Your HSA Covers More Than You Think — HSA Eligible Expenses for 2026

What if I told you you've probably been paying out of pocket for things your HSA could have covered all along?

Sunscreen. Acupuncture. Fitness trackers. Sleep aids. Mental health apps. Feminine products. Reading glasses. Smart scales.

The list of HSA-eligible expenses is far broader than most people expect — and knowing what's on it, what's automatically covered, and what requires documentation changes how you shop for everything health-related.

This guide covers everything, so you can start using it immediately.

What the IRS States is Eligible

Before we move on, let's specifically review what the IRS states.

The IRS defines a qualified medical expense as anything that diagnoses, treats, mitigates, or prevents a physical or mental condition. (Source: IRS Publication 502)

This guidance covers far more ground than most people realize. Not only the items that the IRS lists as automatically eligible, but also anything that diagnoses, treats, mitigates, or prevents a medical condition.

Understanding the Eligibility Types

There are two tiers of eligibility:

• Automatically eligible

  • You can use your HSA funds for all automatically eligible expenses without any documentation.

  • Automatically eligible expenses are sourced from IRS Publication 502 (Medical and Dental Expenses), IRS Publication 969 (HSAs and Other Tax-Favored Health Plans), and the CARES Act of 2020

• Eligible with documentation 

  • Items not automatically eligible require a Letter of Medical Necessity (LMN) from a licensed healthcare provider.

  • The LMN must connect the expense to a specific diagnosed medical condition, treatment, or prevention plan.

  • For more information about LMNs, read our full article here. 

  
  

The second category offers significant additional savings opportunities when you explore it.

Where These Eligibility Rules Come From

HSA eligibility is based on IRS rules—not a separate HSA-specific list.

The IRS defines what counts as a qualified medical expense in Publication 502, and your

HSA follows those same rules.

• Publication 502: What qualifies as a medical expense

• Publication 969: How HSAs work

Your HSA provider uses and interprets these guidelines to review purchases—looking at how an item is used, how it’s documented, and whether it meets their plan criteria—which is why eligibility can vary slightly by plan.

We've done our best to verify the information in this guide, but it's still important to double-check before purchasing. IRS rules can change, and interpretations may differ across websites based on how they interpret the rules and guidelines. Ultimately, you are responsible for ensuring expenses qualify as medical care under IRS rules if audited.

Category 1 — Everyday Health Products You're Already Buying

These are the easiest wins—items you can start running through your HSA immediately.

Most of these are clearly defined as eligible under IRS guidelines for medical purposes.

Skincare and Sun Protection

• Sunscreen SPF 15+ (expanded under CARES Act)

• Lip balm with SPF

• Acne treatments (OTC medicated products; cosmetic-only products may not qualify)

• Medicated skincare

Vision

• Prescription eyeglasses

• Contact lenses and solution

• Reading glasses (even OTC)

• Eye exams

• Prescription sunglasses

Dental

• Exams and cleanings

• Orthodontia

• Dentures

• Dental X-rays

• Night guards

(Teeth whitening does not qualify — cosmetic)

Feminine Health

• Tampons, pads, menstrual cups

• Period underwear

• Postpartum care

Over-the-Counter Medications

• Pain relievers

• Allergy meds

• Cold and flu medicine

• Antacids

• First aid supplies

Baby and Family

• Prenatal vitamins

• Breast pumps

Devices

• Thermometers

• Blood pressure monitors

Source: IRS Publication 502; CARES Act (2020)

Category 2 — Health Technology Most People Don't Claim

This is an area where additional savings opportunities can really add up.

Smart Scales

HSA eligibility for scales depends on the type and use of the scales.

• Body composition scales may qualify, particularly when used for medical monitoring. When shopping, look for an HSA-eligible designation and make sure you are using it to diagnose, treat, mitigate, or prevent a physical condition.

• Standard weight scales are generally not eligible on their own, but may qualify with a Letter of Medical Necessity (LMN) for a diagnosed condition.

