines HSA eligible?
Yes. Since the CARES Act of 2020, over-the-counter medicines qualify without a prescription, and menstrual care products were added.
Is a gym membership HSA eligible?
Usually not, unless a provider prescribes it to treat a specific diagnosed condition, supported by a letter of medical necessity.
Are health insurance premiums HSA eligible?
Generally no, with exceptions: COBRA, coverage while receiving unemployment, and, after age 65, most Medicare premiums (not Medigap), plus qualified long-term care insurance up to age-based limits.
Keep reading
- Do you need to keep HSA receipts? (IRS rules & how long)
- How to build your own long term receipt archive
Last reviewed: July 2026.