What Can You Really Use Your HSA For? A Deep Dive Into Eligible Expenses
An HSA (Health Savings Account) is a special savings account available to individuals with a high-deductible health plan (HDHP). Contributions are tax-deductible, earnings grow tax-free, and withdrawals are also tax-free when used for qualified medical expenses.
This triple-tax benefit makes HSAs a powerful way to save for both current and future healthcare costs—especially in retirement. To learn more about the benefits of HSA’s, see my article A Healthy Investment: Discover the Surprising Benefits of Health Savings Accounts – Gilbert Wealth.
What Can You Use the HSA for?
HSA funds can be used for a wide range of qualified medical expenses, as defined by IRS Publication 502. These include, but are not limited to:
- Doctor visits and copays
- Prescription medications
- Mental health therapy and counseling
- Dental and vision care, including glasses and braces
- Medical devices like crutches, wheelchairs, or CPAP machines
- Chiropractic and acupuncture care
One often overlooked benefit: you can reimburse yourself for past qualified medical expenses, as long as they occurred after the HSA was established. That means if you paid out-of-pocket for a procedure last year, and you had an HSA at the time, you can reimburse yourself now—even years later—if you’ve saved the receipt.
Medical Premiums
HSA’s can be used to cover certain insurance premiums.
| Eligible for HSA Use | Not Eligible for HSA Use |
|---|---|
| COBRA Coverage | Employer-Sponsored Health Insurance |
| ACA Premiums (with Unemployment Benefits) | ACA Marketplace Premiums |
| Medicare Part A (if premiums apply) | Medigap (Medicare Supplement) |
| Medicare Part B | Private Health Insurance (Non-ACA) |
| Medicare Part C (Medicare Advantage) | Health Sharing Ministries |
| Medicare Part D | Dental and Vision Insurance (Premiums) |
| Long-Term Care Insurance (up to IRS limits) | Temporary Health Insurance (Short-term Plans) |
| Travel Medical Insurance | |
| Student Health Insurance | |
| TRICARE / VA Insurance Premiums |
Long-Term Care
Long-term care is one of the most significant medical expenses people face in retirement. HSAs can play a key role here too. You can use HSA funds to pay for:
- Qualified long-term care services, including assistance with daily living
- Long-term care insurance premiums, with annual dollar limits based on your age
HSAs are more than just a way to pay for a doctor’s visit. With the ability to cover a wide array of medical expenses—including past costs, long-term care, and specific insurance premiums—they can serve as a stealth retirement account for healthcare. Just be sure to follow IRS guidelines closely and maintain good records.
If you’re looking for a flexible, tax-efficient way to manage both present and future healthcare costs, an HSA deserves a place in your financial toolkit.