• Specialized medical scales (bariatric, mobility, lymphedema) may qualify when prescribed.

Fitness Trackers & Smartwatches

May qualify with a Letter of Medical Necessity (LMN) tied to a documented medical need.

Blood Pressure Monitors

Fully eligible—no Letter of Medical Necessity (LMN) required.

Continuous Glucose Monitors

Eligible for blood sugar monitoring (verify for non-diabetic use).

Sleep Tracking Devices

May qualify with documentation tied to sleep-related medical conditions.

Source: IRS Publication 502

Category 3 — Wellness Services You Might Not Expect

Many of these are clearly eligible and can be valuable additions to your HSA strategy.

• Acupuncture for the treatment of a medical condition

• Chiropractic care

• Therapy and counseling

• Psychiatric care

• Physical therapy

Massage Therapy

May qualify when recommended or prescribed by a healthcare provider to treat a specific medical condition, not for general relaxation.

Weight Loss Programs

May qualify when recommended by a healthcare provider for a specific medical condition (such as obesity or hypertension). (Food costs typically do not qualify)

Some insurance plans may offer free or discounted weight loss programs or resources. It’s worth checking your plan’s benefits.

Gym Memberships

Generally not eligible. However, portions of a program may qualify when tied to a specific treatment plan.

Fitness Equipment

May qualify if need to mitigate or treat a medical condition.

Source: IRS Publication 502

Category 4 — Supplements With Documentation

This category offers additional flexibility when approached correctly.

Most supplements don’t qualify automatically—but some may qualify when used to treat a specific medical condition and supported by a Letter of Medical Necessity (LMN).

Exception: Prenatal vitamins qualify automatically.

The key is not the supplement itself—it’s the documented medical reason for using it.

Examples of Supplements That May Qualify With Proper Documentation

• Magnesium — for migraines, sleep disorders, or deficiency

• Vitamin D — for deficiency

• Iron — for iron deficiency or anemia

• Omega-3 — for elevated triglycerides or cardiovascular conditions

• B vitamins — for documented deficiency

Some supplements (like probiotics or protein powders) may qualify in more specific situations and do require an LMN.

Source: IRS Publication 502

Category 5 — Lab Testing and Diagnostics

These generally fall under diagnostic care when used to evaluate, diagnose, or monitor a medical condition.

Advanced Lab Testing

Services like Function Health and Superpower are often positioned as HSA-eligible because they provide diagnostic lab testing. Confirm eligibility before purchasing.

At-Home Testing

• Cholesterol tests

• Glucose monitoring

• Allergy tests

• STI testing

Many at-home tests can qualify when used for medical diagnosis or monitoring. Tests focused on general wellness or lifestyle insights may not qualify; eligibility depends on medical purpose.

Imaging

• X-rays

• MRIs

• Ultrasounds

Important Notes

• Diagnostic services are generally eligible, but packaging (memberships/bundles) can affect reimbursement.

• Direct-to-consumer and DNA-based tests vary significantly—verify before purchasing.

Source: IRS Publication 502 (diagnostic services)

Category 6 — Sleep and Recovery

Sleep-related items can qualify when used to treat or manage a diagnosed sleep-related condition.

Automatically Eligible

• CPAP machines

• Sleep apnea devices

• Prescription sleep medications

May Qualify With Documentation

• Therapeutic mattresses

• Sleep tracking devices

• White noise machines

• Pillows

• Mattresses

Important Notes

• Over-the-counter sleep aids may qualify if tied to a qualified medical purpose.

• Items intended for general comfort (standard mattresses and accessories) typically do not qualify unless they are tied to a documented medical need.

Source: IRS Publication 502; LMN required for most non-prescription sleep-related items

Category 7 — Things That Might Surprise You

These items can qualify when clearly tied to a medical need or condition.

