When you think about using your health savings account (HSA) or health flexible spending account (FSA), you may picture paying copays, filling prescriptions and reaching your annual deductible with these tax-advantaged accounts. But these accounts can stretch much further into everyday wellness spending than many employees realize, such as over-the-counter (OTC) allergy medicine, therapy sessions and, in some cases, a gym membership.
Wellness expenses generally fall into two tiers. Some items are automatically eligible for reimbursement with no extra paperwork required. Others become eligible only after a healthcare provider documents that the purchase treats, prevents or manages a specific diagnosed condition, typically through a letter of medical necessity (LMN). This article explores when to use HSAs and FSAs for certain expenses, what they may cover and how to start using these funds.
Overview of HSAs and FSAs
Both FSAs and HSAs exist to help pay for qualified medical expenses using tax-advantaged dollars, and Section 213(d) of the Internal Revenue Code defines “medical care.” Where they differ is who owns the account, who contributes to it and what happens to unused funds. Consider the following distinctions:
- HSAs are available if you’re enrolled in a qualifying high deductible health plan (or HDHP). You (and your employer, in some cases) contribute pre-tax dollars. The account is yours, which means unused funds roll over every year, the balance can be invested and you keep the account even if you change jobs.
- FSAs are set up through your employer and funded mainly through your own payroll deductions, regardless of what health plan you’re on. FSA funds are generally use-it-or-lose-it each plan year, though some plans allow a limited rollover or grace period. In addition, the account doesn’t travel with you if you leave your employer.
Check with HR or your plan documents to confirm which of these accounts you have, since that determines which rules and deadlines apply to wellness purchases.
Generally Eligible Wellness Purchases
The IRS allows HSA and FSA funds to be used for the costs of diagnosing, treating, curing or preventing disease. Several everyday wellness items already meet that bar without any additional documentation, including:
- Continuous glucose monitors—Devices used to manage diagnosed diabetes are eligible.
- CPAP machines and supplies—Equipment used to manage diagnosed sleep apnea, including masks and replacement parts, is eligible.
- Home diagnostic devices—Blood pressure monitors, pulse oximeters and digital thermometers are eligible without additional documentation.
- Menstrual products—Tampons, pads, liners, menstrual cups, menstrual discs and period underwear have been permanently eligible since 2020.
- Mental health visit copays and therapy—Copays for therapy or psychiatric visits are eligible medical expenses when the care treats a diagnosed condition.
- OTC medications and first aid supplies—Since 2020, you no longer need a prescription to use your account for OTC pain relievers, allergy medicine, cold and flu remedies, antacids and first aid items (e.g., bandages and antiseptic wipes).
- Physical therapy, chiropractic care and acupuncture—These treatment-oriented services are generally eligible without extra documentation.
- Pregnancy and ovulation test kits—The IRS recognizes these as eligible medical devices.
- Prenatal vitamins—Unlike general multivitamins, prenatal vitamins are eligible because they support a specific, recognized condition.
- Vision costs—Prescription eyeglasses, contact lenses and contact lens solution are all eligible expenses.
Wellness Purchases That Require an LMN
Other wellness expenses can be eligible but may require documentation from your healthcare provider. These items can support your health, but the IRS allows account funds to be used only when the expense treats, prevents or mitigates a diagnosed medical condition, not general health and wellness. An LMN from your provider is what reclassifies a purchase from general wellness to a qualified medical expense. Common examples include:
- Air purifiers and humidifiers—Both may be eligible when used to manage a diagnosed respiratory condition, such as asthma or severe allergies.
- Ergonomic office equipment—Chairs or standing desks may be eligible when a provider documents a diagnosed back or musculoskeletal condition.
- Fitness trackers and wearables—Depending on your plan administrator, these devices may qualify if they support management of a diagnosed condition.
- Gym memberships and fitness studio classes—Membership fees and class costs qualify when a provider documents that they treat a specific diagnosed condition, such as obesity, high blood pressure or chronic pain, rather than simply supporting general fitness.
- Home exercise equipment—Treadmills, exercise bikes and similar equipment can qualify under the same documentation requirement.
- Light therapy devices for skin conditions—If the medical purpose, such as treating acne, can be documented, these devices may be eligible.
- Vitamins and supplements—Dietary products are eligible only when a medical practitioner recommends or prescribes them to treat a diagnosed deficiency or condition. Daily multivitamins taken for general health don’t qualify.
- Weighted blankets—Plan administrators sometimes approve them for diagnosed anxiety or sensory processing conditions.
- Wigs—An LMN can make a wig eligible when the hair loss is caused by disease or treatment, such as chemotherapy.
An LMN is typically valid for about a year and can cover multiple related purchases during that time, so you generally don’t need a new letter for every purchase tied to the same condition.
Start Using These Funds for Wellness
If you are already planning on purchasing qualifying items for your wellness, take advantage of your HSA and FSA funds to pay for products and services beyond your typical doctor’s office visits. The following steps can help you get started:
- Talk to your provider. If you have a wellness goal, such as fitness, weight management or stress management, ask whether it connects to a diagnosable condition.
- Request an LMN, if applicable. Your provider can document the diagnosis and the recommended treatment.
- Confirm with your plan administrator before purchasing. Eligibility rules can vary by plan, so check that the specific expense qualifies before you buy.
- Keep your receipts and documentation. Save itemized receipts and any LMN paperwork in case your plan requests substantiation or you’re audited.
- Be aware of deadlines. If you have an FSA, plan wellness purchases around your plan year deadline since FSA funds are typically use-it-or-lose-it.
For more information about qualified medical expenses, check out the IRS’s Publication 502 (2025), Medical and Dental Expenses.
Conclusion
Your HSA or FSA dollars may cover more than you think. Take a moment to compare your wellness goals with eligible expenses, and reach out to HR or your benefits team with questions about what qualifies under your specific plan.
This article is for informational purposes only and is not tax, legal or financial advice. For further information, please consult your plan administrator or a qualified professional. © 2026 Zywave, Inc. All intended rights reserved.
