Can I use my HSA for dental expenses?

You can use a Health Savings Account (HSA) for most dental expenses tax-free, including cleanings, exams, fillings, crowns, root canals, implants and orthodontics. Cosmetic procedures like teeth whitening are not eligible. Generally, dental care that treats or prevents a medical condition qualifies under IRS rules.

Can I use my HSA for over-the-counter medications?

Over-the-counter medications—including pain relievers, allergy medicines, cold and flu treatments, and antacids—are HSA-eligible without a prescription. The CARES Act restored this benefit in 2020. General health items like vitamins or supplements typically don’t qualify unless prescribed for a specific medical condition.

Can I use HSA funds for my spouse?

You can use HSA funds for your spouse’s qualified medical expenses tax-free, even if your spouse isn’t covered by your health plan. The key requirement is that the expense must meet IRS eligibility rules. But you can’t contribute extra to your HSA just because you’re married.

What happens if I use HSA money for nonqualified expenses?

If you use HSA funds for nonqualified expenses, the amount is subject to income tax and a 20% penalty. 3 After age 65, the penalty no longer applies, but you’ll still owe income tax on money used for nonqualified expenses. Keeping receipts for audits and using funds only for eligible expenses helps avoid penalties.

Can I use HSA funds for mental health services?

You can use HSA funds tax-free for eligible mental health services, including therapy, counseling, psychiatric care and prescription medications. Services must be for diagnosis, treatment or prevention of a medical condition. General wellness activities like life coaching typically aren’t qualified unless tied to a specific medical need.

HSA-Eligible Expenses: What You Can (and Can’t) Use Your HSA for in 2026

9 MIN READ | JUN 3, 2026

By Ramsey Solutions

HSA Medical Expenses: What's Covered? What's Not Covered?

Key Takeaways

Qualified medical expenses can be paid with HSA funds tax-free.
Medical, dental, vision, prescriptions, therapy, OTC medications and even LASIK can qualify. If it treats or prevents a medical condition, it’s probably eligible.
Cosmetic procedures, teeth whitening, diet foods and general hygiene items don’t qualify. When in doubt, pay with your regular debit card and check the current IRS guidance before reimbursing yourself.

You’re standing at the pharmacy checkout, HSA card in hand, and you’ve got about three seconds to decide: Does this qualify? If you’ve ever just paid with your regular card to be safe, this article is for you. Health Savings Accounts (HSAs) let you pay for qualified medical expenses tax-free—but many people aren’t sure what actually qualifies.

Here's A Tip

You can use an HSA to pay for qualified medical, dental and vision expenses tax-free, including doctor visits, chiropractic care, prescriptions, therapy, glasses and more. Nonqualified expenses—like cosmetic procedures or general hygiene items—aren’t eligible.

What Is an HSA?

An HSA is a tax-advantaged savings account that can help you pay for medical expenses tax-free now and in the future. It’s like an extra emergency fund just for medical costs!

You have to be enrolled in a high-deductible health plan (HDHP) to open an HSA. A higher deductible basically means you’ll need to pay more out of pocket before your insurance kicks in. But in exchange, you get lower monthly premiums and the option to put money into an HSA to save up for your medical costs.

What Are HSA-Qualified Medical Expenses?

HSA-qualified medical expenses are costs related to the diagnosis, treatment, prevention or cure of a medical condition that the IRS says you can pay for with your HSA funds tax-free. The list includes medical, dental, vision, prescription and mental health expenses—and covers more costs than most people expect.

In this article, we’ll walk through many of the IRS-approved medical expenses you can pay for with HSA funds. If you’re on the fence about a specific expense, check the IRS’ current guidance before you swipe.

Not sure if something qualifies? Here’s a quick rundown of several categories of expenses.

Expense Type	Eligible?	Notes
Doctor visits	Yes	Includes specialists
Dental work (like fillings and crowns)	Yes	Excludes cosmetic whitening
Glasses/contacts	Yes	Exams included
Prescriptions	Yes	Includes insulin
Over-the-counter meds	Yes	No prescription needed
Cosmetic procedures	No	Unless medically necessary
Hygiene items (like toothpaste and shampoo)	No	Your bad breath isn’t killing anyone (except maybe your friends and family)
Vitamins/supplements	Maybe	Must be prescribed

That gives you a quick sense of what qualifies. But what if you’ve got a really specific expense in mind? Here’s a deeper-dive list, with many of the most common (and more surprising!) HSA-eligible expenses. Remember, this list isn’t comprehensive and can change.