• Service animals (purchase, training, care)

• Home modifications (ramps, grab bars, stair lifts—only the non–value-increasing portion qualifies)

• Transportation to medical care (mileage, parking, transit)

• Compression stockings (for diagnosed conditions)

• Prescription sunglasses

Gray Areas (Verify First)

• Air purifiers (may qualify with a Letter of Medical Necessity (LMN) for respiratory conditions)

• Special dietary foods (only cost difference may qualify with diagnosis)

• DNA health tests (high variability; often not covered)

Important Notes

• Eligibility is based on medical purpose, not the product itself.

• Some items may only partially qualify depending on use or documentation.

Source: IRS Publication 502

Other Surprising Items That May Qualify

These surprising items become eligible when a Letter of Medical Necessity (LMN) confirming the item is being used to treat, mitigate, or prevent a specific diagnosed condition:

• Bikes — stationary and traditional

• Saunas — traditional, infrared, and barrel saunas

• Cold plunges — cold water immersion tubs and systems

• Massage equipment — massage guns, percussive therapy devices, and massage chairs

• Compression socks and garments — for circulation, recovery, or edema management

• Supportive footwear — orthopedic and adaptive shoes designed to address foot, knee, or joint conditions

• Red light therapy devices — for pain relief, muscle recovery, or skin conditions

• Hike Gear

Check out Truemed's website for more items that may qualify.

What Doesn’t Qualify (Important)

The following items do not qualify:

• Cosmetic procedures

• Teeth whitening

• General supplements without LMN

• Toiletries

• Health foods and groceries

• Insurance premiums (with limited exceptions)

Source: IRS Publication 502 exclusions

How To Make Sure You’re Not Missing Anything

1. Audit your last 2–3 months of spending: Review your bank/credit card statements and receipts.

Flag anything health-related and sort into three buckets:

• Clearly eligible: copays, prescriptions, labs, vision, dental

• Likely eligible: OTC meds, sunscreen, menstrual care, basic monitors

• Needs review: supplements, devices, memberships, wellness services

For items in the last two buckets, check eligibility and keep documentation—you can reimburse yourself later as long as the expense occurred after your HSA was opened. (Source: IRS Notice 2004-50; IRS Publication 969)

2. Organize your documentation (simple system): Create a single folder (digital, cloud, or your HSA provider’s portal if available) and store:

• Receipts (PDF or photo)

• Invoices or order confirmations

• LMNs (if applicable)

• A short note on the medical purpose (1–2 lines)

3. Check eligibility before buying (quick checklist): Before purchasing, run through this quick check:

• Purpose: Is this for diagnosis, treatment, or prevention of a condition?

• Category: Is it listed in IRS Publication 502 or commonly treated as medical?

• Documentation: Do you need an LMN for this item?

• Submission: Will you pay with your HSA card or reimburse later?

Quick tip on Letter of Medical Necessities (LMNs): Ask your primary care provider or specialist to document the condition and why the item is needed. A strong LMN includes your condition, the recommended item/service, and how it supports treatment. Some platforms—like Truemed—offer guided evaluations to help streamline this process.

If anything is unclear, check your HSA provider’s site or contact support before you buy.

4. Use a reimburse‑later strategy (optional). If you can pay out of pocket, keep receipts and reimburse yourself later. This allows your HSA balance to stay invested longer while preserving the tax benefit—keep clear records.

The Bottom Line

If you’re using your HSA for everyday health expenses, this list can translate directly into real savings.

Every eligible purchase made with HSA dollars typically saves you 25–35% compared to paying out of pocket, depending on your tax bracket.

If you choose not to keep all of your HSA invested, using it intentionally for qualified expenses can be a simple way to reduce your overall cost of staying healthy.

The more you understand what qualifies, the more opportunities you have to keep more of your money while still taking care of your health.

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Thanks for reading, The Saving Wiser Team

Disclaimer: HSA eligibility is determined by the IRS. This content is for informational purposes only and does not constitute medical or financial advice. Always verify eligibility before purchasing. Some items require a Letter of Medical Necessity. Refer to IRS Publication 502 and 969 for official guidance.