HSA eligible expenses are the costs you can pay for with a Health Savings Account tax-free. The IRS sets the list in Section 213(d) of the tax code, and it covers most medical, dental, and vision care for you, your spouse, and your dependents. When you use HSA funds for these qualified medical expenses, you pay no tax on the money, which is what makes an HSA so powerful. Below is a plain-language guide to what an HSA can be used for, what does not qualify, and the reimbursement rules to follow.
Most care that treats, diagnoses, or prevents a medical condition is an HSA qualified medical expense. The big categories are:
office visits, specialists, surgery, urgent care, and emergency room bills, plus your deductible, copays, and coinsurance.
prescription drugs and insulin.
cleanings, fillings, crowns, root canals, extractions, dentures, and braces. Yes, dental is covered by an HSA.
eye exams, glasses, contact lenses, contact solution, and LASIK.
therapy, counseling, psychiatric care, and treatment for substance use.
crutches, wheelchairs, blood pressure monitors, blood sugar test kits, and CPAP machines.
Since 2020, you can use your HSA for many over-the-counter products without a prescription. Common HSA eligible expenses in this group include:
This is one of the most useful updates to the HSA expenses list, because everyday drugstore items now count.
Your HSA also covers a wide range of care beyond a doctor’s office:
Because your spouse and tax dependents are covered too, you can use your HSA to pay for their qualified medical expenses even if they are not on your health plan.
Dental expenses and vision expenses deserve a special note: cleanings, fillings, braces (every brace type counts), eye exams, glasses, and contacts are all eligible for reimbursement even though most medical plans exclude them. Weight loss programs qualify only when prescribed by a doctor as treatment for a specific disease.
Most insurance premiums are not HSA eligible, but there are important exceptions. You can use HSA funds to pay for:
This makes an HSA especially valuable in retirement, when you can use tax-free HSA dollars for Medicare.
Some costs are not qualified medical expenses, and paying for them with your HSA before age 65 triggers income tax plus a 20 percent penalty. These generally do not qualify:
After age 65, you can withdraw HSA funds for non-medical reasons without the 20 percent penalty, though you still pay ordinary income tax, much like a traditional retirement account.
Yes
Yes
Yes
Yes
Yes
No
No
No
Yes
Yes (limited by age)
The HSA reimbursement rules are simple but important. You can pay a provider directly with your HSA card, or pay out of pocket and reimburse yourself later. There is no deadline to reimburse yourself, so you can pay a 2026 bill from your own cash, let the HSA keep growing tax-free, and reimburse yourself years later, as long as the expense happened after you opened the HSA. The one firm rule is recordkeeping: keep every receipt and explanation of benefits, because the IRS can ask you to prove a withdrawal was for a qualified medical expense.
Save digital or paper copies of receipts, prescriptions, and any letter of medical necessity for borderline items. If you ever face an audit, these records show the withdrawal matched an HSA eligible expense. Many HSA custodians offer an app where you can upload receipts and track spending against your account balance, which makes tax time easy.
Before 2020, over-the-counter medications needed a prescription to be reimbursable from an HSA. The passage of the CARES Act removed that barrier, so OTC medicines and products are now eligible items you can buy with HSA or FSA money with no doctor’s note. This is why creams and ointments, cold medicine, and allergy pills are now common expenses paid for with HSA dollars. Menstrual care products were added at the same time. If you shop at an HSA store or use an FSA store, eligible products are usually labeled, which takes the guesswork out of what qualifies.
An HSA is one of three tax-advantaged accounts, and they treat expenses differently. A health FSA, or flexible spending account, is owned by your employer and you usually forfeit unspent money at year end, though the same list of qualified medical expenses applies. A dependent care FSA, also called a dependent care flexible spending account, is separate and covers child or elder care, not medical care. A health reimbursement arrangement (HRA), also known as a health reimbursement account, is funded only by your employer, and the employer decides which expenses are eligible for reimbursement. The key difference is ownership: an HSA is yours to keep, while an HRA or FSA belongs to the employer. What counts as an eligible medical expense is largely the same across HSAs and FSAs, so an FSA eligible expense is usually HSA eligible too.
Some costs are only eligible for HSA reimbursement when a health care provider says they treat a specific medical condition. A letter of medical necessity is a document from your doctor that turns an otherwise general item into a qualified expense. Examples include weight-loss programs to treat obesity or heart disease, special foods, certain creams and ointments, and tutoring or education expenses for a child with learning disabilities caused by a mental or physical condition. Care for a dependent who is physically or mentally incapable of self-care can also qualify. When an item is borderline, ask your provider for that document before you use HSA funds.
The IRS keeps two guides that spell out eligible and ineligible costs. IRS Publication 502 explains the full list of qualified medical expenses and what medical care is deductible, and IRS Publication 969 covers HSAs, FSAs, and HRAs and how the tax rules work. When you are unsure whether an expense is eligible for HSA reimbursement, these publications are the final word. For expenses incurred that are primarily for medical care and meant to treat a specific medical condition, you are almost always safe.
Every consultation starts with your questions, not our paperwork.
Any medical expense the IRS defines as care to diagnose, cure, treat, or prevent disease, for you, your spouse, or any eligible dependent, even if they are not on your policy. When people ask “what can I use my HSA for in Michigan,” the answer is the same nationwide: the IRS list applies in every state.
No. Unlike a flexible spending account, you can use HSA funds whenever you like; they never expire. Pay for qualified medical expenses today or reimburse yourself years later, as long as the receipt is dated after the account opened. Many savers invest the balance and let it grow.
A health care FSA is employer-owned, use-it-or-lose-it, and works alongside any insurance plan. HSAs are individually owned, roll over forever, and require a high-deductible health plan. A dependent care FSA is a separate account for childcare, not medical spending. You generally cannot contribute to both a general purpose health FSA and a health savings account in the same year.
HRAs (health reimbursement arrangements) are funded only by your employer and stay behind when you leave. Yours is portable and funded by you, your employer, or both. Some employers pair limited-purpose spending accounts with HSAs for dental and vision.
Yes: ordinary income tax plus 20% before age 65. After 65, non-medical spending just counts as taxable income, like an IRA withdrawal. Keep receipts and you will never trip the penalty by accident.
You can only build an HSA if you have a qualified high-deductible health plan. We are an independent agency, and we help Michigan residents find and enroll in an HSA eligible plan, then explain how to use your HSA for the widest range of qualified medical expenses. Once your plan is in place, every eligible dollar you spend on care comes out tax-free.
Call (855) 847-7020 or request a free quote to find an HSA eligible plan in Michigan and start saving on your medical expenses.