Category	Eligible Expenses
Doctor visits and medical care	Physician visits (primary care and specialists), hospital services (inpatient and outpatient), surgery, lab tests, X-rays and other imaging, chiropractic care, osteopathy, podiatry, obstetrical expenses
Dental care	Artificial teeth, cleanings, fillings, crowns, guards to prevent teeth grinding, extractions, dentures and denture adhesives, orthodontics
Vision care	Eye exams, eyeglasses and related equipment, reading and safety glasses, prescription glasses, contact lenses and supplies, vision correction procedures including LASIK, Braille books and magazines
Medications	Prescription drugs and insulin, over-the-counter medications
Medical equipment and supplies	Wheelchairs, crutches, walkers, blood sugar test kits, CPAP machines, hearing aids and batteries, bandages, thermometers
Mental health and substance use treatment	Therapy and counseling, inpatient treatment programs, addiction treatment
Transportation for medical care	Mileage to and from medical appointments, parking fees and tolls, ambulance services
Long-term care	Qualified long-term care services, eligible portion of long-term care insurance premiums
Home improvements	Installing ramps or lifts, widening doorways, modifying bathrooms
Special programs and therapies	Smoking cessation programs, sleep deprivation treatment, acupuncture, weight loss programs (for specific medical conditions)
Other	Coinsurance amounts, copayments and deductibles, shipping and handling fees for medical products, medical records charges

What Are Nonqualified Medical Expenses?

Even though a lot of medical expenses are HSA-eligible, there are still a bunch of things that aren’t.

Noneligible Expense	Notes
Cosmetic procedures	Not eligible unless it repairs the effects of a disease—for example, breast reconstruction after a mastectomy
Teeth whitening	Not eligible—it’s considered cosmetic
Dental floss, toothpaste, toothbrushes	General hygiene items aren’t covered regardless of dental health
Shampoos and soaps	Personal hygiene items don’t qualify even if used for a skin condition
Babysitting and childcare	Not a medical expense
Prescription drug discount programs	Program fees don’t qualify
Vision discount programs	Program fees don’t qualify
Diet foods	Food for general health doesn’t qualify—medically necessary nutritional products may
Maternity clothes	Not a medical expense
Missed appointment fees	Administrative fees don’t qualify
Late payment fees on medical bills	Not a medical expense

It’s always a good idea to double-check for the most current IRS-qualified expenses before swiping your HSA card.

What Are Potentially Qualifying Medical Expenses?

Some HSA expenses only qualify under specific conditions like being prescribed by a doctor or tied to a diagnosed medical condition. These gray-area expenses may be eligible (you’re dealing with the government, so of course there’s a gray area), but you’ll want to verify before you pay.

Potentially Qualifying Expense	What Makes It Eligible
Acne treatment	Qualifies when prescribed or recommended by a doctor for a diagnosed condition
Allergy medication	Over-the-counter allergy meds generally qualify—verify specific products with the IRS list
Fertility treatments, including IVF	Generally eligible when treating a diagnosed medical condition
COBRA and HMO premiums	May qualify under specific circumstances—check current IRS guidance
Home health care services	Eligible portion depends on the type of care and provider—qualified long-term care services typically qualify
Nicotine gum or patches	Qualify as part of a smoking cessation program
Childbirth classes	May qualify if primarily for the expectant mother’s medical care
Infant formula	Generally not eligible but may qualify if prescribed for a diagnosed medical condition
Gastric bypass surgery	Qualifies when prescribed to treat a diagnosed disease such as obesity
Vitamins or supplements	Only qualify when prescribed by a doctor for a specific diagnosed medical condition—not for general health

Here's A Tip

An expense will probably qualify if it treats or prevents a specific medical condition, a doctor recommends or prescribes it, and you can document the medical need.

Am I Eligible for an HSA?

Not everyone can open an HSA. Here’s what needs to be true for you.

Quick Eligibility Check: Can You Open an HSA?

I’m enrolled in a high-deductible health plan (HDHP). In 2026, that means a minimum deductible of $1,700 for single coverage or $3,400 for family coverage.¹
I’m not enrolled in Medicare.
I’m not claimed as a dependent.
I’m 18 or older.

HSA Contribution Limits for 2026

You can’t just dump a ton of money into an HSA—there are contribution limits. In 2026, you can contribute up to $4,400 if you have single coverage or $8,750 if you have family coverage.²

And those contributions come with some pretty great tax benefits. Your contributions go in tax-free, grow tax-free, and come out tax-free when you use them for qualified medical expenses. Sweet!

You generally have until the federal tax filing deadline to make HSA contributions for the previous tax year. But check the latest IRS guidance to confirm the current deadline.

Let’s look at an example.

What’s an Example of How I Can Save Money With an HSA?

Using an HSA saves you money because you’re paying medical expenses with pretax dollars—meaning you never pay tax on that money when you earn it or when you spend it. Here’s what that looks like:

Imagine you’ve got a $1,000 dental bill for a filling and a crown. Let’s hope it wasn’t painful! But even if your teeth are still recovering, the tax shelter of your HSA can give you some financial relief.

