Can You Use an HSA or FSA for Therapy?

Therapy can help you work through life’s challenges and build healthier habits, and knowing exactly how you’ll pay for it can make it easier to take that next step. If you have pre-tax funds set aside in your health savings account (HSA) or flexible spending account (FSA), you may have more eligible coverage than you think.

In this article, we’ll explain how you can use an HSA or FSA for therapy, what supporting documents you might need, and tips for using these funds for your mental health.

You can use an HSA to pay for therapy that treats a diagnosed mental health condition. Those pre-tax dollars can help you address a range of concerns, such as:

• Anxiety
• Depression
• Bipolar disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Eating disorders
• Substance use disorders

Career and family counseling, and therapies meant to improve your general wellness, can be HSA eligible if they’re medically necessary. For example, marriage counseling might become eligible if you’re looking into it because your struggles with depression are impacting your relationship. These instances generally require a letter of medical necessity (LMN) from a licensed provider that states why the therapy is medically necessary for a diagnosed condition.

Many mental health professionals accept HSA debit cards, so you can pay for psychotherapy directly from your fund. If yours doesn’t, you can generally still request reimbursement later. Just remember to save your payment records to document the eligible expenses for your plan administrator.

You can use your HSA to cover several types of therapy, from traditional counseling to specialized treatments. Some examples of common services include:

• Individual talk therapy
• Group therapy
• Addiction counseling
• Online mental health therapy

Independent mental health platforms like Calm, Shimmer, and BetterHelp may be HSA-eligible if your provider recommends them as part of your treatment plan. You’ll likely need additional documentation alongside an LMN to get them covered, so coordinate with your provider before submitting a request.

You can use an FSA to save tax dollars on eligible therapy expenses, but only if you have a traditional healthcare FSA (HCFSA). Limited-purpose FSAs (LPFSAs) and dependent care FSAs (DCFSAs) don’t generally cover these costs.

Unlike HSAs, an FSA is employer-owned and usually comes with plan-year spending rules and deadlines that limit how long you have to use your funds before they expire. So, when you’re deciding how much to put into your FSA for the year, be sure to include your copays if you attend therapy regularly.

FSAs can cover individual therapy, group therapy, and other mental health services for eligible customers just like an HSA. Beyond therapy, this may also include services related to:

• Psychiatric evaluations
• Prescription medications
• Medication management
• Specialized treatments (TMS, esketamine therapy)
• Intensive outpatient programs (IOP)
• Residential treatment programs (RTC)
• Partial hospitalization programs (PHP)
• Substance use disorder (SUD) rehabilitation
• Telehealth outpatient programs

The same eligibility rules apply to both HSAs and FSAs: The treatment needs to address a diagnosed condition. Services that don’t obviously address a medical need, products that could also be used for general wellness, and newer treatments may qualify with additional documentation.

Before using your HSA or FSA funds for therapy, talk to your plan administrator to learn what documentation you’ll need. These requirements can vary depending on your plan and treatment, but common documents you may need include:

• Itemized receipts showing the services you received and the costs
• Treatment invoices from your provider
• Explanation of benefits (EOB) from your health insurance company
• Reimbursement claim forms for submitting eligible expenses
• An LMN from a qualified provider explaining why you need the treatment

Spending your HSA/FSA on therapy is a straightforward process, and it’s usually the same whether you’re paying for in-person or virtual therapy:

• Verify eligibility: Make sure your therapy services qualify and ask your HSA/FSA administrator about any documentation requirements. You may need to provide an LMN before your first session.
• Pay for your appointment: Use your FSA or HSA card at checkout if your provider accepts it. Otherwise, pay using another method.
• Gather your documents: Request an itemized receipt from your provider or medical center showing who provided care and the service, date, and cost.
• Request reimbursement: If you paid out of pocket, follow your administrator’s claims process to reimburse yourself through your HSA/FSA account.
• Save your records: Keep copies of all your supporting documents in case you need to verify activity with your plan administrator or substantiate a withdrawal with the IRS.

Getting the most out of your HSA/FSA starts with knowing how to use your pre-tax dollars to your advantage. These tips can help you avoid unexpected costs and make mental health care more affordable:

• Review your insurance coverage: Check your deductible, copays, and coinsurance to learn how much your HSA/FSA fund could cover for mental health care.
• Know how your plan works: FSAs typically have a “use-it-or-lose-it” rule, but some plans offer a grace period or limited balance carryover. Learning your plan’s rules helps you make the most of your pre-tax dollars.
• Budget for ongoing treatment: Track your annual therapy costs to budget your HSA/FSA contributions at open enrollment each year.
• Explore mental health apps: Mental health and coaching apps may qualify if they’re used to treat a diagnosed condition.
• Avoid double reimbursement: Record which therapy expenses you’ve paid for with insurance and HSA/FSA funds, so you don’t accidentally get reimbursed twice for the same service.
• Think beyond therapy: Therapy is just one of many HSA/FSA-eligible expenses. Check your available funds regularly, so you can budget for other healthcare needs throughout the year.

When you’re looking for a new provider, consider HSA/FSA-friendly online therapy. Eligibility varies by plan, but many popular platforms like BetterHelp accept HSA/FSA cards, making it easier to pay for virtual therapy with pre-tax funds.

Therapy can help you manage symptoms of anxiety, depression, and burnout while giving you the tools to progress toward your goals. And your HSA and FSA funds can likely do more for your wallet as well as your health.

Truemed’s platform helps qualified customers use pre-tax dollars for eligible products that support their mental health, including those that require an LMN.* Here’s how it works:

• Explore our marketplace: Browse products from Truemed’s participating partners through our website, or directly from the partner’s site.
• Complete a health survey: Answer questions about your health needs when you select Truemed at checkout.
• Get a clinical review: A licensed clinician evaluates your information and, if appropriate, issues an LMN.
• Use your HSA/FSA funds: If approved, you can pay with your HSA or FSA card at checkout.

Discover other ways to spend your HSA/FSA funds through Truemed.

*Truemed is for qualified customers. See terms at truemed.com/disclosures.