What HSA dollars actually cover
The HSA-eligible expense list is the same list as the FSA-eligible expense list. Both accounts are governed by IRS Publication 502 and the SIGIS Eligible Product List Criteria. If a product is FSA eligible, it’s HSA eligible. If it requires a Letter of Medical Necessity for one, it requires one for the other.
What’s different is the money side. HSA funds don’t expire, can be invested, travel with you between jobs, and offer a triple tax advantage that no other U.S. retirement vehicle can match. That changes how strategic HSA holders should think about spending.
The triple tax advantage
The HSA is the only account in the U.S. tax code where all three of these are simultaneously true:
- Contributions are pre-tax (payroll deductions) or tax-deductible (post-tax contributions).
- Investment growth is tax-free — same as a Roth IRA, but without the contribution-side tax.
- Qualified medical withdrawals are tax-free — at any age.
A 401(k) is taxed on withdrawal. A Roth IRA is taxed on contribution. An HSA is taxed on neither when used for healthcare. This is why financial planners often recommend maxing the HSA after the 401(k) match but before any other retirement vehicle.
For 2026, the IRS contribution limits are:
| Coverage type | Limit | Catch-up (55+) |
|---|---|---|
| Self-only HDHP | $4,300 | +$1,000 |
| Family HDHP | $8,550 | +$1,000 |
Contributions can be made until the tax filing deadline of the following year — April 15, 2027 for the 2026 tax year — which gives you flexibility to true up after the calendar closes.
What’s always eligible (no documentation needed)
These categories follow the same SIGIS classification system used by FSAs. Buy with your HSA debit card; no paperwork needed.
Vision care
Eyeglasses and prescription sunglasses, contact lens solution, prescription contacts, eye drops, reading glasses, vision exams, contact lens fittings, and LASIK or other corrective surgery. See Vision Care.
First aid and diagnostic devices
First aid kits, thermometers, blood pressure monitors, pulse oximeters, glucose meters, CPAP machines and supplies, hearing aids, and pregnancy or ovulation tests. Browse First Aid for current products.
OTC medications
Tylenol, Advil, Zyrtec, Mucinex, Pepto-Bismol, Neosporin, hydrocortisone cream, and the rest of the OTC Medications category. The CARES Act of 2020 permanently restored OTC eligibility without a prescription.
Sunscreen
SPF 15+ broad-spectrum sunscreen — Coppertone, Sun Bum, Banana Boat, La Roche-Posay, EltaMD, Neutrogena, and similar. See the full Sunscreen & Skincare category.
Pain relief and therapy products
Heating pads, TENS units, knee/back/wrist braces, kinesiology tape, foot orthotics, percussion massage devices for therapeutic use, and cervical/lumbar pillows. See Pain Relief & Therapy.
Mental health services
Therapy and counseling with a licensed mental health professional, psychiatric care, teletherapy (Talkspace, BetterHelp, Cerebral), and ABA therapy. See Mental Health for products.
Baby, mom, and family
Breast pumps and supplies, prenatal vitamins, postpartum recovery products, baby thermometers, nasal aspirators, and pediatric humidifiers. See Baby & Mom.
Feminine care
Tampons, pads, menstrual cups, period underwear, and yeast-infection treatments — all permanently eligible since the CARES Act.
Dental services
Cleanings, fillings, root canals, crowns, oral surgery, orthodontics (braces, Invisalign), denture supplies, and TMJ treatment. See Dental Care.
Other always-eligible categories
Acupuncture, chiropractic care, physical therapy, occupational therapy, speech therapy, smoking cessation programs and OTC nicotine products, ambulance services, and prescribed weight-loss programs for documented diagnoses.
Eligible with a Letter of Medical Necessity
Same dual-purpose categories that apply to FSAs. A licensed provider must document the medical necessity.
- Most dietary supplements (multivitamins, vitamin D, fish oil, probiotics, herbals). Three exceptions are always eligible: glucosamine/chondroitin, bulk-forming fiber laxatives, and prenatal vitamins.
- Blue light glasses without a vision correction component
- Compression hosiery below 30–40 mmHg
- Weighted blankets for sensory or anxiety disorders
- Air purifiers and humidifiers for respiratory diagnoses
- Gym memberships for documented diagnoses (obesity, hypertension, cardiac rehab)
- Light therapy lamps for seasonal affective disorder
- Special diet foods for celiac disease or other documented conditions
For a full breakdown of the eligibility framework and surprising items most plans miss, see the complete FSA/HSA eligible items list.
What’s not eligible
The IRS draws the line at general health and personal hygiene. These don’t qualify even with provider recommendation:
- Toothpaste, toothbrushes, mouthwash, dental floss
- Cosmetics, deodorant, shampoo, perfume
- Cosmetic procedures (teeth whitening, elective plastic surgery)
- General fitness equipment without an LMN
- Most dietary supplements without an LMN
- Insurance premiums (with limited exceptions for COBRA, long-term care, and Medicare)
Why HSA strategy is different from FSA
FSA holders are racing the clock. The deadline is real and the money disappears at year-end. HSA holders aren’t.
The optimal HSA strategy for many people is:
- Max the contribution every year (the contribution itself is the tax savings).
- Pay current medical expenses out of pocket when possible.
- Invest the HSA balance above your custodian’s cash threshold (often $1,000–$2,000) in mutual funds or ETFs.
- Save receipts for medical expenses paid out of pocket. The IRS doesn’t require you to reimburse yourself in the same year — you can reimburse decades later, tax-free, at any time.
- Let the balance compound until retirement. After 65, HSA funds can be withdrawn for any purpose (taxed as ordinary income, like a 401(k)) — but qualified medical withdrawals stay tax-free indefinitely.
This turns the HSA into a stealth retirement account for healthcare, a category of expense that grows substantially in retirement.
The trade-off is that you forgo the immediate “spend it on sunscreen and contacts” use of HSA dollars. For most working-age HSA holders with adequate cash flow, that’s a worthwhile trade. For HSA holders without that flexibility, spending HSA dollars on current eligible expenses is still significantly cheaper than paying with after-tax money.
After age 65
Once you turn 65, HSA rules become more flexible:
- Qualified medical withdrawals remain tax-free.
- Non-medical withdrawals are taxed as ordinary income (no 20% penalty as before age 65).
- Medicare premiums become eligible HSA expenses (Parts A, B, C, and D).
- Long-term care insurance premiums become eligible up to age-based IRS limits.
This is why many financial planners describe the HSA as the most tax-efficient retirement account available.
A note on FSA vs HSA
If you’re not sure which account type you have, see FSA vs HSA in 2026 for the full breakdown. The short version: HSAs require enrollment in a high-deductible health plan (HDHP), are owned by you, and never expire. FSAs are owned by your employer and follow a use-it-or-lose-it rule with limited extensions.
Eligibility caveats
The eligibility list is governed by the IRS and SIGIS, but the day-to-day enforcement happens at your plan administrator. For edge cases — especially LMN-required items, dual-purpose products, and anything in a gray zone — confirm with your administrator before assuming a purchase will be honored. They can either pre-approve it or tell you exactly what documentation they need.
Use the balance tool
Whether you’re spending current HSA dollars or planning a year of healthcare purchases, the balance spend-down tool generates a curated bundle of eligible items for any balance you enter. Switch the tool to HSA mode (the deadline urgency drops away — your HSA isn’t going anywhere) and explore from there. Or browse eligible products by category if you’d rather plan deliberately.