If you pay that bill the normal way (out of your checking account), you’re using money that’s already been taxed. So depending on your tax bracket, you might’ve had to earn around $1,300 just to end up with that $1,000 in your pocket.

Here’s where an HSA starts saving you money.

If you use money from your HSA, you’re paying that same $1,000 with pretax dollars. In other words, that money never got taxed in the first place. And because you’re using the money for a qualified medical expense, you won't pay taxes when you withdraw it either.

So instead of earning $1,300 to cover a $1,000 bill, you only needed to earn $1,000.

Same bill. Less income needed to pay it.

In this example, that’s about $300 in tax savings on something you were going to pay for anyway.

Bonus savings: Any money you put into your HSA also grows tax-free. Like any good savings account, it earns interest until you need to use it.

	Without HSA	With HSA
Amount Needed After Taxes	$1,000	$1,000
Pretax Income Required	$1,300	$1,000
Taxes Paid	$300	$0
Your Savings	$0	$300

How Do You Use Your HSA Funds?

Once you have your HSA set up, you’ll receive what looks like a debit card in the mail. And you can use that card for qualified medical expenses exactly like you would a debit card.

Say you’re checking out at the pharmacy or your doctor’s office. When it’s time to pay, reach for your HSA card instead of cash or your debit card. (Don’t forget to hang on to those receipts! An income tax return is generally considered “open” for three years after filing. If you ever get audited, you’ll want to have your paper trail ready.)

But say you left your card at home or just forgot to use it. No big deal. You can reimburse yourself from your HSA later. Check with your HSA provider for their specific instructions on how to do that.

Remember, you can only use your HSA for qualified medical expenses. If you use your funds for nonqualified expenses, medical or otherwise, you’ll get dinged with a penalty. If you’re unsure if something qualifies or not, pay cash or use your debit card. You can always reimburse yourself later when you’re sure it’s an eligible expense.

How Do I Set Up an HSA?

If you have an HDHP, opening an HSA is really a no-brainer. Your employer may offer an HSA as part of your health benefits, and you can enroll during open enrollment or after a qualifying life event. If your employer doesn’t offer one, you can open an HSA directly through a bank, credit union or HSA provider.

If you don’t have an HDHP, or aren’t sure you have one, connect with our RamseyTrusted^® friends at Health Trust Financial. Their independent insurance experts will do the heavy lifting for you and hold your hand through the whole shopping experience! They can run numbers and help you figure out if an HDHP is the right fit for you. And if it is, they’ll shop around to get you the best plan at the best price so you can cash in on HSA tax benefits and direct some of your money straight to medical expenses.

Next Steps

Learn more about HSAs.
Read up on HDHPs.
Run some numbers with a health insurance expert and talk about whether an HDHP is a good fit for you.
Connect with Health Trust Financial to get in touch with a health insurance agent today.
Next open enrollment, sign up for an HSA-qualified HDHP.
Open an HSA and start funding it up to your limit as an individual or family!

Connect With Health Trust Financial

Interested in learning more about health insurance?

Can I use my HSA for dental expenses?: You can use a Health Savings Account (HSA) for most dental expenses tax-free, including cleanings, exams, fillings, crowns, root canals, implants and orthodontics. Cosmetic procedures like teeth whitening are not eligible. Generally, dental care that treats or prevents a medical condition qualifies under IRS rules.
Can I use my HSA for over-the-counter medications?: Over-the-counter medications—including pain relievers, allergy medicines, cold and flu treatments, and antacids—are HSA-eligible without a prescription. The CARES Act restored this benefit in 2020. General health items like vitamins or supplements typically don’t qualify unless prescribed for a specific medical condition.
Can I use HSA funds for my spouse?: You can use HSA funds for your spouse’s qualified medical expenses tax-free, even if your spouse isn’t covered by your health plan. The key requirement is that the expense must meet IRS eligibility rules. But you can’t contribute extra to your HSA just because you’re married.
What happens if I use HSA money for nonqualified expenses?: If you use HSA funds for nonqualified expenses, the amount is subject to income tax and a 20% penalty.3 After age 65, the penalty no longer applies, but you’ll still owe income tax on money used for nonqualified expenses. Keeping receipts for audits and using funds only for eligible expenses helps avoid penalties.
Can I use HSA funds for mental health services?: You can use HSA funds tax-free for eligible mental health services, including therapy, counseling, psychiatric care and prescription medications. Services must be for diagnosis, treatment or prevention of a medical condition. General wellness activities like life coaching typically aren’t qualified unless tied to a specific medical need.

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About the author

Ramsey Solutions

Ramsey Solutions has been committed to helping people regain control of their money, build wealth, grow their leadership skills, and enhance their lives through personal development since 1992. Millions of people have used our financial advice through 22 books (including 12 national bestsellers) published by Ramsey Press, as well as two syndicated radio shows and 10 podcasts, which have over 17 million weekly listeners. Learn More.