HSA FSA wellness purchases qualify only when the money goes to medical care, which the IRS defines as the diagnosis, cure, treatment, or prevention of disease. Gadgets and habits that only support general good health usually do not count. This guide sorts the common buys so you know what to expect before you swipe the card. It is general information, not tax advice.
The basic test the IRS uses
Health savings accounts (HSAs) and flexible spending arrangements (FSAs) both use the same idea of a medical expense. The IRS says medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. The costs must be mainly to ease or prevent a physical or mental illness.
Notice what is missing. Feeling better, looking better, or staying fit is not on that list. That gap is why so many popular wellness buys land in the gray zone.
Plan rules can be stricter than the tax rules. Your plan may also ask for proof of the purchase. Check your plan documents before you buy.
What usually qualifies
Some items are clear. Doctor visits, dental care, eyeglasses, prescriptions, and hearing aids all count as medical care under IRS Publication 502.
A 2020 law added two more categories. Under the CARES Act, signed on March 27, 2020, over-the-counter medicine (whether or not prescribed) and menstrual care products count as medical care. That applies to HSAs, FSAs, and similar accounts for amounts paid or incurred after 2019. So you no longer need a prescription for items such as pain relievers or allergy pills.
Also note that the rule is about medicine. A bottle of cold tablets counts. A bottle of daily multivitamins is a different question, covered below.
What usually does not qualify
Publication 502 names several wellness favorites that are not medical expenses.
- Gym and health club dues. The IRS says you cannot include membership dues in a gym, health club, or spa.
- Diet food and drinks. These replace food you would eat anyway, so they do not count.
- Weight-loss programs for looks or general health. The cost counts only when the weight loss treats a specific disease diagnosed by a physician, such as obesity, hypertension, or heart disease.
- Cosmetic procedures. Face lifts, hair transplants, hair removal, and similar work are generally excluded, with limited exceptions for deformities from birth defects, injury, or disease.
- Everyday personal items. The IRS example is a toothbrush and toothpaste. An item used for ordinary personal purposes does not count unless it is used mainly to prevent or ease an illness or disability.
Supplements and gadgets: when a doctor's note matters
This is the gray zone. For vitamins, herbal products, and similar items, Publication 502 says you cannot include the cost unless a medical practitioner recommends them as treatment for a specific medical condition diagnosed by a physician. The IRS adds that these items are usually taken to maintain ordinary good health.
The same logic reaches wellness gadgets. A fitness tracker, a sleep mask, or a home air monitor is built for general use. The IRS personal use rule treats such items as nondeductible unless they are used mainly to prevent or ease a specific illness. A device with a clear medical purpose, such as a blood pressure cuff for diagnosed high blood pressure, sits on firmer ground than a general lifestyle product.
For borderline buys, many plan administrators ask for a letter of medical necessity from your doctor. The letter should name the condition and say why the item is part of treatment. Publication 502 does not use that exact phrase, so ask your own plan what it accepts. Without a diagnosis and a practitioner's recommendation, assume the purchase will not qualify.
Rules and limits that apply to your account
The two accounts work differently, so the stakes differ.
With an HSA, money used for non-qualified purchases is taxed as income and may face an extra 20 percent tax. You must also keep records showing that each withdrawal paid for a qualified expense that was not paid or reimbursed from another source. You do not send those records with your return, but you should keep them. For 2024, the HSA contribution limit is $4,150 for self-only coverage and $8,300 for family coverage.
An FSA is tied to your employer's plan. For 2023, the health FSA salary reduction limit was $3,050, and a plan could allow a carryover of up to $610 in unused money. Plans may set a lower carryover, or none, so check your own rules early in the year rather than in December.
A quick checklist before you buy
- Is the item aimed at treating or preventing a disease, not just general health?
- Is it over-the-counter medicine or a menstrual care product? If so, it qualifies.
- Is it a supplement or gadget? Ask your doctor whether they will recommend it for a diagnosed condition, in writing.
- Is it on the IRS excluded list, such as gym dues or diet food? Pay with regular money.
- Did you save the receipt and any doctor's note?
When the answer is unclear, ask your plan administrator or a tax professional before you spend. A small delay costs less than a tax bill and a penalty.