The rules around what you’re allowed to spend your HSA on are nuanced, sure, but boil down to a simple, three-part question. Here goes:

  1. Is the treatment in question recommended by a doctor?
  2. Is it treating a specific ailment?
  3. Is it medically necessary?

If the answer is yes, yes, and yes, the treatment in question is probably covered by your HSA (for the full IRS guidelines on what’s reimbursable, read more here).

A few common examples that further break down this idea of “medical necessity” are as follows:

  • Massage: You like to get a massage once a month to relax (we totally get that). Unfortunately, this is not covered, as treatments covered by your HSA must be medically necessary.
  • Acupuncture: Covered! But keep in mind, this should be covering an acute ailment, not regular relaxation. Best to request a letter of recommendation from your doctor.
  • Chiropractor: Largely covered without any letter/documentation, though it’s always a best practice to get documentation.
  • Not covered: Over the counter medicines, essential oils, fitness classes. But check out the IRS doc above for a comprehensive list.

Have you noticed a trend here? Getting and saving documentation of medical necessity is important.

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