IRS Sources: HSA Rules, Eligibility, & Forms
- Saving Wiser
- 14 minutes ago
- 5 min read
There is a lot of noise online about what your HSA can and can't cover. We built this site to cut through it. Eligibility determination and commentary on SavingWiser.com is grounded in official IRS guidance and federal tax law — the same sources your plan administrator relies on. Below are the primary documents and guidance we reference. If you ever want to go deeper or verify a specific claim, this is where to look.
IRS Guidance
HSA rules don't come from a single document — they come from a layered system of federal statutes, IRS publications, regulatory notices, and legislation. The sources below represent that full picture: the laws Congress passed, the guidance the IRS uses to interpret them, and the most recent updates that affect what you can do with your account today.
IRS Publication 969 — HSAs and Other Tax-Favored Health Plans: The IRS's official guide to Health Savings Accounts, FSAs, HRAs, and Archer MSAs. Covers contribution limits, eligibility rules, what qualifies as a high-deductible health plan, and how distributions are taxed. If you want to understand how HSAs work from the source, start here.
IRS Publication 502 — Medical and Dental Expenses: The IRS's master reference for qualifying medical expenses. Publication 502 defines what counts as a deductible medical expense under federal tax law — and by extension, what's eligible for HSA reimbursement. This is the primary source behind most of the expense listings on this site. Items clearly listed in Publication 502 are generally considered automatically qualified by HSA administrators and do not require additional documentation, such as a Letter of Medical Necessity.
IRS FAQ — Medical Expenses: Nutrition, Wellness & General Health: The IRS's official FAQ addressing whether nutrition and wellness expenses qualify as HSA-eligible medical expenses under Section 213(d). Published in 2023 and updated January 2026, it provides direct yes/no answers on some of the most commonly asked gray-area questions — including gym memberships, nutritional supplements, weight-loss programs, nutritional counseling, therapeutic foods, and over-the-counter medications. For anyone using their HSA to fund a proactive health and wellness lifestyle, this is one of the most practically useful documents the IRS has published.
IRS Notice 2004-50 — HSA Q&A: This Q&A notice established — among other things — that there is no time limit on reimbursing yourself for qualified medical expenses, as long as the expense occurred after your HSA was established (Q&A 39). That rule is the foundation of the shoebox reimbursement strategy. The same Q&A also makes clear that you must keep records showing the expense was not previously reimbursed and was not taken as an itemized deduction, which is why documentation matters as much as the strategy itself.
IRS Revenue Procedure 2025-19 — 2026 Contribution Limits The official IRS announcement establishing HSA contribution limits and HDHP minimum deductible and out-of-pocket thresholds for 2026. All 2026 contribution figures on this site are sourced directly from this document.
IRS Notice 2024-75 — Preventive Care Expansion (2024 Update): The most recent IRS expansion of the HDHP preventive care safe harbor, issued October 2024. Adds OTC oral contraceptives, male condoms, continuous glucose monitors, certain insulin products, and all forms of breast cancer screening to the list of services HDHPs can cover before the deductible is met — without disqualifying the account holder's HSA eligibility. Builds on the earlier framework established in Notice 2019-45 and is now referenced in Publication 969.
IRS Form 8889 — Health Savings Accounts: The tax form used to report HSA contributions, deductions, and distributions on your federal return. The form instructions also provide a useful plain-language summary of key HSA rules and recent updates that are worth reading.
Key Legislation and Updates
The IRS guidance above interprets and applies federal law — but the laws themselves are passed by Congress. This section covers both the foundational statute that defines HSA-eligible medical care and the two most significant legislative expansions to HSA eligibility in recent history.
IRS Section 213(d) — Definition of Medical Care The federal statute that defines "medical care" for tax purposes and serves as the legal foundation for HSA expense eligibility. The determination of what qualifies follows a clear hierarchy of authority: Congress established the definition in Section 213(d), the IRS interprets that statute through guidance documents such as Publication 502, and HSA administrators apply both to make final eligibility determinations under your specific plan. Understanding that hierarchy is key to understanding why eligibility rulings are made the way they are.
CARES Act 2020 — Section 3702: OTC Medications & Menstrual Care Products (historical document): One of the most practically significant expansions of HSA eligibility in recent history. Prior to 2020, the Affordable Care Act required a prescription for over-the-counter medications to qualify as HSA-eligible expenses. Section 3702 of the CARES Act permanently eliminated that requirement, effective January 1, 2020. OTC medications — pain relievers, allergy medications, cold and flu remedies, antacids, and more — are now qualified medical expenses that can be purchased or reimbursed with HSA funds without a prescription. The same provision added menstrual care products, including tampons, pads, liners, and menstrual cups, as permanently eligible expenses. Neither change has an expiration date. While these items now appear in Publication 502 as eligible expenses, the CARES Act is the legislative source of that eligibility — and many HSA holders still aren't aware that the prescription requirement was ever removed.
One Big Beautiful Bill Act (2025) — HSA Eligibility Expansion: Signed into law on July 4, 2025, the One Big Beautiful Bill Act made the most significant expansions to HSA eligibility since the accounts were created. Three key changes affect HSA holders directly. First, first-dollar telehealth coverage is now permanently allowed under HDHPs without disqualifying HSA eligibility — retroactively effective for plan years beginning January 1, 2025. Second, effective January 1, 2026, Bronze and Catastrophic ACA Marketplace plans are now treated as HSA-compatible HDHPs, opening HSA eligibility to millions of additional Americans. Third, also effective January 1, 2026, individuals enrolled in Direct Primary Care arrangements with monthly fees up to $150 (individual) or $300 (family) may continue contributing to an HSA, and those DPC fees are now qualified medical expenses payable from an HSA. The IRS issued guidance on these changes in Notice 2026-05 in December 2025.
HSA Forms
HSA activity is reported to the IRS through three forms. Two are sent to you by your HSA administrator each year. The third is the form you complete and file with your federal tax return.
IRS Form 8889 — Health Savings Accounts: The tax form used to report HSA contributions, deductions, and distributions on your federal return. Filed as part of your annual Form 1040. The form instructions are also worth reading — they provide a plain-language summary of key HSA rules and incorporate the most recent regulatory updates.
IRS Form 1099-SA — Distributions From an HSA Sent by your HSA administrator each January, this form reports all distributions taken from your HSA during the prior tax year. You will need it to complete Form 8889. The total on Box 1 covers all distributions — qualified and non-qualified — so the burden is on you to document which were used for qualified medical expenses.
IRS Form 5498-SA — HSA Contributions Sent by your HSA administrator each May, this form reports all contributions made to your HSA during the prior tax year, including employer contributions. Arrives after the tax filing deadline because contributions made between January 1 and April 15 can still count toward the prior year. Keep it for your records — it confirms your total contributions and is useful if your return is ever questioned.
We make every effort to keep this page current as the IRS issues new guidance and legislation changes. However, we recommend verifying this information directly with the IRS, your HSA administrator, or a qualified tax advisor before making any decisions based on the information found here. The content on SavingWiser.com is for informational purposes only and does not constitute tax or financial advice. HSA eligibility varies by plan and administrator — when in doubt, verify before spending. Last reviewed May 2026.